Originally published in Sun Journal – 12/27/2020
At an assisted-living facility in Central Maine, two chairs sit side-by-side, with plexiglass mounted between. These chairs are supposed to be used by residents and their visitors, but have remained empty for months. Since March, nursing homes and assisted living facilities in Maine and across the country have been locked down, with family visits a rarity. The rationale? We have to protect the vulnerable.
This spring Auburn resident Audrey Murphy’s father fell at his assisted living facility. Upon discharge from the hospital, he was sent to a rehabilitation facility. With no family visits to provide familiarity and routine, his mental status deteriorated and he was discharged to a memory care unit. In mid-summer, Murphy got a phone call notifying her that he was dying, and to come quickly. She attributes her father’s rapid mental and physical decline and subsequent death to isolation, and says that “No one should be forced to die alone.”
According to the Centers for Disease Control, recent studies found that social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity. Social isolation was associated with about a 50% increased risk of dementia, and loneliness among heart failure patients was associated with a nearly four times increased risk of death.
“The isolation is robbing them of whatever good days they have left — it accelerates the aging process,” Joshua Uy, associate professor at the University of Pennsylvania Perelman School of Medicine, said. “You see increased falls, decrease in strength and ability to ambulate. You see an acceleration of dementia, because there is no rhythm to your day.”
Around the country, there is a new cause of death listed on death certificates: social isolation and failure to thrive. Failure to thrive is a medical condition characterized by reduced appetite, weight loss, lower activity levels, often with depression, and closely linked with isolation. A Chicago-area nursing home found that two-thirds of its residents lost weight between December 2019 and the end of April 2020.
Today, anyone who questions the COVID-19 policies in long-term care facilities is often labeled a “Grandma killer,” and the conversation is effectively cut short. But I would suggest that we need to continue the conversation, and to that point I give you the pre-COVID study out of Norway that showed a median survival of 2.2 years once admitted to a nursing home, with a yearly mortality rate throughout the three-year observation period of 31.8%. If you prefer a study done in the US, a 2010 study of 8,433 participants found the median length of stay before death was five months, with 65% dying within one year of nursing home admission.
We are seeing outbreaks of unprecedented numbers in long-term care facilities in Maine. I asked a nursing home primary health care provider if it was possible that COVID restrictions were actually contributing to these outbreaks. Their response? A compromised host is more susceptible to disease, so yes, failure to thrive in residents resulting from the restrictions could absolutely be a contributing factor.
As we move past nine months of nursing home lockdowns, no one is asking the question: Are we succeeding in protecting the vulnerable? Or are we doing just the opposite, and encouraging physical and mental decline, brought on by the best of intentions? If you look at the optimistic median survival of 2.2 years (rather than five months), that means we have locked away our elderly for almost half of their remaining lifespan.
Has anyone asked our Maine elders in long-term care facilities what they want? As our elders live out their twilight years, after living full lives as productive members of society, they deserve autonomy in decision making. I have submitted emergency legislation that would allow for essential caregiver visitation. We must work to prevent the negative results of isolation of our most vulnerable by allowing visits from loved ones. Rather than dictating what our elders must do, we should engage in a discourse that includes them in the conversation and considers both their health and their autonomy. To do otherwise is to infantilize them, and disrespects and dishonors our elders.