In March 2020, Birchwood Terrace resident David Rines caught Covid-19. Rines, who’s now 80, had no symptoms.
His roommate at the Burlington nursing and rehabilitation center was another matter. The man screamed and screamed, Rines recalled. Silence came only after the man died.
Coronavirus forced nursing homes to take unprecedented steps in those early days of the pandemic. The facilities were all but shut down — except for staff members and hospice visits — for weeks on end.
Residents lucky enough to live in a first-floor room with a window could get a glimpse of the outside world and their loved ones. Others tried to stay in touch with phone calls and virtual visits.
Life on the inside had come to a standstill. Knitting circles, Scrabble groups and other gatherings — all potential Covid-spreaders — had to stop. Virus precautions even discouraged touch, the most basic form of human connection.
Rines is still scarred from that time, according to his daughter, Andrea Thorpe.
“He just felt like the world abandoned him,” she said. “He went through seven days of quarantine, and I almost lost him, not because he was sick from the virus but because he was isolated.”
As Rines sees it, the battle against Covid-19 cast aside many of the things that make life worth living — family, friends, talking with people, having meals together.
Nursing homes reopened their doors to visitors in November, but Rines and his loved ones worry about future lockdowns. Another viral spike could again shut the door on connection, weekend visits and the outside world.
Birchwood officials did not respond to interview requests in the past week. But a lobbyist for the state’s long-term care facilities acknowledged that staff and administrators faced difficult choices.
Since the doors have reopened, “nursing homes have been doing everything they can to balance those needs of residents to make sure they can maintain those connections with family and friends,” said Laura Pelosi of the Vermont Health Care Association.
Covid-19 is still circulating in nursing homes. In the first three weeks of January, 21 residents and 17 staff members at Birchwood came down with Covid, Medicare data showed.
The Burlington nursing home remains open for now, albeit with a sign that warns visitors that active Covid-19 cases lie within. Masked visitors are allowed inside after a temperature check. Some activities have resumed. A few weeks ago, for example, a musician visited Birchwood, Thorpe said. A hairdresser was scheduled to give haircuts to residents but canceled because of Covid.
On a recent Sunday morning, Rines sat in the sunlit room he shares with his wife, Joyce, surrounded by photos of loved ones. His daughter, who lives in Underhill, joined them there, too.
When he talked about the week he spent in isolation, a shadow crossed his face.
“I can understand jail time now,” he said. “I didn’t fathom it this much before this happened.”
Hidden neglect
In the world of nursing homes, family members are the residents’ eyes and ears. They schedule medical appointments for their loved ones, and look out for worsening symptoms, unusual behaviors and other telltale signs of poor health. They can also file complaints with the state government or the long-term care ombudsman in cases of neglect.
All that stopped with the lockdown, Sean Londergan, the state long-term care ombudsman, said.
Londergan compiled some of his findings in a report covering the fiscal year that ended Sept. 30 — weeks before long-term care facilities, including nursing homes, reopened.
Family members filed fewer complaints during lockdown, in part, because they were not there to witness the day-to-day conditions of residents, Londergan said. Advocates from the ombudsman’s office were shut out, so some quality-of-care violations likely went unreported.
It all happened during what has arguably been one of the biggest public health emergencies in the state’s history. Birchwood alone had 21 residents die of Covid-19 in those early days. By June 2020, outbreaks in two nursing homes — Birchwood and Burlington Health and Rehab — were responsible for more than half of Vermont’s Covid deaths. By mid-January, more than 130 nursing home residents had died of Covid-19 in Vermont, according to Medicare data.
Thorpe caught small signs of neglect in her parents’ care when lockdown ended. Her father got a fungal infection on his arm from a wristwatch that should have been removed before showering. His dentures had tartar that made it difficult to eat.
Thorpe said her mom gained 65 pounds during lockdown and developed Type 2 diabetes. Her upper teeth rotted from lack of dental care.
“All I wanted to do is be there to care for my parents,” Thorpe said.
‘Cruel and inhumane’
Londergan’s report outlined another core concern: Social isolation and loneliness became rampant in nursing homes.
Social isolation increases the risk that older people will die prematurely. The distress it causes can raise stress hormones and blood pressure, accelerating mental and physical decline.
Geriatric specialist Richard Dupee said it’s hard to know exactly how many people died prematurely in the Covid lockdown.
Dupee, a physician at Tufts Medical Center in Boston, said that, beyond the impact of Covid, the decline of people in nursing homes often follows a predictable path.
Patients with dementia become agitated and confused without their family members around, he said, eventually landing in the hospital with delirium, an infection or broken hip. Many die there. Other residents decline gradually as depression sets in.
“When you become depressed, and you’ve got a lot of other diseases going on, those diseases then begin to manifest themselves, and those folks get hospitalized,” he said.
Amy Saunders, an elder rights advocate from Westford, believes her mom, Gloria Kravetz, died of malnutrition during lockdown.
Saunders outlines her experience in “Protecting Them to Death: The impact of isolation in long term care,” a collection of testimony from family members whose loved ones lived through or died in lockdown. The book was created by the Essential Caregiver Movement, a grassroots organization whose members want to change lockdown procedures in long-term care facilities.
“What we did was cruel and inhumane to the people who are surviving and the people who died alone,” Saunders said. “Asking health care workers to be their surrogate family members, that is a lot.”
Saunders and other members of the organization have been urging Congress to pass the Essential Caregivers Act of 2021, a federal bill that would allow up to two caregivers per resident to enter nursing homes and other long-term care facilities during public health emergencies.
The bill was introduced in the U.S. House of Representatives last summer and is now working its way through committees.
Saunders also worked with state Rep. Alyssa Black, D-Essex, to introduce a similar bill to that effect in Vermont. The bill, H.595, was referred to the House Committee on Human Services in January.
‘Failure to thrive’
Saunders knows that legislation won’t bring her mom back.
Kravetz died at Birchwood last summer of geriatric failure to thrive, a catch-all term to describe weight loss and decline that often precedes death in older adults.
Saunders believes that Kravetz, who had dementia, was not eating enough because her daughter was not there to sit with her.
Staff members eventually allowed Kravetz to sit outside with Saunders during lunch if weather allowed, but it was not enough to stop the decline.
Kravetz died about two weeks after she turned 87.
“My mother lived through one of the worst health emergencies in Vermont and did not get Covid,” Saunders wrote in the book. “ … She died because of the toll isolation took on her.”
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