MINNEAPOLIS — One year after COVID-19 changed the lives of Minnesotans and everyone in the world, long-term care centers are slowly reopening to in-person visits.
And experts warn the reunions may reveal a new reality: a change – even a dramatic decline – in seniors who’ve survived a year of social isolation and extraordinary circumstances.
“We do know from research that loneliness, social isolation, is linked to a number of negative health outcomes, as well as mortality. And COVID-19 unfortunately exacerbated those problems for many older persons living in long-term care,” said Dr. Joe Gaugler, Professor and Robert L. Kane Endowed Chair in Long-Term Care and Aging at the University of Minnesota’s School of Public Health.
One Family’s Story: A reunion with a delayed reaction… and a realization
Larry Thielen long ago earned his nickname: “Epic Larry.”
The 82-year-old grew up in Paynesville, Minnesota as the youngest of 16 children. He served as a Navy Airman in Saudi Arabia. And the accomplished retired commercial printing salesman also enthusiastically supports football and his faith.
“He’s just always been a very fun-loving, very much a trailblazing, ‘make my own rules,’ kind of guy,” said his daughter, Lisa Zmuda.
But “Epic Larry” has also always enjoyed the comfort and companionship of his four children, until COVID-19 changed his life.
“I like to see my kids, too. I just like to see my kids, too, you know?” Thielen told KARE 11’s Karla Hult about the pandemic separation he described as, “tough.”
The Thielen family’s long-term care journey began days before the shutdown started in March 2020. The family decided Larry – who has heart disease, bipolar disorder, a long-term catheter, and Mild Cognitive Impairment -- needed the care and support available to him at Crest View Senior Communities in Columbia Heights.
For the next several months, visitations were only possible through a window or, in the summer, outside. In November, Thielen battled and beat a COVID infection. Also in the late fall, his daughter, Terrianne Jones, was able to start seeing him occasionally and by appointment – as the family’s designated “essential caregiver.” But it wasn’t until the new year, Thielen reunited with another daughter for the first time in nearly a year.
On that frigid February day, Zmuda masked up and waited for her dad in the Crest View community room.
“Who am I, Dad?” Zmuda asked, when Thielen was brought into the room.
“Lisa? Is it Lisa?” responded Thielen, upon realizing the masked woman sitting in front of him was his daughter.
The reunion – more than six feet apart and without the wanted hugs – may not have been what the family would have scripted. But it did deliver stories of a long-ago ice-fishing outing. And it also gave joy to a dad who’d longed to see his daughter.
“It was really nice, because I haven’t seen them in a long time,” Thielen said about his family visit.
But while Thielen savored the reunion, the sisters also reflected on his condition after a year of battling illness and loneliness.
“He’s changed a lot in a year. He’s dramatically aged in my opinion,” Zmuda said about the pauses and needed prompts in her dad’s verbal skills.
“COVID, I think, expedited things six to nine months easily,” added Jones about her dad’s decline.
Other families see it, too
And when it comes to that sentiment, the sisters share their concerns with others in the greater community.
“I can count on both my hands how many times I’ve seen her in person in 2020,” said Lauren Hauter about her mother’s year at Rakhma Homes in Minneapolis.
Hauter praised the staff caring for her mom, but she also noted the challenges unique to those suffering from dementia: “The window visits – those are great options for a lot of people. But for those with dementia, they don’t understand the masks. They don’t understand why the outside visits are the way they are.”
For Beth McCoy, she realized the extent of her dad’s pandemic “before and after” when she saw him interacting with his dog.
“He would be excited to see the dog when the dog would come to visit. And now he doesn’t know what to do when the dog comes to visit,” she said about her 89-year-old dad, Jerry Belanger.
“It’s heartbreaking,” she said, reflecting on the decline of both her dad – and others at his LTC facility.
And that brings us to how families should prepare – and then react – to those long-awaited reunions.
Gaugler’s first bit of advice: while every case and person is unique, all families should recognize your loved one’s cognitive and physical health may have declined during the last year.
“I think there’s a strong possibility that their loved ones may be suffering or may be living through more severe cognitive decline and health problems than perhaps before COVID-19,” he said.
And given the potential for that decline, Gaugler suggests families simply pause to process the change.
“It’s going to be an incredibly emotionally challenging time for families who are seeing their mom, their dad, a loved one, a relative, for the first time perhaps in months,” Gaugler said, noting that family should remember their loved ones will “read” their reaction.
“The emotional cues that you give off to your loved one is critical, and that is what your loved one is going to relate to,” he emphasized.
Gaugler says it’s then important the family – with the help of the long-term care center – assess their loved one’s current state of health.
“What is the extent of the change? How has my loved one changed, cognitively, functionally, etc.,” he said.
And with that information, Gaugler strongly advises family, again with caregiver input and support, draw up new approaches to communication, activities, and overall care for their loved one – recognizing the importance of protecting and nurturing the health that is “still there.”
“It’s less about focusing on decline. And less about focusing on what’s been lost. And more focusing on what is there. What is still there to build interactions, involvement, engagement and care around,” he said.
And the final step? Gaugler says families need to continue that involvement, communication, and visits, such that they – along with the caregiving staff – continue to adjust the care for their loved ones.
“Always remember that your involvement is critical and important. It may not seem that way over short periods of time, but rest assured, your contact is critical and important to maintaining quality of life and the well-being of residents during, before and after COVID-19,” Gaugler said.
And while Gaugler’s advice for individual families may end there, he does recommend the greater community consider how the challenges of the last year reveals what’s lacking in the long-term care community.
“I think, in a lot of ways, it’s shone a really harsh light on some structural problems that have always been there, in terms of how we value long-term care, in terms of how it’s delivered and paid for,” he said, noting the problems require a community-wide review and response to prevent further crises down the road.
Back to Larry
Back in Columbia Heights, “Epic Larry” may well be entertaining more regular visitors in the coming months.
“I’m glad to be here today, so this is amazing,” Zmuda said moments after the reunion with her dad, adding, “I’m going to come back with my big shield, and I’m going to try to do it more frequently.”
Jones also longs for the day she can get beyond the masks and distancing to share a cup of coffee or meal with her dad.
“It will be better when we can have a cup of coffee together,” the daughter said, before reflecting moments later: “It’s just acceptance of this is just what it is right now. But also, I am trying to make the most of whatever we have left with him.”
As for Larry, the visits – both present and planned – may well be an answer to prayer.
“You know when you pray, He hears every word,” before repeating for emphasis, “The good Lord hears every word when you pray.”