Life in a nursing home in the time of COVID
By Andrew Sharp
It can be easy to see the COVID-19 pandemic in bar charts and line graphs instead of a collection of human stories. We’re flooded with data on COVID cases by state, county, zip code; average cases per day, hospitalizations, deaths.
The big question of how to respond to the virus, too, can clog our emotions and attention and quickly gets entangled in politics.
This story is not primarily about the numbers, or how to respond to COVID, although those are worthy topics. Instead, it’s a peek inside a local nursing home to see what the pandemic has done and is doing to people, both staff and residents.
Like other long-term care facilities around the state, the Country Rest Home in Greenwood has struggled to balance residents’ needs with safety precautions to protect them.
Also like other facilities, it’s had outbreaks. After successfully keeping the virus out all summer of 2020, it had an outbreak last fall and some cases over the winter, but then again went through the spring and summer with no cases, according to numbers provided by the Country Rest Home. Then as infections in Delaware increased with the delta variant, the facility saw another outbreak of 15 cases in September with several deaths (it’s now back down to zero and has been able to close its COVID unit).
All around the country, nursing homes have been hit hard by the virus. Those are grim statistics, but they’re also people.
Long term care residents can be treated as society’s leftovers. “Actually, they have so much value, but it just takes time to get to know them,” said Queena Mast, who works at the rest home. Mast’s father, Mark Yoder, owns the rest home and her family is heavily involved. Mast, who is a certified nursing assistant and helps organize activities for the residents, said even those with deep dementia have a wealth to offer.
Recalling the difficult parts of the recent outbreak, she spoke of one resident in particular.
This woman took part in activities Mast organized. She could be crusty, Mast recalled, but she could manage to make the resident smile. “I always felt like I had a really good day when I made her smile,” she said.
When the resident came down with COVID she was moved to the special unit, “and she seemed to be doing just fine.” But day by day, Mast saw her decline, her vital signs and breathing getting worse. And then came a day when the woman was no longer able to stand. Then she stopped drinking.
“No matter what I did, I couldn’t get her to drink,” Mast said. She could see the inevitable coming.
It was even harder because the woman had anxiety and tended to get really lonely. Now she was stuck in COVID isolation, unable to get visits from family. Mast made sure the cards they sent were taped to the wall where the woman could see them, and played hymns for her on her phone and tried to calm her.
“Sometimes she would cry out,” she said.
The woman’s family was only able to come in for a brief goodbye at the end.
As a nursing home worker, Mast said, she’s very familiar with death and the process of dying, but in some ways it never loses its shock value, the way the body struggles so hard against death.
“That was hard,” she said.
Queena Mast geared up for work in the COVID unit. Submitted photo
The toll on residents and their families
If viruses had a personality, COVID would be a bully, going after the most vulnerable, especially older people, with deadly efficiency. But COVID has taken more than their health over the past year.
For example, it can be harder to do group activities, especially if there’s an outbreak. That cuts out social interaction, reduces variety in the day and means less for residents to look forward to. It takes typical nursing home challenges and makes them worse.
Mast compared taking care of people’s basic needs to oatmeal, and activities to cake. “The oatmeal is important. But you have to have cake to look forward to … they’re both important.”
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Dementia adds another layer to that. Tim Yoder, Queena Mast’s brother and the nursing home administrator, noted that ordinarily you’d never shut up a person with dementia in a room with plastic barriers and keep them there for 10 days. “It’s just not, it’s not good.”
Even when they’re not in isolation, residents also don’t have the same interactions with staff as they used to.
“There’s something lost when you can’t actually get down and speak face to face,” Tim Yoder said. “You have residents just saying get that (mask) off your face … I can’t hear you.”
Families, too, are caught in a bad place. My grandmother stayed at the Country Rest Home until her death in October 2020. She didn’t die of COVID -- it was complications of Parkinson’s -- but because of COVID restrictions I wasn’t able to go in and say goodbye. Instead, the night she died I spoke to her on the phone while looking in the window from outside.
“The emotional part of all this to me is ... before COVID hit us we literally were 24/7 visiting,” owner Mark Yoder said. “That's how I wanted it, always. We can't do that anymore. And so we’re constantly challenged with getting people in to see their loved ones. It’s difficult to do it in a way that is satisfying to them, and acceptable to the state, and is safe to the people who are trying to take care of them.”
“I want to bring my kids in,” Mast said. “I think the elderly really need interactions with children.”
Even before COVID, families struggled with the decision to leave their loved ones at a nursing home. “It has always been hard to have people walk in here crying, because they can no longer do what needs to be done,” Mark Yoder said.
Some of the impact of COVID is more murky. After last year’s outbreak, for example, some who survived the disease itself went into decline afterward and even stopped eating, Mark Yoder said. “I don’t know how much of that’s mental and how much of it’s physical, but it definitely seemed like people just, the will to fight and live wasn’t as strong after they had COVID.”
A Country Rest Home staff member at the doorway of the COVID unit. Photo courtesy of the Country Rest Home
The toll on staff
Mast calls working at the rest home “one of the most rewarding jobs that you can possibly have. Because at the end of your shift, you’ve just provided what an elderly person needs to … survive and thrive.”
It’s also not easy at the best of times. It can be physically demanding, for one -- helping residents get out of bed and get around takes strength.
When there’s an outbreak and residents are separated into a COVID unit, more hurdles are added. Staff have to stop at a plastic barrier to gown up going in, then repeat the process in reverse on their way out.
The protective gear doesn’t just ward off the virus and make staff look like extras in an apocalyptic movie — it also traps body heat.
“You’re sweating like crazy, and then it’s hard to drink because you have the mask and you have your (face) shield,” Mast said.
Staff also carefully monitor COVID patients’ vital signs, an essential but time consuming process, and of course are caring for patients who even if they aren’t dying may have nausea or other symptoms.
Add to those challenges the issue of working shorthanded. A number of staff have come down with the virus, so that reduces staffing levels. The fear of COVID also keeps some staff out of the unit or drives them to quit. The Country Rest Home, like many other businesses, is struggling to find staff right now, but the fear of COVID has made that worse.
“We had a person in the kitchen, when she found out there was COVID, she just quit,” Mark Yoder said.
It’s not always just a fear of getting the disease, but of the impact it can have on their families or on other jobs.
One nurse with extensive time in the COVID unit, who did not want to be named, said her exposure to COVID at work stops her from going a lot of places. She had not been to church in a month because some of the people there are immunocompromised.
“You want to protect your residents as much as possible,” said Blanche Pinkett, another nurse who worked in the COVID unit, “but you still have your life to live up out of here, too.”
While they’re juggling all that, worried family members are calling, wanting an update on their loved ones. That’s to be expected, of course, but is also another demand on time.
The nursing home, like other facilities, also works with nurses who have other jobs, but are available to pick up work as needed. When COVID hits, Tim Yoder said, some of those nurses stop coming in.
The remaining staff can be stretched thin. Some are working 60 hours a week, Mark Yoder said. And all the precautions can take a psychological toll.
“We have had amazing staff … that have seen what needed to be done and they have come, they have pitched in, they have worked beyond the call of duty.”
“You just do your job,” Pinkett said.
Staff members at the door of the COVID unit. Photo courtesy of the Country Rest Home.
Some context
The family-owned Country Rest Home is far from the largest of the state’s more than 80 similar facilities. It has fewer than 60 beds. For comparison, the Delaware Veterans Home in Milford has almost three times that many. So while the Country Rest Home’s battle against COVID-19 offers a window into what staff and residents face, it’s not identical to other sites.
Overall in the state, the number of those hospitalized has been slowly rising since the end of September, with 198 in the hospital on Sept. 26, per state data, and 233 as of Friday. On the other hand, new hospital admissions have been trending slightly downward, and the average percentage of positive tests has stayed fairly flat.
As of Sept. 30, the state’s long term care facilities had seen 2,897 positive COVID-19 cases during the course of the pandemic. Eight hundred forty-two had died of complications related to the virus.
During the first outbreak at the Country Rest Home in September and October 2020, 30 residents tested positive for COVID, according to statistics provided by the nursing home.
Of the 15 who got sick in the latest outbreak, nine were fully vaccinated.
Recent state numbers show that a number of vaccinated people have been hospitalized, but as of Sept. 26 around 80 percent of hospitalizations were people who were unvaccinated or partially vaccinated. As of Friday, per state numbers, there were 3,768 breakthrough COVID cases in Delaware, which is less than 1 in 100 of fully vaccinated residents.
An uncertain future
Will another, worse variant make the rounds, or will the virus fade? It’s difficult to predict which way the virus will go from here, with numbers seemingly on the decline nationally but holding steady in Delaware.
In the year ahead, Mark Yoder hopes for a return to something more like normal, to get to a place where the Country Rest Home doesn’t have to regulate visits or worry about masks or vaccination status.
“To go back to that kind of thing just sounds like a dream,” Tim Yoder said.
Queena Mast referred to the recent outbreak as “times that try men’s souls,” quoting Thomas Paine’s revolutionary-era pamphlet “The American Crisis.” It’s a title that seems apt now.
But this crisis is making the nursing home stronger, Mast said. When better times return, “I feel like we’re set up to flourish.”
Despite a long and tough year and a half, she said she’s more committed than ever to what she does as a CNA at the nursing home.
“It’s such good work.”