Retired Atlanta attorney Cindy Smith misses her best friend.
Smith hasn’t seen her 94-year-old father, Morton, in more than a week. She lives near Emory. Her father lives in The Piedmont in Buckhead, a senior living community.
Morton is doing fine. He’s healthy and Smith says there are no reports of any Ccoronavirus cases in her father’s building. But every Thursday Smith and her father used to attend the symphony. “We were symphony partners,” she said. “He was my Scrabble partner, too. We miss that.” She’s not allowed to even visit him.
“I thought we could take walks together, but he’s being discouraged from seeing other people.”
Many Atlanta Jewish families with elderly members living in senior living facilities are experiencing similar heart-wrenching separations.
Many of Dr. Bruce Rudisch’s patients are medically unwell. In one case he described a patient’s son who is unable to visit his elderly mother. “She’s anxious and her son feels very guilty that he can’t help her,” said the trained geriatric psychiatrist. “It would be a comfort to be with her and hold her hand, but he can’t now. He told me that ‘my mother helped me all my life and now I can’t help her.’”
According to Rudisch, social isolation and loneliness among the elderly are real problems, even without the coronavirus pandemic. “People who suffer from social isolation are at greater risk of illnesses. I worry about the elderly particularly, although I worry less if they are coupled or have close family members to support them either by phone or video.”
In general, Rudisch is seeing a whole spectrum of responses to the coronavirus that has shut people into their homes and has essentially deprived them of their normal social interactions. “It is important to note that the responses don’t necessarily correlate with an individual’s objective risk of death should they contract the coronavirus. Some elderly who are at high risk are particularly less anxious about the illness than one might expect. In some cases, older patients are accepting of their own mortality.”
He pointed to patients in their 70s and 80s who have lost both parents, a spouse and their siblings and “the idea of death isn’t so anxiety provoking. One patient of mine realized that she survived those deaths and she understands that her family will be able to make it without her. While this realization is on some level sad to her, it has also reduced her anxiety.”
On the other hand, he sees some younger patients who are at less risk of dying from coronavirus and “they’re very anxious about it. In many cases, it is related to their personal life histories and pre-existing emotional conflicts. If one has a deep sense of emotional damage or a prior history of trauma, this may translate into a greater sense of physical vulnerability and fragility in the face of the very real threat of COVID 19,” said Rudisch.
Some of Rudisch’s patients are confined to their rooms, similar to Morton Smith — not one of his patients — where The Piedmont at Buckhead is delivering food three times a day as well as puzzles to the residents. Rather than in-person meetings with his patients, 90 percent of Rudisch’s consultations are via video conference. The remaining 10 percent are on the telephone. “The American Psychiatric Association, the mental health community and Medicare have come together around supporting telehealth,” he said.
Dr. Melissa Black, a geriatrician who provides direct primary care, also provides “video visits,” or consultations over the telephone, but sometimes she still needs to visit in-person to take bloodwork or provide a physical exam.
Direct primary care, Black explains, is independent of any insurance with patients paying a monthly fee. The average age of her patients is 75 to 80, although the range is 65 to 105. “This is a patient population that is prone to isolation anyway, but my phone has been ringing off the hook,” she said.
Nancy Kriseman, a licensed clinical social worker who specializes in working with older people and their families, suggests that there could be an increase in suicides among the elderly as a result of the coronavirus pandemic. “I could see passive suicides, in which the person gives up,” Kriseman said.
That’s why she thinks it’s imperative for families to reach out to their elderly family members in very specific ways. Author of “Meaningful Connections: Positive Ways To Be Together When A Loved One Has Dementia,” Kriseman understands that it’s challenging sometimes to have daily phone call with elderly family members.
“What do I say when I call every day? Let’s say a prayer together, or let’s talk about a favorite time we had together,” she said. “Remind them by showing pictures of family members on video or talk about recipes. Each call can focus on a different subject.”
If the elderly person has cognitive issues, he or she may worry about the family. “Tell them what we’re doing to take care of ourselves, so we can take care of you,” she suggests. She also advises family members to send cards or “grab-and-go” boxes in which family members can send objects that represent the elderly person’s favorite hobbies, like gardening. To one client who was a mechanic, she sent little tools. Another client liked birds, so she bought a book that plays bird songs. Kriseman calls these “reminiscing activities.”
Family members with elderly in congregate living centers – which can include independent living, nursing homes and assisted living – are generally the eyes and ears who alert staff if their loved ones are having issues. When these family members can’t actually visit their loved one, being their advocate becomes more challenging. Both Kriseman and Rudisch suggest that families establish relationships with specific staff members at those centers with whom they can check in regularly.
If a family member has a concern with the facility itself, as in normal times, they can call the Georgia Office of the State Long-Term Care Ombudsman at 1-866-552-4464, then choose option 5. Because of the coronavirus, Ombudsman Melanie McNeil told the AJT that instead of their regular quarterly visits to long-term care facilities, her office’s representatives are calling them once every two weeks to check on them.
Another piece of advice for family members is to discourage the elderly from watching the news all day. “People can forget and not forget” what they’re hearing, Rudisch states, referring specifically to those with some level of dementia. “Maybe they lose articulate verbal memory, but not emotional memory of what they are exposed to on the news. Some might imagine that a parent doesn’t remember bad news, but they can be taking it in emotionally and unconsciously.”
One thing that is helpful for family members, Rudisch says, “is to help normalize the feelings someone is having. Acknowledge what they’re feeling.
Acknowledgement and validation can help to reduce anxiety. For a family member who cannot be in physical contact with an isolated loved one such as an elderly parent, feeling guilty is a natural response and can even be thought of as a measure of their love. It is a sign of healthy attachment.”
He points out that crises like this pandemic, for some, can have a positive side. “It can be an opportunity for growth and affirmation for some. One way to cope with this is to reach out and help someone, perhaps in the community. Helping someone else is often the best anecdote to the natural feelings of helplessness that many are feeling in response to COVID 19.”
Apparently, Morton Smith intuitively understood this. Responsible for the employee holiday gift fund at The Piedmont, his daughter told the AJT that he just initiated a collection to help employees who are providing care to residents under the current stressful conditions.