Isolated but Not Alone, Pandemic Lessons on Keeping People Connected

November 4th, 2021 | Viewpoint


Margaret Franckhauser could hear the fear growing in the voice of the older woman on the other end of the phone as Franckhauser explained she’d been exposed to a new virus and needed to stay home. The woman had no family nearby and was already low on food and medicine.

“The human consequences were so profound. We’d get on the phone and the person on the other end would be overwhelmed and crying,” said Franckhuser, JSI’s director of aging services. “I would say, ‘I know how difficult this is. I’m here to try to help you get through it.’”

That day Franckhauser stayed on the phone, listening to the woman’s concerns, talking through options and ultimately connecting her with someone at an assisted living facility who would help her get groceries and fill prescriptions. She also continued to work on another need that so many older adults in long-term nursing facilities face—the profound loneliness that comes with being cut off from usual social connections.

During the early days of the pandemic, Franckhauser transitioned into working with the state of New Hampshire to provide training and develop protocols to manage the outbreaks in congregate facilities such as nursing homes, assisted living facilities, and schools. It was an extension of JSI’s partnership with the state to support public health initiatives, and fit well with her background in managing communicable diseases. With the demand rapidly increasing, she carried her own caseload of facilities and heard the challenges first hand.

While others were setting up an office at home, Franckhauser set up hers in New Hampshire’s massive command center. Franckhauser and dozens of safely distanced colleagues tried to keep up with rapidly changing disease updates and plan accordingly.

“It was certainly a very dramatic learning curve, and it was tense,” she said. “Information would change from morning to evening. And we had to make a lot of rapid decisions.”

The team would be notified of any case inside a nursing home and then begin the process of reducing the spread there, starting with contact tracing. Nursing homes, with shared rooms and a heavy reliance on gatherings in communal spaces, were particularly challenged.

With each report, they looked back to where cases had started, but more importantly, they delved into reducing the impact. They guided staff and patients in screening to identify emerging cases while reducing transmission within the facility. They set up testing programs. They helped facilities obtain personal protective equipment and taught staff how to use it. Throughout, they supported communication to staff, patients, and families.

Nursing homes were abruptly closed to visitors to protect both residents and those on the outside. Daily routines were upended and group gatherings were restricted. This was all in line with the typical response to a rapidly spreading disease. Isolate. Build barriers to contain the illness. Treat those affected and stop the spread. However, it soon became clear that much more was needed.

“Among other things, we had to focus on mental health,” Franckhauser said. “When we isolated people, that kept their bodies safe, but it injured their social and human selves, and those are extremely intertwined with overall wellness. We have to balance those two. Not merely protect the body, but understand how important it is to keep people socially engaged.”

As part of the protocols developed, nursing home staff were encouraged to pay more attention to interactions with residents, to check on them more often, and take more time and talk with them about what was happening on the outside and with their families. They also turned to technology, using a mix of portable devices and large screens to connect residents with friends and relatives on the outside, as well as people in the next room and down the hall.

These new ways of connecting could make a lasting difference for older adults, Franckhauser said. They provided options and alternatives to help people within facilities as well as without. Even as people stayed in their rooms, there were opportunities to maintain and build relationships through virtual lunches, classes, and wellness checks.

These efforts will be bolstered by state initiatives to expand broadband networks to reach more rural areas. Having this access will help not only with social connections but also telemedicine delivery, which can reduce disparities, Franckhauser said.

Moving forward, there’s also a need to rethink the structure of the facilities that fostered the spread of Covid, Franckhauser said.

“We have to stop designing assisted living facilities like large hospitals where we cohort people in tiny rooms,” she said. “We need to think about how we can reorganize them to make them more accessible, more home-like.”

Read the other Pandemic Perspectives in the series.

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