White Coat, Black Art·THE DOSE

How to help seniors get through the COVID-19 pandemic

From questions to ask a long-term care facility to some advice on minimizing loneliness, here are some key things to consider when thinking about the impact COVID-19 is having Canada's elderly.

As Canadians isolate, many are gaining empathy for the reality seniors face

Shirley Larkin and her sister stand outside their mother's long-term care home to show her they are thinking of her, even though they can't visit during a facility lockdown to try to prevent an outbreak of COVID-19. Since this photo was taken, restrictions have tightened within the home and their mother can no longer come down to the main floor. (Supplied by Shirley Larkin/White Coat Black Art)

The deaths of dozens of seniors in Canada from COVID-19 have been an unfolding horror for anyone who may have doubted how serious the coronavirus pandemic really is.

"Now we're actually seeing what many of us in the hospitals knew would eventually start happening — people would start dying," said Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network in Toronto.

Weakened immune systems and underlying medical conditions make older people especially susceptible to severe illness if they get COVID-19.  

But in addition the risks to physical health, both Sinha and Dr. Theresa Tam, Canada's chief public health officer, note that the protective measures of physical distancing and isolating seniors — who are already at heightened risk of loneliness and feelings of depression — can take a toll on their mental health.

"Staying connected has never been more important," Tam said, encouraging Canadians to keep in touch with loved ones through phone or video calls. 

COVID-19 has ramped up the urgency of protecting both the physical and mental health of our elderly loved ones and neighbours, Sinha told Dr. Brian Goldman, host of CBC podcast The Dose.  

Here are some things to consider:

How can we help while physically distancing?

One side effect of the COVID-19 pandemic is that as Canadians have had to adopt an unprecedented lifestyle of self-isolation, they may be developing empathy for how many seniors feel every day. 

"I think we're finally seeing what they're experiencing, right? Being in your house, not being able to just get up and go when you want to go," said Gabrielle McMillan, a volunteer and past-president of Life After Fifty in Windsor, Ont.

When COVID-19 forced the non-profit to close its recreational centres in mid-March, McMillan and other volunteers started doing "telephone assurance" calls to elderly members try to maintain a connection in the absence of in-person social interaction.

Already, she can hear the toll that isolation is taking "in the voices of some of the people I call," McMillan said. 

When they first pick up the phone, "you can hear a bit of depression … they're very down," she said.

But that personal check-in, even if it lasts for just 10 minutes, has an effect. 

"We talk for a bit and they're better when I hang up," McMillan said. "It's amazing how much that means and how much that can help." 

Gabrielle McMillan, a volunteer who has been doing 'telephone assurance' calls to check in with seniors in isolation in Windsor, Ont., says she can hear how down people are feeling in isolation. But 'it's amazing' how much their mood is lifted by the end of that simple social contact.   (Gabrielle McMillan)

Finding "creative" ways to stay in touch is critical to helping seniors get through this period, Sinha said. 

Telephone calls are great, but he also recommends maintaining a face-to-face connection with seniors through Skype, FaceTime or other video chat platforms, if possible.   

Some family members are going low-tech and standing outside their elderly loved one's window, holding up supportive signs and waving. 

It's also important to remember than many seniors don't have family members checking in on them — so small gestures by neighbours go a long way. 

Leave a note outside an elderly neighbour's door with your phone number, Sinha suggested, inviting them to call if they need groceries, prescriptions, or just want to talk.

In a time where so many people are feeling "a bit helpless," he said, reaching out to a senior can be rewarding. 

"It's a two-way street," McMillan said. "When I hang up, I'm smiling."

What questions should I ask a long-term care home?

In addition to an increased level or frailty or dementia that leads someone to require placement in long-term care, there are a number of factors that can put people in nursing homes at heightened risk.

Residents may be living close together, especially in older facilities, where it's common to have up to four people in one room. 

"This idea of social distancing and other things that we ought to be trying to do, it's much more difficult in these older facilities," Sinha said.

Pinecrest Nursing Home in Bobcaygeon, Ont., devastated by the deaths of 20 residents amid a COVID-19 outbreak, is an example of one such facility, he said.

Pinecrest Nursing Home in the small town of Bobcaygeon, Ont., is one of several long-term care homes in Canada devastated by residents' deaths from COVID-19. (Chris Glover/CBC)

Compounding the problem is the "precarious" nature of staffing in many care homes, because employees often get only  part-time work, Sinha said, forcing them to take jobs in multiple facilities or do home care "just so they can make ends meet."

That movement between facilities and homes can contribute to the spread of coronavirus. 

One bit of reassuring news is that most long-term care facilities have pandemic plans and infection-control measures in place to deal with outbreaks such as influenza, Sinha said. But COVID-19 poses a unique challenge. 

"We don't have treatments, we don't have a vaccination," he said. "And it's very contagious. So once it gets in, it can spread around quickly, and it can kill.

"[That's] why we're trying to do our best [to] keep COVID out of a nursing home in the first place." 

Here are some questions to ask:

  • Do you have enough personal protective equipment for your staff? Even if there are no known cases of COVID-19 in the facility, staff should still be wearing at least surgical masks, Sinha said. If there are people in the building who are infected, they should be wearing N-95 masks, face shields, gowns and gloves.  
  • What specific infection control measures do you have in place to guard against COVID-19?
  • Do you feel confident in your ability to support my loved one right now?  

What about taking my loved one out of long-term care?

Some families may not be confident in the care home's efforts to minimize the risk of COVID-19 and may want to take their loved one home, Sinha said. But it's not a decision that can be taken lightly.

"[That's] huge, and it's not something that people can easily do," he said. "We might not just have the space. We might just not have, you know, the person-power."

It's important to remember that some long-term care homes have better protection measures in place than others, said Dr. Isaac Bogoch, an infectious disease specialist at University Health Network.

Family members also need to weigh the risks of bringing their elderly relative home, he said.

For example, if there are people living in the family home who are coming and going, it's possible that someone could bring the COVID-19 infection in, Bogoch said.  

Other considerations include whether the home is a safe layout and whether family members can realistically provide the level of care needed for an elderly, frail person.  

Depending on the person and the circumstances, moving them from a familiar environment to an unfamilar one could cause also psychological distress, Bogoch added. 

Both Sinha and Bogoch agree it's an individual decision. 

"Not all long-term care facilities are created equally, and not all [family] homes are created equally," Bogoch said. 

What about seniors living at home?

Because seniors are so vulnerable to COVID-19, health officials have asked people 70 years of age and over to self-isolate at home. 

"Their greatest risk is when people come to visit them," Sinha said. 

Family members, friends or neighbours bringing groceries, medications and meals should maintain physical distancing and leave items outside the senior's door whenever possible.  

But for seniors receiving home care, some visits —  including medical treatments or bathing — may be essential, he said.  

If personal support workers or other people must enter the home, seniors or their families should: 

  • Make sure the care workers wash their hands.
  • Ask them to wear a mask. Care workers travel from home to home — and may also work in long-term care facilities, so it's vital to do everything possible to minimize the risk of virus transmission even if they have no symptoms.  

What other hardships are seniors suffering?

As we ask people over age 70 to isolate themselves at home and prohibit all but essential visits to nursing and retirement homes, "older adults who are quite isolated already [are] becoming even more isolated," Sinha said. 

The emotional toll is "collateral damage" from efforts to protect seniors from infection, he said.

"This is where we're having to make some of those tradeoffs to try and save lives, but at what cost overall?"

For elderly people with dementia, the restrictions can be especially devastating, because they may not understand what's happening — or why. 

"They're getting more distressed, because the folks in their lives are trying to stay away from them and they don't remember they're trying to stay away from them to protect them," Sinha said. 

Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network in Toronto, says COVID-19 has shown Canada how much more needs to be done to protect seniors' health and well-being. (Taylor Simmons/CBC)

Many seniors also don't have people they can rely on to bring essential supplies to their door — and can't afford  store delivery services. 

These are areas that non-profit agencies are trying to address. The federal government has pledged $9 million to the United Way — which funds community-based charitable organizations across the country — to help vulnerable seniors during the COVID-19 pandemic. 

The money will fund supports to help seniors "self-isolate safely,"  with a particular focus on those living in low-income or precarious housing conditions, said United Way spokesperson Anita Khanna in an email to CBC News.

Services will include delivering groceries, picking up and dropping off prescriptions, providing transportation to medical appointments and "friendly-check in phone calls," she said.

Seniors can also call 211 in most areas across Canada to access information and support. 

 

About the Author

Nicole Ireland is a CBC News journalist with a special interest in health and social justice stories. Based in Toronto, she has lived and worked in Thunder Bay, Ont.; Iqaluit, Nunavut; and Beirut, Lebanon.

With files from Dr. Brian Goldman and Dawna Dingwall

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