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Prolonged isolation taking a toll on residents of nursing homes

Irene VandenAkker, 88, a patient at St. Camillus Health Center in Whitinsville, was wheeled outside to visit her niece Shelley Buma through a gate.Barry Chin/Globe Staff

A nurse found Dennis Thresher on the floor near his bed late one early May night at the Holyoke Soldiers’ Home.

“Where are my car keys?” he asked.

The 89-year-old Korean War veteran had fallen out of bed and wanted to go home. He had seen his daughter, Cheryl Turgeon, in person only once since early March.

“That was really gut-wrenching,” said Turgeon, who got a telephone call from the nurse shortly after her father fell. “That broke my heart. He wants to see me and I want to see him.”

More than two months after state and federal officials restricted visits at long-term care facilities to protect patients from the coronavirus, Thresher has avoided infection and survived one of the deadliest known COVID-19 outbreaks at a long-term care facility in the United States. But whether he survives months in lockdown, cut off from his loved ones, remains unclear.

“He’s been through another war,” said Turgeon, who lives in East Longmeadow. “The last thing I want is for him to think that I’ve forgotten him.”


As policy makers in Massachusetts and elsewhere consider how to ease isolation measures at long-term care facilities, the stakes are high. Even though the federal government restricted visitors and communal activities in nursing homes on March 13, fast-moving outbreaks have devastated many facilities.

In Massachusetts, patients at nursing and rest homes account for 61 percent of the state’s 6,473 COVID-19 fatalities.

Last week, the Centers for Medicare and Medicaid Services, the country’s top nursing home regulator, released guidelines for reopening homes in phases and gave state and local officials flexibility to implement the recommendations.

The same day, Governor Charlie Baker unveiled a plan for reopening Massachusetts that strongly suggested that pandemic restrictions in long-term care facilities won’t be lifted soon.


CMS recommends nursing homes remained closed to most outside visitors until there have been no new cases of the virus for 28 days. In a statement, a spokesman for the COVID-19 Response Command Center said the state is considering limited outdoor visits as the weather improves.

“We recognize how extraordinarily painful this pandemic has been for residents of long-term care facilities and their families,” the spokesman said.

The risks associated with reduced social contact are significant. An article accepted for publication by the American Journal of Geriatric Psychiatry said the risk of premature mortality due to a lack of social connection is comparable to the hazards posed by an unhealthy diet, physical inactivity, alcohol misuse, and smoking.

Loneliness is also associated with cardiovascular disease, metabolic syndrome, hypertension, pain, fatigue, insomnia, depression, dementia, and suicide, the authors wrote.

“This is our body alerting us to a threat,” said Elizabeth Dugan, a professor of gerontology at the University of Massachusetts Boston. “We need others to survive.”

Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that advocates for better quality of life for patients in long-term care facilities, said the industry had been failing to provide healthy social experiences before the pandemic. In January, the organization published a report that compared nursing home care to the standards of zoos and kennels.

“We allow nursing homes to basically act as storage facilities for people,” he said. “These are people’s homes.”

Relatives and friends are sometimes deeply involved with caring for patients, assisting with feeding, dressing, bathing, and laundry, all tasks that workers must now do without the extra hands.


Social activities like group dining, movies, and games have disappeared during the pandemic. The nursing workforce, considered family by some patients, has also been transformed as they wear protective gear that makes them difficult to recognize or miss shifts because of illness.

Before the pandemic, Cynthia A. Korhonen of Brighton visited Rivercrest Rehab and Nursing in Concord nearly every day, setting the table for lunch, feeding her 99-year-old mother, and participating in group activities.

Now she can only speak with her mother by phone. She recently e-mailed the administrator and requested an outdoor visit with her mother, Onerva Miriam Korhonen, saying she would wear a mask and keep her distance.

In response, the administrator said state Department of Public Health guidelines prohibit such visits, according to an e-mail exchange that the Globe reviewed.

“My expectation is that I won’t ever see my mother again, but I won’t blame anybody,” Korhonen said.

Turgeon said she briefly visited outdoors with Thresher on April 27 because the Soldiers’ Home feared he was in serious condition. His health has improved, but Turgeon believes Thresher hasn’t been outside since that five-minute meeting.

She said she has written to state Secretary of Health and Human Services Mary Lou Sudders and Val Liptak, interim administrator of the Soldiers’ Home, asking for visits to be reinstated and for the veterans to go outdoors at least occasionally.


“Today is a gift and tomorrow is not guaranteed,” Turgeon said she wrote. “I do not want my last visit with my father to be an end-of-life visit. I want to enjoy him now when he can talk and he is feeling a little better.”

A Baker administration spokeswoman said the veterans aren’t allowed outdoors “because of strict adherence to infection control protocols.” Families may arrange window visits or car parades with advance planning, she said.

Exactly how long-term care facilities may relax visitor restrictions is murky. The American Health Care Association, which represents nursing facilities, said Friday that it isn’t aware of any states that have unveiled plans.

In British Columbia, the provincial health officer said last week that she hopes visits may resume in June.

A report from Australia published this month by the International Long-Term Care Policy Network laid out options for allowing visitors on a limited basis by screening them for fever, conducting meetings outside or in well-ventilated, private rooms, and requiring masks, shoe protection, hand-washing, and social distancing.

Irene VandenAkker, 88, a patient at St. Camillus Health Center in Whitinsville, was wheeled outside on Thursday to visit her niece through a gate.

Since the outbreak, VandenAkker’s mild memory issues have worsened. She was moved to a dementia unit, where she tested positive for the virus but did not develop symptoms. Her niece Shelley Buma said the facility won’t say how many patients have died. The facility’s administrator didn’t respond to requests for comment.


During the visit, VandenAkker sat in a wheelchair with her head bowed and a gate separating her and her niece. She reflected on family and friends who haven’t stopped by in months.

“I still just don’t understand it,” VandenAkker said.

Shelley Murphy of the Globe staff contributed to this report.

Laura Crimaldi can be reached at Follow her @lauracrimaldi.