Few dispute the need to protect seniors citizens from the SARS-CoV-2. But at what cost?

Sharon Schaefer, 70, of Joliet – who calls herself a “Zoom maniac” – is proud that she bought her own web camera and installed it.

With it, she’s able to take two difference exercise classes for a total of five days a week, as well as participate in a book club and cooking classes from Senior Services Center of Will County in Joliet.

This enthusiasm is very different from the first few months of the pandemic, when Schaefer found herself depressed.

Zoom “honestly kept me sane,” Schaefer said.

The health consequences of isolation

April Balzhiser, program director at Silver Oaks Behavioral Hospital, said that, even without the COVID-19 pandemic, many senior citizens are at risk for isolation, which can impact their mental health.

Other than the pandemic, factors that raise that risk include death of a spouse and friends, children who live in their own homes, and health and/or mobility issues, which makes it more difficult for seniors to leave their homes.

Humans need connection and interaction. Isolation can lead to depression and anxiety, and exacerbate any pre-existing mental health disorders, she said.

Children and grandchildren are torn between missing their senior relatives and protecting them from COVID -19 and the possibility of serious health complications, she said.

“It’s tough for anyone,” Balzhiser said. “I hear from seniors, ‘I can’t wait to have a real hug and not behind all this PPE.’”

Balzhiser said she’s seen an increase in anxiety across every age spectrum due to the unknown. But with seniors, anxiety can be especially acute, she said.

Not only do they want to return to “Sunday meals with my grandchildren,” they have no guarantees they’ll live long enough to celebrate the holidays with their families again, especially if they have end-of-life issues, Balzhiser said.

“For all of us, it’s very unknown,” Balzhiser said. “It makes us stop and appreciate our loved ones while we have them.”

Addressing anxiety and depression in isolated seniors is no different than addressing anxiety and depression in anyone else.

“We just need to make sure they are getting the help they need to live the fullest life,” Balzhiser said.

A good start is providing the tools and training for virtual connections, she said. This way, seniors can enjoy virtual dinners and gatherings with relatives and friends anywhere in the country

“Take the time to get them that phone or tablet and give them instruction on how to use it,” Balzhiser said.

Some families have set up tables outside a senior’s home so everyone can have dinner together, separated by a window, she said. Instead of mourning the loss of traditions, set new ones, she said.

‘I’m not enjoying it but I’m coping.’

That’s the attitude Carol Malfi, 86, of Joliet has adopted. Before the pandemic, Malfi was highly involved with Senior Services Center of Will County as a volunteer and through attending exercise classes and many of its activities, she said.

“I’m probably healthier than most women my age,” Malfi said. “I’m probably more upbeat than most women my age.”

Malfi entertains herself by reading (“I’ve been reading two books a week for as long as I can remember,” she said) and working jigsaw puzzles and puzzles in the newspaper. She participates in Zoom events through Senior Services and celebrated the holidays with her family via Zoom.

She gets out about twice a month for routine doctor appointments and shopping. When the weather is mild, Malfi walks outside, too.

Malfi said she is not lonely. But she is lonesome.

Virtual is not the same as in-person for her. She made many friends through Senior Services and she can’t wait until they can all meet for lunch again.

“I’m not enjoying it,” Malfi said. “But I’m coping.”

Keeping residents’ spirits high

At the beginning of the pandemic, Plainfield East High School fine arts teacher Emily Tonon asked her students to create a page for a coloring book to give to essential workers.

She recently tasked her National Art Honors Society students with creating another coloring book for nursing home residents.

Each coloring book contains 22 pages of students’ drawings.

After printing out a few of the coloring books, Tonon wrapped them with a note and delivered them to Lakewood Nursing and Rehab Center in Plainfield and The Pearl of Naperville.

To view the online coloring book, visit drive.google.com/file/d/1QvyBGUqwceFNRcm9IrQiSJFLU5YnD2kM/view?usp=sharing.

Natalie Bauer Luce, spokeswoman for Symphony Care Network, said staff works hard to devise new and creative ways to keep residents connected and spirits high.

Staff will stand in the doorway and chat, bring trivia quizzes and puzzles, provide special dinners (even when residents must remain in their rooms to eat them eat them) and arrange virtual visits with families.

“Staff is obviously on the phone all day long trying to keep families updated to know how residents are doing,” Luce said.

What’s a society to do?

Kelly Bryant, director of clinical excellence and nursing and Linden Oaks Behavioral Health, said it’s important to look at the social determinants of health, which is part of the Centers for Disease Control’s Healthy People 2020, a 10-year plan for improving public health.

Before the pandemic, many seniors socialized at church, community centers and group activities, which isn’t possible now, Bryant said. But social distancing can lead to social disconnectedness, which ultimately results in loneliness, she said.

The health risks associated with COVID-19 can’t be ignored. Older adults may have weaker immune systems, and diabetes and cardiovascular disease puts them at greater risk for severe COVID. Adults with cognitive decline might refuse to wear a mask, she said.

“When English isn’t the first language, that creates another whole set of challenges,” Bryant said. “If you’re living by yourself ... and you cannot speak English or talk to your caseworker, then you are really at risk.”

Malnutrition is another consequence of isolation if the senior can’t speak English or afford food delivery, Bryant said. It may be harder to find and participate in virtual events when the senior can’t speak English, she added.

Compounding those concerns is the increased risk of substance abuse in seniors and the risk of suicide in adults over age 80, Bryant said. Even seniors whose mental health is well-managed might find that coming apart due if they are anxious and isolated due to the pandemic.

Bryant said the question then becomes: “What are some actions we can do as a culture, a society, to promote healthy relationships not only with others but with ourselves?”

The solution may have multiple answers. Reading and working puzzles provide mental stimulation. Walking with a mask and waving at neighbors fosters connection. So do neighbors who check in with seniors and shop for them, she said.

Friends can send a regular delivery of cards, an occasional plant, new library books, she said. Loved ones can schedule phone calls and video visits so seniors can write them on their calendars and look forward to them, she said.

Seniors being treated at Linden Oaks engage in a variety of virtual, expressive therapies that include art, dance, music and group projects, she said.

Many seniors are reaching out to other seniors to create a sense of belonging, Bryant said.

“Many of them are alone, so they look out for each other,” she said.

However, Bryant added, it shouldn’t take a pandemic to figure out ways to keep seniors connected. And Sue Markgraf, formerly of Joliet and now of Mundelein, agrees.

‘We looked at her through a door with metal bar handles.’

Markgraf called COVID “one of the nastiest things to hit our universe.”

Markgraf’s mother Wanda Lou Johnson, who had dementia and died Nov. 11 at the age of 82, spent the last months of her life in a Joliet nursing home separated from her family, Markgraf said.

So now Markgraf wants to see reform in nursing home hospice centers and the development of uniform communication care standards across the U.S.

“My feeling is that my generation in particular has really dropped the ball on taking care of our elders in these facilities and paying attention to what is going on,” Markgraf said. “And we really need to change that. Our seniors in these facilities are the ones who raised us. And they deserve so much better than that.”

Markgraf said the nursing home, overall, did a great job caring for her mother. Staff addressed Johnson’s health needs and Johnson had a terrific caregiver, Markgraf said.

But Markgraf wished more attention was paid to her mother’s emotional and spiritual needs. And she feels other facilities struggled to provide in these areas, too, which society needs to fix, Markgraf said.

“These facilities do not have the planning, the structure and the infrastructure, to handle a universal, worldwide, pandemic,” Markgraf said.

Markgraf said the family had FaceTime visits with her mother twice a week and window visits from the sidewalk. That was hard in the elements for her father, in his early 80s, although a tent and seating was provided in late spring, she said.

“But even that was different,” Markgraf said. “We looked at her through a door with metal bar handles.”

And Johnson often looked back at them, crying.

“My mother at one point asked, ‘What did I do wrong?’” Markgraf said. “Is somebody mad at me that they won’t come in and see me?’”

Markgraf is thankful the nursing home allowed her and her siblings a compassionate care visit at the end of Wanda Lou’s life.

“We were allowed to be with my mom at her passing,” Markgraf said. “But we were in full PPE. My mother said goodbye to us wearing full PPE and she was a hospice resident … We said goodbye to my mom wearing a full face mask, shield, gown, rubbers gloves, and that includes my three siblings, myself and my father who is in his early 80s … her last vision of her four adult children and my dad was of the shields over our faces and masks over our mouths.”

No matter what life experiences happened to Johnson’s family, Wanda remained in her room 24/7, through good times and bad, Markgraf said.

“We should not have to put families through this,” Markgraf said. “Not when we have the expertise, the education and the technological platforms to provide services in creative ways that keep everybody safe. We have those tools. We should not have to educate someone on how to use them. That should be part of their training. And with reform, it will be.”

Some seniors, facilities struggle with new technology.

But virtual is still a tricky way to keep seniors connected, Stacy Jager of Lockport, a music therapist who’s worked with Will County seniors, said.

“I was able to do outdoor music therapy for a while when the weather was good,” Jager said. “Obviously now, it’s just Zoom.”

But it’s not just the seniors who are unfamiliar with technology. A lot of facilities are new to the platform, too, Jager said, which underscores Markgraf’s point. Some people and facilities are willing to dive into it and some are hesitant, Jager said.

Yet adopting it has benefits, Jager feels. Music therapy is a powerful tool to decrease anxiety and depression, and foster communication and interaction. Listening to the radio in a room by oneself isn’t the same as when everyone comes together to sing their favorite songs.

“It gives them a feeling of acceptance and unification,” Jager said. “They start reminiscing and everyone is able to relate to the music and the memories.”

Senior Services Center of Will County takes multi-faceted approach.

Sue Kainrath, director of the Community Connections Collaborative for Senior Services of Will County, agreed that preventing isolation in seniors in challenging, even without a pandemic.

That’s the reason why Senior Services offered so many in-person health and recreational activities until the center closed in mid-March.

“We have had seniors tell us before they found senior services that they were literally sitting on their couch, waiting to die,” Kainrath said. “The services we provide are so vital to keeping that connection with the outside world.”

But within a week of the shutdown, Senior Services was calling seniors and checking on them. The center ordered products through food companies and delivered groceries to 250 seniors.

“We also got toilet paper and paper towels,” Kainrath said. “We bought laundry pods and put those into baggies so they could do laundry. We just anticipated anything they might need to go outside of the house for.”

Volunteers bagged groceries and delivered them, Kainrath said.

“We had tremendous representation from Rotary and as well as the Chamber of Commerce,” she said.

Senior Services has hosted food drives, holiday meal drop-offs, social distance parades and a postcard program. Robocalls go out every three weeks useful information about upcoming programming and how to participate.

“We remind them that we are here to help,” Kainrath said.

To that end, Senior Services has uploaded how-to YouTube videos and step-by-step instructions on its website on how to get online and use Zoom, Kainrath said. Virtual programs have included book clubs, tap dancing and Zumba Gold, she said.

Kainrath said Senior Services did host an annual picnic outdoors in August with limited capacity. But many seniors, even active participants before the pandemic, were simply too frightened to attend, Kainrath said.

“So they’ve been isolated this entire time,” Kainrath said.

Kainrath said no one can live in fear this long and not have it take a toll. And that’s the point, she added.

“Everybody kept thinking, ‘Two weeks and then a month or two and it will be fine,’” Kainrath said. “It will be fine by the school year. But things just keep getting worse.”

Even when seniors understand technology, many don’t want to use it for fear their computers will be hacked and the money in their bank accounts will be stolen, Kainrath said.

“We used to host computer safety classes and then on a dime, we started saying, ‘Hey, by the way, go on your computer and use your web camera. It will be fine,’” Kainrath said.