Paul's Passing Thoughts

Every long term facility is unique in regard to the residents who call those places home. That is, in a manner of speaking; to be more precise, many never accept long term facilities as their home and will let you know it often. At least half, if not more, of long term facility residents would rather be living at the home taken from them before they were placed in a long term facility by their families. Those facilities receive the lifelong fruits of the resident’s labor in exchange for end of life care. For better or worse, most residents feel imprisoned at long term care facilities. Now, because of COVID-19, they are imprisoned within the prison.

Before COVID-19, long term care facility prisons were a good place to be as far as prisons go. Many have really good food, spacious courtyards, activities, visiting medical specialists, and in-house nursing care. Family and others were free to visit at any time. Right now, all of that is restricted and residents are actually confined to their rooms 24/7. It’s solitary confinement. Before all of this, there was a joke circulating around that prisoners in correctional facilities have more rights than long term facility residents. Humor is funny because to some degree there is truth in it; unfortunately, there is no humor left in that particular joke.

So, has the isolation policy worked to prevent COVID-19 in long term facilities? No, not at all. And isolation has done more to kill residents than COVID ever could. Isolation policies at long term care facilities has been a colossal disaster. COVID outbreaks are dominating a majority of facilities. ER doctors and nurses would be horrified if they could see the protocols being played out in real time. Many units that were entirely occupied by residents of the “independent” classification are now all either heavy one-person assist or two-person assist. It is very unlikely that they can be restored to independent status. That’s what isolation does. Especially in latter life, mental and physical heath will deteriorate quickly. The body is made to work and do things, and we are social beings. Isolation first breaks the will and well-being of the residents, and than comes the COVID. The results are not good.

The biggest mistake was restricting families from the facilities. Family members who visit their loved ones in the facilities are a certain type of individual; they more than likely would have helped the situation greatly on many levels. Family restriction was/is a policy monstrosity on apocalyptic levels. Experts can be really, really stupid, and government often makes stupid look good.

And before I move on, I might mention that courage is a peculiar thing and prevalent in humanity. For the most part, it is the specialists who won’t go near the facilities. I won’t reveal which specialist was portrayed yesterday, but labels cannot trump neglect when it gets to that point. Abandonment by aides and nurses is only about 25%. Several have caught the virus more than once and the second time is worse. This past week, I worked with two nurses who almost died from it. Both were young, healthy, and a little less cocky, but not much.

This article is about a particular unit where the residents took a stand. I said every facility and units within facilities are unique, and in this particular unit, there is an unusual amount of sundowners. They are defined this way:

While most people are “winding down” or relaxing as the day reaches its end, those with sundowner’s syndrome become increasingly active.  Sundowner’s syndrome has links to dementia, a condition that affects memory, personality, and the ability to reason. It is also known as sundown syndrome or sundowning.

The symptoms of sundowner’s syndrome typically occur between the hours of 4:30 in the afternoon and 11:00 in the evening.

These include:

• • • • confusion as to the location and identity of people
      • mental confusion that does not respond to reasoning
      • paranoia
      • sleep disturbances, such as inability to sleep at night, possibly leading to excessive sleep during the day
      • sudden changes in behavior unexplained by any other trigger
      • trouble speaking and thinking clearly
      • visual hallucinations
      • wandering
      • yelling or aggressive behavior

In regard this unit? Yes, all of the above. Yes, at about 4 or 5 pm, they all come out of their rooms and start wondering around. Creepy? Definitely. Like nothing I have ever experienced before? No doubt. But wait, they are all in isolation and confined to their rooms, right? Well, good luck with that. As the other aides and I watched the nurses try to instruct them to return to their rooms, we could only smile and shake our heads; not going to happen. Then, several of them went to the dining area and sat down at the tables. Some sat quietly, others, not so much. Requests to return to their rooms was met with comments like, “You think you’re hot sh** don’t you sweetie?” I mentioned to the nurses that at least they were practicing social distancing. They didn’t seem to be amused.

There wasn’t anything we could do. It was a sundowner rebellion. Perhaps there is something to be learned from their example.

paul