NEWCASTLE, WYOMING — “If my daughter comes, I want to go with her,” said Karen Krause, 79, in her raspy voice as she made her way to the head of the makeshift bowling alley in the Weston County Manor nursing home on a Tuesday afternoon in March.
"OK, honey,” replied Meredith Tolley, the activities director of the 58-bed nonprofit facility in this small city in east Wyoming. She knew that if Krause's daughter were to arrive, COVID-19 restrictions would prevent her from taking her mother off premises. For the past year, residents wanting to leave the facility were required to undertake a 14-day quarantine upon return in most circumstances. The venture out wasn't worth it.
The staff of the Manor had lost count of how many times Krause, a dementia patient, had asked to leave with her daughter during the pandemic. Attempts to explain why she couldn't only made Krause confused, stressed and sad. “I don't want to put her through that,” Tolley said.
Reassured by Tolley's white lie, Krause continued with her game, leaning over her walker, placing her left hand atop the lightweight blue bowling ball and pushing it down the ramp aimed at the pins. Seven out of 10 fell over. Her fellow residents clapped and cheered.
Afterward, as residents headed back to their rooms, Krause turned to Tolley once again. “If my daughter comes,” she repeated, “I want to go with her."
Tolley nodded. “Yes, ma'am.”
A couple of weeks later, Krause's wish came true. The Manor's management team gave residents who were fully vaccinated against COVID-19 permission to leave for a few hours to enjoy an Easter outing with loved ones, without having to quarantine afterward. The families of 16 residents signed them up for short escapes over the holiday weekend.
The changes followed new federal guidance to nursing homes that made it easier for residents to visit with their loved ones after a year of pandemic-inspired lockdowns. While the new guidance didn't directly address whether residents should leave a facility, the Manor decided that vaccinations and declining cases were grounds for short, off-premises visits.
So a few minutes before 10 a.m. on Easter Sunday, Tolley met Krause at the entrance doors of the Manor, carefully placed the loops of a surgical mask over the oxygen cords that sit behind Krause's ears and asked: “Are you ready, Karen?”
Krause didn't respond. She pressed the wheels of her walker up against the glass doors that separated her and her daughter, Tammy Harman, who was waiting outside, waving. Tolley pushed open the doors, allowing Krause to leave the Manor for the first time in months.
"Oh, my daughter, my daughter,” said Krause, as she buried her face into Harman's shoulder. “Oh, I love you, I love you, I love you.”
"I love you too, Mom,” said Harman, rubbing her mother's arched back. “Now, come on, let's get you out of here.” Krause relished the embrace a few moments longer before pushing her walker — a little quicker than usual — toward the parking lot.
Coming back but far from normal
It's been a grueling year of COVID-induced loss, loneliness and longing for normalcy in America's nursing homes, where the virus has killed more than 130,000 residents, infected around 650,000, and stripped hundreds of thousands more of their routines, social connections and freedoms.
And while there is no official tally of how many residents died from the effects of social isolation and loneliness caused by lockdowns — which were meant to protect residents from COVID-carrying visitors — experts predict the toll is high.
Now, thanks to a sharp decline in COVID-19 cases in nursing homes after widespread vaccinations among residents, simple pleasures are returning. Bowling with friends, holding a family member's hand, a quick jaunt out of the facility — all off limits for most of the last year — are coming back.
And yet the challenges and confusion continue.
Some residents at Weston County Manor won't emerge from their rooms, where they were forced to stay for months. Continued mask mandates make family reunions and socialization tricky. Burned-out workers continue to face overloaded schedules in the face of new hurdles, including low vaccine uptake among staff members. And as a possible fourth coronavirus surge looms, many worry that the recent liberties granted to nursing homes might be taken away again.
"Life is still far from normal,” said Maureen Cadwell, chief executive officer of Weston County Health Services, which includes the Manor. That's “wearing on everybody,” she said — residents, staff and loved ones.
The struggles extend to nursing homes throughout the country, which are home to more than 1.2 million residents. “In a lot of ways, we are coming back to ourselves,” said Carol Silver Elliott, the chair of the board for LeadingAge, a national association representing 5,000 nonprofit aging services providers, including Weston County Manor. But “our people are antsy and impatient for the world to open up.”
"We spend a lot of time preaching about how we have to still be cautious because it ain't over till it's over.”
Bingo and bonding
Sharla Lax, an activities aide at Weston County Manor, sat at the head of the dining room in front of a large television screen that displayed the bingo numbers her laptop was autogenerating. Each time a new number appeared, she had to shout it out extra loud so that the residents, who were spaced 6 feet apart, could hear her through her mask.
"The little ball that started it all — what is it?” she asked.