- Daniel Fishel
In late 2019, Seven Days and Vermont Public Radio published a series of stories that revealed Vermont's state-regulated eldercare facilities often failed their mostly elderly denizens, with medical errors and accidents leading to harm and even deaths. Just a few months later, COVID-19 struck, leaving residents of these assisted living and residential care homes more vulnerable than ever, this time to a virus especially deadly to older people.
Desperate to keep COVID-19 out of the homes, state and federal officials resorted to extreme measures and instructed the facilities to lock their doors. Residents have been confined inside since then, away from family and even each other.
Want to search Vermont's assisted living and residential care home inspection reports?
Visit our online Vermont Eldercare Navigator. It's based on 854 inspection reports created between 2014 and 2020.
Seven Days and Vermont Public Radio created the database when we teamed up in 2019 to produce Worse for Care, a series of investigative stories grounded in our joint review of those reports. You can still read that series, and search the updated database.
Listen to radio versions of the eldercare stories published in this issue of Seven Days. They'll run during VPR's "Morning Edition" at 7:44 a.m. and "All Things Considered" at 5:44 p.m. on these dates: March 24, 29 and 30. You can also look for them on vpr.org.
"We had to shut them off from the outside world, which seemed, you know, in some ways cruel, as well," Gov. Phil Scott recently told VPR. "It's bothered me ever since, but it was necessary to protect them."
Scott's executive order may have slowed the spread. But state and federal guidelines also kept out regulators and watchdogs charged with keeping residents safe. The problems that existed before the pandemic continued and sometimes worsened, only largely out of sight. One home operated throughout the last year with lax pandemic precautions — and an expired license.
The men and women who live in these facilities suffered in lonely quarters, deprived of social activities, visitors and hugs. At times, they were restricted to their rooms for weeks on end, a sort of solitary confinement.
Despite these precautions, COVID-19 swept through close to two dozen of Vermont's 120-plus assisted living and residential care homes, afflicting tiny group residences and large campuses alike. As of February 23, nearly 350 residents and caregivers had been infected, and 27 residents had died. That's about 13 percent of all COVID-19 deaths in Vermont.
Now that vaccination clinics have halted new outbreaks, residents and their caregivers aren't quite so alone. New guidelines allow more contact between residents and their families — but the visits are still subject to numerous, ever-changing conditions. Regulators and watchdogs have yet to return in full force. A single new infection can push residents back into their rooms.
Once again, Seven Days and VPR have teamed up. Our stories this time examine how regulators approached the pandemic and what lapses they noted, as well as how the seclusion affected residents.
The cost, it is clear, is only beginning to come into view.
Elder Vermonters Forced Into Seclusion Face Depression and Declining Health
- James Buck
- Pam Reith holding a photo of her mother, Beverly Peters
Mansfield Place seemed like the perfect place for Beverly Peters to spend the rest of her life. The 120-bed assisted living facility in Essex Junction was a town over from her daughter, Pam Reith. As one of the largest eldercare homes in Vermont, it offered an abundance of ways for Peters to stay social, while caregivers would be available to help with her weakening physical strength.
She and Reith were close, and when Peters moved to Vermont from Southern California, they started spending more time together, shopping and doing crafts.
The first few years at Mansfield Place were great, Reith said. Her mother, an extrovert, started a glee club and joined a resident group that lobbied for better food. She played a little electric piano in her room. And she saw her daughter a lot. Every Monday, she'd sleep over at Reith's house. Reith retired early in 2019 so she could spend even more time with her mom.
When COVID-19 hit last March, Peters, then 93, and her daughter thought Mansfield Place would be locked down for a few weeks. They had no idea how quickly it would become a prison.
For the first few months, Peters seemed OK. She couldn't leave her apartment, but she'd smile and laugh and tell her daughter not to worry. The two talked on FaceTime every day. Peters was hard of hearing, so Reith would write messages on her cellphone and hold them up to an iPad camera so her mom could read them. Sometimes their virtual visits were derailed by the apartment's spotty internet. A few times Reith drove over to Mansfield Place and stood outside the building. Her mom would wave from the window of her third-floor apartment.
In the summer, as coronavirus cases dropped, the state allowed eldercare homes to arrange outdoor, socially distanced visits between residents and family members. Mansfield Place set up eight-foot-long tables for the visits. But that arrangement proved challenging for Peters.
"We would be at opposite ends of that eight feet, but she couldn't hear me," Reith said.
By last August, Peters' demeanor was changing. She had no interest in FaceTiming with Reith. She had lost 35 pounds since June and begun to fall more frequently. In Reith's view, her mom had lost "her will to live." Her doctor diagnosed her with depression and failure to thrive. Peters stopped reading and playing the little piano in her room. She didn't watch TV because she couldn't hear it.
"She was just staring out the window, looking at the cars," Reith said. She told her daughter an orange car drove by every day.
In November, Reith sent a letter to Gov. Scott with two pictures of her mother. One, from February 2020, showed Peters grinning and buoyant. In the second, a FaceTime screenshot from the following June, Peters' lips were drawn, her eyes distant.
"My mother is dying from Covid every bit as much as those who are infected by the virus, and she is not alone," Pam wrote. "I am truly begging for your assistance to get my mother some personal, loving, family contact before she gives up all hope and passes away due to loneliness."
While Mansfield Place kept COVID-19 out of its building, the restrictions caused her mom's health to deteriorate, said Reith, who doesn't blame the facility. And while Reith knew her mother's health was bound to fail one day, she thinks the isolation of the past year brought it on much faster.
"It's been a year of hell watching my mother decline like this," she said. "I feel like that's the last gift I get to give her, is to help her die gracefully in the way that she wanted. So that's been hard, to feel like I haven't been able to do that."
Jessica Rouse has seen firsthand how the pandemic has affected older Vermonters. A physician who runs Village Health, a private family practice in Middlebury, Rouse has continued to visit patients in eldercare homes.
Those visits have given her a window into her patients' well-being over the last year, as they endured isolation and strained caregiving. She believes many have suffered mental and physical health declines as a result. More elderly patients are being diagnosed with depression and prescribed antidepressants. The effects of isolation have been most pronounced for people who have dementia, she said.
"At the beginning of the pandemic, we made the choice that we needed to protect our elders because their risk of dying from COVID was more significant," Rouse said. "But there absolutely has been these consequences that we weren't really expecting."
- James Buck
- Peters family photos
Reith is one of several family members who described the last year as a living "hell." Carol Blakeley, whose mother lives at the Residence at Shelburne Bay, went further: "It's been hell on wheels," she said.
Her mother, Florence Winn, 92, has Alzheimer's disease. According to Carol, Winn entered the Residence at Shelburne Bay in May 2019 with mild dementia: She had a score of 21 on the Mini-Mental State Exam, a test used to measure cognitive function.
She declined to 19, or moderate dementia, over the next year. That's in line with the average decline of someone with Alzheimer's of "about two to four points each year," according to the Alzheimer's Association. Over the course of the pandemic, she dropped from 19 to 10, meaning her disease is now severe.
Blakeley's mom has been stuck in her room on the top floor of the upscale facility, one of three in Vermont owned by Massachusetts-based LCB Senior Living. Her daughters got her a giant stuffed dog to keep her company.
"There's no socialization, no anything," Blakeley said. "She was just so depressed. She's happier now that she's on antidepressants."
Blakeley said her mom can't work FaceTime on her own, which means the nurses have to help her. But to Blakeley, the nurses seem stressed and overworked: "We feel like we can't ask them to give us FaceTime with mom even weekly because they're so stressed. Other than talking with her on the phone, we haven't been able to communicate with her."
The facility's activities staff has held "social engagement" events that take place in hallways with residents standing in their doorways, LCB Senior Living spokesperson Ted Doyle said, adding that the company purchased additional iPads for its homes to allow more virtual visits during the pandemic.
"Anytime a family member called anywhere and said, 'I want to talk to my mom or dad,' we would make that happen," he said.
Blakeley's family pays $6,700 per month for Winn's apartment and care. As her condition declined in recent months and she required more services, Blakeley said, the home sought to increase the monthly bill to $7,500. Winn caught COVID-19 during a winter outbreak that infected 15 staff and 28 residents, killing three. She survived.
Some homes, already strapped for caregivers, didn't have enough staff to manage all of the new burdens of operating during a pandemic while also tending to residents' emotional health.
Rouse, the Middlebury physician, said that, prior to the pandemic, family members could help fill some of the gaps.
"If somebody needs a glass of water or needs help getting up out of a chair to get to the bathroom and a family member is there visiting, that absolutely happens," Rouse said. "And when you're talking about a facility that already is understaffed, not having those extra people ... has consequences."
There are state regulations to ensure that residents get social and emotional support. The residents' bill of rights requires that homes have visiting hours and states that residents "shall be allowed to associate, communicate and meet privately with persons of the resident's own choice."
During the pandemic, advocates say, residents lost those rights due to restrictions put in place to slow the spread of the virus.
"Those folks still should have had some choices," said Alice Harter, a regional long-term care ombudsman in the Northeast Kingdom. "They should have more choices than what they were given."
Some operators acknowledged that their residents missed out on an important part of their care during the last year. Prior to the pandemic, Riverbend Residential Care Home had an "open-revolving door." Families didn't even have to call; they could just drop by the Chelsea facility, said owner Jennifer Doyle.
Now, families need to schedule visits, and a Riverbend staffer supervises to make sure everyone stays six feet apart. All residents are vaccinated, but the only touching allowed is a brief hug hello or goodbye — no snuggling, Doyle said.
It's not an ideal setup, she admits, but the state directed eldercare homes to "do what we can to protect people from dying."
"Their physical care, their medical needs have been absolutely well met," Doyle said. "Emotionally, we're doing our best to meet their needs, but we can't deny that decreased family access has had an impact on people."
- Courtesy Of Pam Reith
- Beverly Peters (left) and Pam Reith before the pandemic
State regulators have signaled that they won't penalize homes for not providing social stimulation during the pandemic. Pam Cota, the state's eldercare home licensing chief in the Department of Disabilities, Aging and Independent Living, said it would take a "pretty egregious situation" for state regulators to cite a home.
"Everyone is really just trying to do their best," Cota said.
The much-heralded arrival of vaccines in December and January hasn't solved the isolation problem — at least not everywhere.
Julia Gignoux and Leslie LaCroix's mother, Patricia Hill, has been at Valley Terrace in White River Junction since the fall of 2018. Early in the pandemic, they were impressed by the facility's "aggressive" stance on COVID-19.
"They did a fantastic job," Gignoux said.
Even in early January, when their 92-year-old mother caught COVID-19, they felt that the home was responsive and did a good job taking care of her. But the outbreak, which infected nine people, prompted the home to restrict residents to their rooms. They were allowed to walk the hallway one at a time.
On February 16, the home appeared clear of COVID-19. The facility started to allow residents to leave their rooms and eat together. But days later, another employee tested positive and the residents were again restricted to their rooms, even though many of them had recently received their second dose of the vaccine.
LaCroix and her sister were frustrated to learn that not all staff at Valley Terrace were vaccinated; even one new case was having repercussions for their mom. They began pushing the facility to mandate that its workforce get inoculated.
The outbreak at Valley Terrace is now over. The facility's executive director declined to comment on any specifics but in an email said Valley Terrace is "100 percent committed to the safety and well-being of its residents and staff."
The months of isolation have added up. Hill doesn't have dementia and was, LaCroix said, "sharp as a tack" before the past year. Now she has no short-term memory, according to her daughters.
"You see that her life is getting shorter," LaCroix said. "She's not who she was a year ago."
"This is not what we had ever hoped for the end of her life," Gignoux added.
For Reith, one thing has crystallized: Families must have a way to support their aging loved ones, especially through crises. "We need to do better," she said.
In her November letter to Scott, she urged him to create a designation for "essential caregivers" in hopes that she could get training and permission to participate in her mother's care as the virus resurged. She didn't hear back.
Advocacy groups have sprouted up around the country in recent months to push states to take up proposals such as Reith's. Caregivers for Compromise and the Essential Caregivers Coalition want laws allowing each resident to designate one family member as an essential caregiver. The person would follow the same coronavirus protocols as facility staff and be allowed in to provide social and emotional support.
In January, Reith's mom was diagnosed with dementia and went into hospice, which means that, under state protocols, Reith can again visit her in person. She goes every day.
On a recent Saturday, Reith stood outside Mansfield Place, preparing to suit up in the required protective equipment: goggles, face shield and mask. Reith stays for as long as she can, usually a couple of hours. They play games, chat and watch cheesy Hallmark Christmas movies.
But her mom gets tired a lot and sleeps about 20 hours a day now. Reith tries to keep her awake during her visits.
"Sometimes she just can't seem to stay awake, and she'll lie down on the bed," Reith said. "So I just curl up behind her and kind of put my arms around her and hug her."
"The human touch is so important," Reith added. "And she hasn't had that for so long."