The senior population have long been experiencing a silent epidemic of isolation. In fact, this isolation is a factor of many seniors declining health as they age. Due to the shortage of healthcare workers, seniors in living facilities are put into an even greater deficit of care. Add a national pandemic that requires prolonged quarantine and complete restriction from in-person socialization, and the problem becomes a matter of life and death. This issue became personally unavoidable when my grandmother and childhood nanny became sick during the onset of the pandemic. I was a direct witness to the terrors this isolation caused in both of their lives. This made me seriously question the way we care for our senior population and investigate the experience seniors have in living communities.
In an effort to narrow my scope from the broad topic of ‘senior isolation’, I considered what daily rituals a senior in a living facility would experience. In doing so, I found that mealtimes were the most routine and unavoidable part of their day. In addition to occurring three times every day, researchers have long stated the importance of sharing meals together. The tradition of eating with others has long been shared by all members of the human race; it is in our genes to break bread with one another. For these reasons, I decided that focusing my research on meals and meal experiences was a great narrowing of scope.
My goal for primary research was to learn from residents and staff at living facilities what meals were like before and after covid-19 hit. It is relevant to mention upfront that all of my primary research is collected from one living facility in the Columbus area and serves, in a way, as a case study. This particular living facility has a large campus with varying levels of care: independent, assisted, and nursing. Each level of care responded to the pandemic differently, which I will enumerate next.
After speaking with the assistant director of culinary and nutritional services, she explained to me that their priority has been to apply a restaurant dining experience as much as they can. She noted importance to make the meals family oriented and a social event, saying that socialization is key.
Within independent living, most residents cook meals for themselves. When asked if their mealtime was affected by covid-19, 16% of respondents said it hadn’t. This is likely due to the freedom associated with having a kitchen. However, for those that do take advantage of the dining services, they experienced more major changes. Prior to covid-19, they had access to a full-functioning restaurant where they could make reservations and dress up for events. One of the most beloved dining experiences, however, was the lunch special which consisted of soup, a salad bar, and desert. A resident I interviewed expressed how it was routine for single people to set a time and table during lunch where five or six single friends, men and women, joined every day. After the pandemic hit, this lunch special stopped all food was delivery. Sarah reflected how miserable of a situation it is, saying that people “really, really miss coming together for meals.” In response, residents have tried to get creative: tech savvy people are ordering a lot more meal delivery services, residents eat meals and share drinks in their doorways at the same time.
Prior to covid, assisted living residents had meals on their individual floors. These residents don’t have kitchens in their apartments, so they are more reliant on staff or outside sources. After the hit of covid, assisted now only eat on the main floor as opposed to on all their individual floors. If they opt in to dine on the main floor, the must sign up for a seat and time. It is a matter of whether or not a resident wants to come down. Part of the problem that dining staff are facing is how to make doctor ordered diets, such as pureed, thickened, or no added salt, appetizing to residents, especially when they are being delivered in boxes that migh result in lukewarm food.
Dining staff have had to quickly scramble for new ways of making sure all 500 residents were fed. My culinary interviewee helped explain the new delivery process to me. It all revolves around devices called hot boxes, which are big insulated containers on wheels. They get tickets brought down eg. ‘Mr. Smith wants a hamburger with fries, a salad with Italian dressing, and pie’ then make the orders as they come in. They have trays, hot pellettes, insulated warmers, then the actual food on a warmed plate that all gets covered. Ideally, that food stays warm for an hour and a half while they fill up the rest of the hot box with 15-25 orders. This box, along with cold items and silverware, gets sent up and handed over to the nursing staff. The box waits there for an hour and a half until all the trays are loaded and brought back down. In the words of my interviewee, the process “isn’t by any means the most ideal for anyone involved.”
It is clear after hearing from my interviewees and survey responders that isolation due to covid-19 has impacted residents meals. In the biggest way through lack of social contact, whether with family, friends, or other residents. My resident interviewee shared that the toll of isolation on her neighbors was visible. She noticed a lot of people had really declined sharply and especially those that had family nearby. She then said that there is “…a degree to which isolation is as dangerous as the virus.”
A very tragic fact was revealed to me through an interview that the independent living campus has had suicide. She went on to reflect that covid possibly had something to do with it, due to a sense of depression she acknowledged. This source also shared with me that they have seen an uptick in deaths. But, they’re not covid-19 related at all. “So what is it?” she asked me. This specific exchange was just a small moment in our entire conversation. However, it has stuck in my mind very heavily. There is very clearly a correlation between isolation and rapid decline in health, even death.
It’s been shown that loneliness increases the risk of Alzheimer’s disease, increases unhealthy habits, leads to higher instances of elder abuse, and is as deadly as smoking.1 Technology is just a saving grace if residents have it and if know how to use it. But, that’s not always the case for elderly who either have no desire or no ability to learn the new skill.
Patients are not the only people being negatively affected by this isolation. Family members are experiencing a breakdown of trust in housing systems where their relatives live. As the Executive director put it, family are very cranky because they don’t see what’s going on so they assume the worst. From the staff’s perspective, there is fear. Overall, the environment of stakeholders is fraught with tension and distrust.