MUNCIE, Ind. (AP) — More than most, Anna Shoemaker, 101, has adapted to changes brought on by national turmoil.
Growing up on a farm, the Dunkirk native survived the Dust Bowl and dozens of other widespread natural disasters. She lived through the Great Depression and witnessed the escalation of World War II, a conflict that would take the life of one of her brothers.
In an echo of her present circumstances, she recalls the dread brought on by seasonal polio outbreaks, which shuttered movie theaters, pools, bowling alleys, playgrounds and other sites of recreation.
But Shoemaker said, in her century of life, she’s never experienced anything like the isolation necessitated by the COVID-19 pandemic.
“There’s nothing like COVID. It’s very unusual and difficult,” Shoemaker said. “There were some similar things with this and the polio scare, but not to this extent.”
Shoemaker, who is mother to two daughters and has three grandchildren and four great-grandchildren, is described by her family as being “extremely” social.
It’s a fact that made her daughter and son-in-law’s recent in-person visit to her long-term care facility, Westminster Village, after nearly a year of quarantine, all the more momentous.
Carol and Jim Haler, prior to COVID-19, were accustomed to visiting with her mother at the facility multiple times per week. Despite their multiple phone conversations each day, Carol said, the forced solitude of the last year took a toll on her normally vivacious and “stubborn” mother.
“I don’t want to say it, but I think she went downhill without having that social aspect,” Haler said. “She thoroughly misses not being able to eat with her friends in the dining area or just sit with them and chat.”
Carol said the closest she’s physically been to her mother in the last year was during the three times she was taken to the hospital for heart issues, where Carol and Jim would wave to her as Shoemaker was wheeled back to her residence.
“That was probably the hardest thing, not being able to care for her when she was having health issues,” Carol said.
Wellness has always been important to Shoemaker, whose late husband of 66 years, John Shoemaker, was a pharmacist on the Indiana State Board of Health.
Her daily exercise routine upended by the pandemic, Shoemaker recently opted to leave her wheelchair and shuffle down the lengthy hall that winds from her apartment to Westminster’s lobby for that long-awaited hug from her daughter.
“We were fortunate to be able to talk on the phone, but it’s just not the same as this,” Shoemaker said.
The face-to-face meeting wasn’t the only critical return to normalcy for Shoemaker. Recently, she was finally able to schedule an appointment at the nursing home’s reopened beauty salon where she gets her hair shampooed and styled each week.
“Oh, I was very, very excited about that.” Shoemaker said.
Limited visitation and the restoration of some amenities at Westminster were made feasible by the state’s rollout of COVID-19 vaccinations. Indiana State Department of Health statistics indicate around 15% of the state’s population has been fully vaccinated.
Shoemaker received her final vaccination, along with most other Westminster residents, on March 8. Carol and Jim waited two weeks after they were vaccinated to visit her nursing home.
Vice President of Westminster Village Mary Crutcher said the ability to reunify nursing home residents with their families couldn’t have come soon enough.
“We did have some residents who were deeply affected by not being able to have visitors,” Crutcher said. “We did absolutely everything we could. We’re blessed that we have two social workers, four activity organizers and a chaplain to help out.”
Crutcher said loneliness was particularly acute for some residents on holidays and birthdays.
“We’d try to make those days as special as we could for them with social distancing,” Crutcher said. “And we emphasized greeting and interacting with residents as much as possible when they would do things like pick up their meals in the commons.”
“Loneliness” as a psychological condition has been examined extensively since the 1970s. Two years before COVID-19 obligated solitude among nursing home residents, loneliness already was characterized as a mental health “epidemic” among older adults by researchers.
A pre-COVID study by the University of California, San Francisco, revealed more than 40% of Americans age 65 or older reported regular feelings of loneliness.
More than just negative feelings, loneliness, like other mental health conditions, comes with a myriad of physical consequences. Multiple studies indicate it contributes to depression, anxiety, cognitive decline and even accelerates the progression of Alzheimer’s disease.
An analysis presented to the American Psychological Association in 2017 by Julianne Holt-Lunstad, professor of psychology and neuroscience at Brigham Young University, showed loneliness was at least as damaging to health as obesity in terms of causing premature death.
While the effects of COVID-19 isolation on mental health remains inestimable, the fact that, like Shoemaker, most of the 1.4 million people living in nursing homes in the United States spent the last year in strict quarantine is troubling to health-care workers.
Crutcher said it’s vital to the well-being of nursing home residents that we find ways to keep them socially connected to the larger community, even in times of crisis.
“Socializing is really something that needs to be emphasized in long-term care,” Crutcher said.
Blindsided by the rapid spread of the pandemic, nursing homes nationwide had little recourse but to severely limit visitation and other social activities.
While nursing home residents represent only 0.62% of the U.S. population, they account for 42% of the nearly 560,000 COVID-19 related deaths, according to a study conducted for the Foundation for Research on Equal Opportunity.
The ISDH counted 6,180 long-term care facility deaths from COVID-19 in the state, with around 115 such deaths occurring in Delaware County.
In Indiana, nursing home infection rates became severe enough that Gov. Eric Holcomb redirected the National Guard in October from food bank distribution to aiding staff at long-term care facilities.
At Westminster, infection rates have been relatively low. Crutcher said the first of a total of 14 COVID-19 infections was detected in October. Of those 14 infected, 12 recovered and two died from the disease.
“We have great employees, followed all the guidance from the state and we were very careful,” Crutcher said. “But health-care workers have been through a lot of hard times this year and we always say we don’t throw stones in these situations.”
Through contact tracing, Crutcher said they determined none of the 14 infections detected at Westminster originated from inside the facility.
“Part of it was we were as safe as possible,” Crutcher said. “But I’ll tell you, we read from the book ‘Jesus Calling’ at every meeting and just prayed for a hedge of protection around us.”
A few months into the pandemic, Shoemaker said she was able to see her great-grandchildren through the window of her apartment during a brief visit.
“Oh yeah that was exciting,” Shoemaker said. “But with the six feet and my eyes getting worse I could just hear them and kind of make out the shapes.”
Tragically, Shoemaker’s sister, who was in her early 90s, died last year in a Fort Wayne nursing home from complications likely stemming from COVID-19.
Carol said with her aunt’s death and her mother’s vulnerability to the disease — and Shoemaker’s status as an adamant “rule follower” — Shoemaker took charge in getting the family to follow COVID-19 protocol.
“None of us like the distance. We’re a hugging family,” Carol said. “She wanted to see us, but at the same time she would be the one to tell us to stay away so we weren’t risking anything.”
Shoemaker said she doesn’t want health concerns getting in the way of any upcoming plans. Her other daughter, Kay Neher, is planning to travel from Florida to join other family members in celebrating Shoemaker’s 102nd birthday.
“I’m really blessed, I never believed I would live this long,” Shoemaker said. “I’m trying not to let COVID mess that up.”