Minnesota’s efforts to protect its most vulnerable residents during the coronavirus pandemic is also having an unintended consequence — the isolation is killing some of them.
“Families are literally watching as their loved ones die of loneliness,” said Kristine Sundberg, executive director of Elder Voice Family Advocates. “We know full well, isolation has a significant impact on both physical and mental well-being.”
Sundberg and other advocates for seniors and vulnerable adults say the recent guidance the state Department of Health released for window and outdoor visits doesn’t go far enough. After more than three months in isolation, long-term care residents desperately need contact with their loved ones, they said.
“So many of our families are just desperate to see their people, especially those with memory issues,” Sundburg said. “We are seeing serious impacts. We need to figure this out. We need to help families get together.”
Three Minnesotans, all in their 90s, who died in early June had “social isolation” listed as a cause of death or contributing factor on their death certificates. Only one of them had tested positive for COVID-19, but all three lived in long-term care facilities that have been ordered to restrict outside visitors to protect residents from the coronavirus.
Stella D. Fadden, 99, and Chester E. Peske, 98, both died June 2 at Copperfield Hill – The Lodge in Robbinsdale. Both were struggling with Alzheimer’s and while only Peske tested positive for COVID-19, the coronavirus was also suspected as a contributing factor in Fadden’s death.
The third fatality, Forest D. Lehman, 90, died June 4 at Ecumen Prairie Hill in St. Peter. Lehman also struggled with Alzheimer’s disease and while he was not suspected to have the coronavirus, “failure to thrive” due to isolation because of COVID-19 restrictions was listed as the chief cause of death.
Family members of the three who died due to social isolation were unable to be reached at press time.
Ashley Fjelstad, who oversees licensing and compliance for Copperfield Hill, said as soon as they learned isolation was listed as a cause of death for two of their residents, they were “very concerned” and immediately contacted Allison Fiedler, the certified practical nurse who certified the residents’ death certificates.
Fjelstad learned that Fiedler determined isolation played a role in the residents’ deaths because they had lost interest in eating and slept constantly after having their routines disturbed during the pandemic.
“We already knew a change in routine is tough, especially for people with dementia,” Fjelstad said, noting that residents still had regular contact with staff, but their interactions with family and other residents was curtailed. “Their daily routine is what was upended, more so than any type of complete isolation.”
State officials said listing “social isolation” as a cause or contributing factor in someone’s death was unusual. They noted that the Centers for Disease Control and Prevention did not recognize social isolation as a cause of death in its vital statistics manual.
Health officials said a search of Minnesota death records did not find other references to social isolation as a cause of death.
“We absolutely know social isolation and emotional disconnectedness is a major health concern in its own right,” said Jan Malcolm, state health commissioner. “The separation that has happened for residents of long-term care facilities and their loved ones is one of the most heartbreaking things about the epidemic.”
Malcolm noted that the state Department of Health recently announced guidelines for visiting long-term care residents at their windows and outside. Window visits became common for some during the pandemic and outdoor visits are the latest step state officials have taken to address seniors in isolation.
Malcolm acknowledged that those types of visits may not be enough for long-term care residents and their families. But health officials warn that further contact comes with inherent risks and they want to do it as safely as possible.
“It is a tricky balance to strike,” Malcolm said.
Dustin Lee, president of Prairie Senior Cottages, agrees it is a tough balance, but he says it can be done. Prairie Senior Cottages has seven locations across rural Minnesota and caters to seniors needing dementia care.
“I do think opening up to visitors will open up exposure,” Lee said, but he added that the risks need to be balanced against the benefits for residents.
Prairie Senior Cottages sites have worked hard to avoid exposing residents to the coronavirus. But Lee says the separation of families is causing trauma for both seniors and their loved ones.
“Untreated trauma leads to long-term health consequences,” he said. “We have to find some kind of balance.”
In addition to window and outdoor visits outlined by the state Department of Health, operators of long-term care facilities and advocates for residents are trying to figure out safe ways for families to visit.
That would likely include separate spaces inside long-term care facilities where families and residents could spend time together. State officials have yet to offer any guidance on how such visits may occur.
Without that kind of contact, advocates fear more residents will die of loneliness.
“They need to listen to families. … This is literally killing people,” Sundburg said.
