GOSHEN — Standing out on one of the columned porches of Evergreen Place at Greencroft, 93-year-old residents Paula and Eli Stoltzfus’s eyes filled with anticipation at seeing their son without a pane of glass between them for the first time since March.
Eric stood on a small lawn near a bench, more than six feet from his parents. They all wore masks and joked that they were already hard of hearing and the masks made it worse.
“They came and surprised me on Father’s Day,” Eli said. But they had to see each other through a window.
And before quarantine, Eric’s family visited them every week.
“We miss him,” Paula said.
The couple has been using Skype for a while because their daughter lives in England. So, they were able to use it seamlessly when the coronavirus put them in lockdown.
At Greencroft and other elder care facilities, residents have been pretty much confined to their rooms. Recently, they’ve been allowed 20-minute walks, but not with other residents.
“We like each other, but enough is enough,” Eli said.
“Even he can be aggravating sometimes,” Paula added.
Before lockdown, Paula spent about 75% of her day outside of her room.
Eli said, “She has to be doing something all the time. I’m lazy.”
“Something useful, not just fooling around,” she interjected.
One of Paula’s hobbies is quilting. Normally, she would quilt on a frame in a hall at Evergreen.
Eric explained that she has a portable frame she can use in her room, but there’s not a lot of room to set it up.
Paula said her living room is more an electronics room with a computer, TV and Eli’s electronic reader.
Eli has lost most of his sight, so having a reader in his room has really helped during lockdown.
The couple lived in Maple Court for 18 years before moving to Evergreen, an assisted living facility, about three years ago. They like to be on the go, so being cooped up for this length of time, has been awful, according to Eli.
“We sit in our room and complain,” Eli said of how they cope with the solitude.
Paula agreed and said they get tired of doing that as well.
Food is another issue. Before lockdown, they could go to the cafeteria and pick from a variety of food. Since the COVID-19 lockdown, they are given just one choice. If they don’t like it, then they don’t eat it.
That said, they are grateful for what Greencroft has done to ensure their safety. The assisted living section has not had a coronavirus case yet.
“We try to feel grateful,” Paula said. But she said she’d really like to walk across 15th Street and get a fresh strawberry from Yoder’s Strawberry Patch.
“We’ll be glad for when it’s all over,” Eric said.
Once it is over, Paula said the first thing she would like to do is go to the grocery store by herself and visit a few of her friends she never gets to see anymore.
Eli wants to get back on his scooter.
“For us, it’s just a treat being here,” Paula said of being on the porch visiting with their son.
Although Greencroft Goshen’s assisted living has not had any COVID-19 cases, the independent living and health care divisions have not been as fortunate.
Independent living has seen five positive cases with four recoveries.
It’s the health care division that the coronavirus has had the most impact. On Friday, Amy Riemke, vice president of marketing, said she was reporting her fourth COVID-19-related death. They have had 17 positive cases, with test results pending on seven people. They have had six recoveries.
The Middlebury campus has independent and assisted living — not the health care portion. Riemke reported that one independent living resident has recovered from COVID-19 and that has been the extent of the virus there.
Those in independent living have always been able to leave, she explained.
Assisted living residents were asked to stay in unless they had to leave for a medical reason. If they do leave, they are then quarantined to their room for two weeks.
Outdoor visitation started two or three weeks ago, she said. They have followed the guidance from the Indiana State Department of Health.
Recommendations from the state to have outside visitation were that a facility had to be free of COVID-19 for 14 days, visits had to be outside, maintain a distance of six feet and the area had to be sanitized.
“So, family members have been able to come over,” Riemke said of assisted living. Greencroft has outdoor areas for people and everyone wears masks, plus the areas are sanitized, she said.
“It’s great for family members to be able to see each other,” she said. And although they cannot hug, they can be together.
She said residents are doing really well with that and being able to socialize has made a difference in their mental health.
“It’s a difficult time,” Riemke said. “It’s stressful for families because they have not been able to visit. They have been able to do window visits.” And in health care, the situation is stressful. But families and residents have been supportive of the measures taken.
State surveyors came in and looked at all of the precautions and procedures Greencroft has in place and were told they were doing everything they should be doing, she said. Twice the state has come in to test all team members, Riemke said. They had their first round last week with 199 tested, and they are in the process of doing another 120.
Riemke said they had some team members who tested positive. Some people had no symptoms and other started to exhibit some symptoms. She added that those with COVID-19 are recovering at home.
“So, we don’t require team members who are sick come to work,” she said. Those who have tested positive but who are not sick are allowed to work in the COVID unit, Riemke said.
Greencroft chose to participate in the emergency family medical leave act so that those who are sick can have two weeks off paid. Greencroft also has critical care pay for team members who are working with those who have tested positive for COVID-19.
“We’ve learned a lot,” Riemke said. “It’s a new virus. Everything we’ve had to do is new.” Although, the components in those new areas are in line with emergency preparedness Greencroft practices.
Colleagues have had to change how they work with residents because there are no group activities or dining. “The thing I’ve been most inspired by is how supportive community and team members have been and the outpouring of support from the Goshen community, like delivering coffee and putting signs up,” she said.
She said the dedication of team members to serve residents with love and caring has been inspiring to her as well.
“That just touched my heart and it gives me hope we will get through this and we’re going to work together,” she said.
Working as a team and personal sacrifice are how Hubbard Hill got through an early crisis with COVID-19.
Barb Kauffman, strategic storyteller at Hubbard Hill, said the facility was in good shape from where they were toward the beginning of the pandemic.
Like Greencroft, Hubbard Hill works on being transparent about coronavirus on campus.
They were the first in the county to come out and state they had residents who tested positive.
It was the journey they went through with those residents, the personal sacrifice staff members made, that helped residents survive the illness, she said.
Kauffman explained the Living Wisdom Center, which is the dementia care facility, had seven or eight residents who were at very high risk of succumbing to COVID-19. A team of seven staff members checked into the Holiday Inn Express across the street from Hubbard Hill, which is located at Ind. 19 and C.R. 24. They stayed 14 days with the quarantined residents. “Every single resident made it through,” Kauffman said. “They jeopardized their own lives.”
Hubbard Hill has had one death over the life of the virus on campus and that was early on. They had 14 residents with the virus, “and to turn that ship around the creek was in no small part due to the effort of that team,” she said.
Containment became key. At the end of the third week of June, they got the final test result to know everyone on campus was COVID free.
“What we’ve learned is that transparency was key in keeping people updated on what was going on,” Kauffman said. “It made family members more comfortable, to be candid.”
She realizes that family members feel frustrated about not seeing their loved one for three months. But starting Friday, Hubbard Hill will be doing outdoor visitation.
Family members can come and have blocks of time with loved ones outside. Social distancing and masks will be required. “At least they can sit across each other for the first time in three months,” she said.
“It’s really starting to have negative clinical impact on residents not being able to see their family,” Kauffman said. “We’re thrilled we are developing this program.”
Communal dining has returned as well. “That’s huge — huge. That’s the social event of the day,” she said. Although it will not be the same as before with only a couple of people per table, the residents will be able to see each other.
The beauty shop can also open up. The staff at the beauty shop have been tested, Kauffman said. They will start taking appointments early next week when the coronavirus test results come back.
Kauffman explained that nurses who are able to cut hair have been filling in in the meantime.
With the state allowing elder care facilities to open up a bit more, there are still serious concerns especially with Elkhart County’s infection rate continuing to increase. “We are very concerned about what’s going on in Elkhart County,” Kauffman said.
”You’re the risk unless you have been tested,” she said. “We know it’s hard.”
And although the small bits of reopening are not ideal, “at least it’s progress,” Kauffman said. “It gives people more hope. We’re happy that we’re doing things that make residents happy that make family members happy.”
COURTYARD HEALTHCARE CENTER
At Courtyard Healthcare Center, Executive Director Brian Cook said one resident tested positive on Memorial Day and has since tested negative. They are waiting on a second test to confirm that. Three staff members also tested positive: one in April, one in May and one June 15.
“Whenever we have a positive test, we have a 14-day quarantine,” he said. That means the outdoor visits also stop for 14 days. They are almost to the end of the 14-day period for this last staff member.
“We have had 255 staff members test negative,” Cook said. And of 58 residents, one tested positive. “It’s a miracle it didn’t spread with one case.”
He said his biggest concern is that while the state of Indiana is decreasing in coronavirus numbers and its guidance is to open up, “Elkhart County is not on that trajectory.”
As the state is looking at eventual indoor visits, Cook said, “I have a lot of fear of doing those things.”
More people can gather, and as they do, the chances of coronavirus spread becomes higher. What the state is seeing is “not our reality here.” The more long-term care facilities open and the more access there is, the more chance the virus has of entering.
One of his nurses who contracted the virus said the only symptom she had was that her taste buds were almost numb. Because as a nurse she recognized the coronavirus-related symptom, she got tested the next morning and her test was positive. It was such a slight change, other people may not have noticed it and been otherwise asymptomatic, he said, adding that if they were going without a mask, they could have been spreading the virus.
“We want so desperately for residents to get back to a normal life,” Cook said. “With all of that comes a little bit more risk and a little bit more risk and a little bit more risk. … We’re battling what residents want and what we’re called to do to protect them.”
As the state puts out its guidelines, elder care facilities have some leeway in compliance, but at some point the state will mandate openings, he explained. Outdoor visits will be mandatory in mid-July, he said.
On Monday, communal dining could begin since they will have been longer than two weeks without a COVID case, but they may hold off for another two weeks.
He would like to see the state consider Elkhart County’s outbreak. The average age of a person at Courtyard is 87 years, and they all have underlying conditions. Those are the most vulnerable to the coronavirus and “those are our people,” he said.
The beauty shop opened Tuesday, people have been able to visit outside and residents can get out of their rooms once or twice a week. “They’re doing OK,” Cook said of the residents. “They, like the rest of us, are ready for this to be over.” They are appreciative, though, he added.
“But it’s got to be hard to look at the same four walls and masked people that aren’t their family,” Cook said.
When outdoor visitation began, they were just beaming, he said. “It infused them with a lot of joy.”
And the state is looking at indoor visitation toward the end of July. “It makes me scared, honestly,” he said. But Courtyard’s staffers are going to be proactive about it, have a plan, meet the standards and make sure it is a safe environment, he said. Until it’s a proven success, Cook said he will continue to be nervous about it. He will also continue to keep residents’ families informed through a daily email or phone call.
“We can’t go on like this forever,” he said. “We’ll make it work. But it’s a little scary.”
Personal protective equipment is in good supply so far at the long-term care facilities. Their directors and staff have been out beating the bushes, finding masks, gowns, gloves and the like. And they are keeping their eye to the future, expecting a second wave of coronavirus in the fall.
“It only takes one screw up and you know it, then it’s game-set-match again,” Kauffman said.
Cook said he has been on top of gathering PPE and they have plenty, but surprisingly the biggest challenge has been gowns. The disposable ones are $4 to $7 each and they go through about 150 a day, so it’s expensive. And the gowns are harder to come by. So, they have gone to reusable gowns that are washed and sanitized. He said they are much more cost effective.
As for their supplies, Cook said they are coming from some nontraditional sources, such as LaVanture Produces in Elkhart, which supplied them with 7,000 N95 masks, or Calderon Textiles of Indianapolis for linens.
Three to four hours of his day is spent looking for PPE, Cook said. “It’s a big task right now, where it never really was before.”
Whereas before it cost Courtyard $1,000 a month for PPE, now they are spending $18,000 to $20,000 per month. “Our costs have just gone through the roof,” he said.