Nursing homes have been disproportionately affected by the coronavirus pandemic. In part, that’s because elderly residents are at a higher risk of developing complications from the disease than other age groups. But it may also be because nursing home staff often have a hard time getting personal protective equipment (PPE). What’s more, some hospitals and healthcare facilities (especially in some U.S. states) without enough beds to house the sudden influx of coronavirus patients sent infected people into nursing homes.
The loss has been tremendous. The New York Times reported that a third of all coronavirus deaths in the U.S. occurred in nursing homes and long-term care facilities. Here in Canada, 81% of COVID-19 deaths are in long-term care facilities. We checked in with Amanda Clears, 30, a creative arts therapist at a nursing home in New York City, who has continued to work through the pandemic. She opened up about what she’s going through right now as an essential worker taking care of elderly residents.
Refinery29: What did a day in your life as a creative arts therapist look like before the pandemic?
Amanda Clears: "As a creative arts therapist, we wear many different hats. Normally, I would be a part of the interdisciplinary team and oversee the care of many residents in our facility. I work with families. So during the day I might be in and out of meetings, I might be running some creative arts programming on various floors, I might be with the residents holding certain classes throughout the day, things like that."
What does your day to day look like now?
"Everything has changed. Everything changes from day to day. I guess initially, the first thing really that changed was we weren't allowing any visitors to enter the property. Family members and loved ones weren't allowed to visit residents. From there, the quarantine process continued. One floor would get infected, so we would quarantine that floor. That continued until there were no floors not on quarantine.
“All of our community programs are cancelled because we can't have residents in large numbers together. Now, my job as a creative arts therapist — aside from the creative arts and connecting with people through creative arts — is really to continue to boost morale, continue to embrace and foster connection with residents, and essentially just be one of those people who holds the emotions of the community. We try and do that in many different ways. We might visit residents throughout the day in their rooms, and we might help residents connect with their loved ones via FaceTime."
How have your residents been reacting to the pandemic?
"The residents at our facility have a wide range of cognitive and physical capacities. They call that 'the continuum of care.’ Some residents who have been through the Holocaust and find this to be nothing. Others are incredibly frightened for their safety and for their loved ones. Some have no idea what's going on because they might be advanced in their dementia.
“I'm a big believer in a collective spirit, I guess you can call it, where — especially in a facility like ours — there's just this collective sense of something going on, like this undertone of fear. I think all humans, regardless of cognitive capacity, have the capacity to feel that. It affects everyone.
Nursing homes have been hit especially hard by coronavirus. What’s it been like to work somewhere that’s so vulnerable, and that’s been experiencing so much loss?
“One of the things that was most striking about this experience, I think, has been the silence. I was just wondering if it’s the same in hospitals. The overwhelming silence. And what does silence mean? It means the absence of life.
“The whole experience is one of incredible loss, of incredible grief. I’ve never experienced trauma on such a scale. This is our residents’ home. I’ve been here for several years and really developed very meaningful relationships with them and their families, and I loved them very much. Loss, of course, is a part of working in a nursing facility. But it’s 10 times more than before. I walk into work every day, and feel so fearful to see who has passed.
“It's just an immense amount of grief that, for the time being, has to be placed on the shelf in order to survive. If I allowed myself to fully feel the immense grief that I feel for each resident that has passed, I would not be able to wake up in the morning. I’m just trusting that in the future, I'll be given time to properly process this experience.
“But I’d also say, any loss is hard. Any loss is difficult. The whole world is experiencing that loss right now. I don’t feel that it’s singular to where I work, specifically.”
What are some things you wished people knew about nursing homes right now?
"I think that the aides, the nurses, and the certified nursing assistants are amazing. I really admire them. I’m in awe of their bravery. We've lost staff. Staff have died. In the beginning we were really lacking when it came to PPE.
“The people in my department as well, are the unsung heroes of this fight. I think in general they're overlooked, but particularly now."
Have you had any experiences that have helped you keep going, or brought you hope, throughout the day?
"Watching residents talk to their loved ones. There was a woman who was speaking to her husband over FaceTime, and she ended up hugging the iPad. The most beautiful things in life are when we are able to connect with each other in a time of isolation, in a time of quarantine, in a time of apartness. Any glimpse of togetherness, of community, of connection, are bright spots. When I'm talking to residents who I love dearly just having regular conversations.
“Celebrating residents’ birthdays is great too. We'll have one of our in-house musicians be there, and we'll sing “Happy Birthday.” We might have their children or loved ones on the iPads singing them “Happy Birthday.” Any situation in which we can connect, even if it's for five seconds — which is the case with people with advanced dementia to begin with — is fulfilling enough to get me through my day and to give me a desire to come back tomorrow.”
Have you received any support that you've particularly appreciated?
“Personally, I am very lucky to have an incredible personal network of support. But the only thing anybody can really do is just provide hope and support, as you would a friend who's going through any difficult, tragic experience.
“I can't cure coronavirus. I can't cure Alzheimer's. On a daily basis, there has to come a massive amount of acceptance around that. The only thing that I can do, which I'm doing right now and I try to do every day in my professional and personal life, is to hold space for somebody else's pain, frustration, fear, and grief.
“That's really all anybody can ask for during these times. From the outside world, I've felt a lot of love.”
How have you been keeping yourself safe from coronavirus?
“We just recently started to have the proper amount of PPE but people are still kind of scrambling around and really working themselves to the ground to provide these things for us.
“It's been really hard for me personally because I’m very affectionate. Working with older adults, touch is very important for them and not being able to hug them or hold their hands has been very difficult. Touch really is the best medicine, aside from laughter.
“At work, they encouraged us to spread out our offices throughout the facility so that we weren't overcrowding. I really appreciate that. I'm definitely isolated at work, but I'm so grateful for that space because it makes me feel safe. They clean the facility all day long. I personally don't feel like I'm in danger.
“Emotionally, I'm a bit of an isolator to begin with. The only cure for isolation is connection. And I've been just trying my best to stay connected with everyone who's in my support network, whether that means Mother's Day over Zoom or Zoom meetings with my friends. That's really the only way that I can get through this.
“When this first started, I was really thinking a lot about 9/11. I'm a native New Yorker and I remember I was in sixth grade when the first plane hit. When something like that happens, there's an external thing that we can all look at and direct our anger towards, but at the same time, we can all hold hands and literally walk through it together. And this being something that we cannot see, and this being something that’s forcing us apart, has made this incredibly difficult. How can I stay emotionally connected to others without allowing those feelings of grief or frustration or fear overpower me? I sleep a lot on my days off [laughs].
“We are all in this together, even though at times it might not seem this way. I really believe that everybody is doing their best.”