Finally Seeing the Emotional Toll of Lockdowns During COVID-19 on Seniors

Having been in my current job for four months now, I have finally begun to see for myself the effects that the lockdowns at the senior living facility where I work have been taking upon the residents.

While I had heard from others in the building when I had first started that the social isolation had caused people to deteriorate more quickly than they previously had been, I just their word for it. However, now it’s something that I am actually seeing for myself.

Sure, keeping residents safe from COVID-19 is a laudable objective, yet keeping them cooped up is not only causing physical deterioration and mental deterioration, but emotional deterioration, as well; and that might be the hardest of the three to witness. My heart breaks for them and their loved ones in these tough times of COVID-19.

I hope the federal and state health authorities can adjust their regulations going forward, because I don’t think this is going away anytime soon.

Death & Dying – Not Always Like TV & Movies

Thursday marked exactly three months of my having been in my current position as a Director of Pastoral Care at a senior living facility and one thing that has struck me is that dying and death are much different here than it is as portrayed on television and movies.

This particularly comes to mind, as a longtime resident breathed her final breath the other night. But her passing was the furthest thing from sudden, as she was not only a centenarien,* but also had been on hospice for over a week, with her octogenarian (octogenarien(?)) daughters having spent all of last week with her and having gotten to say their final goodbyes.

Having a week getting to say one’s goodbyes to one’s parent is something I’ve realized is not uncommon around this place, especially when the person has been placed on hospice. I also recently experienced this with a Holocaust survivor whose daughter said her final goodbye to her and then she was placed on hospice. But then she ended up living another week and a half – she was definitely a fighter.

Whereas it is depicted in television and movies as having a certain sadness around death, especially owing to the shock and suddenness of a loved one’s passing, with an older demographic, it can be far from sudden. To be sure, there is some sadness around the departure from this world for the family, which they mourn, but it is almost more of the finality of it, than necessarily any sense of surprise.

Dying and death can certainly be a long drawn-out process and, as I’ve witnessed, sometimes even family members get impatient with their loved one hanging on for longer than expected. The family members have said their goodbyes multiple times, and then have the opportunity to say them again.

It has been an enlightening first three months, experiencing dying and death, not just for the residents, but also for their family members.

____________________________

 

*Yes, I’m aware the spelling for a man who is 100 years or older is centenarian, but the person under discussion was a woman, so just wanted to be genderly correct.

Opening Up Slightly Provides Noticeable Improvement in Mood [Chaplaincy Chronicles]

Having mentioned previously about the surprise COVID-19 case we had at the senior living facility where I work, I have some follow-up to the story, which is that there’s good news and there’s bad news. The good news was that the case was confined to just one particular resident, and the bad news is that this particular resident passed away, as a public letter on August 4th from the building’s administrator that was sent out to all residents, staff, and families said, “the resident who tested positive for COVID-19 has passed away at a location outside of” the facility. According to this letter, the administrator continues

What I can tell you is that this resident was sent to the hospital for an unrelated COVID-19 illness. They were not showing any signs or symptoms of COVID-19 at the time of their hospitalization. They were then tested at a later date during their hospital stay. Our contract trace testing that was conducted amongst our other residents and employees came back negative for COVID-19.

Following the discovery about that resident testing positive for COVID-19, all of the residents in that resident’s hallway were tested for COVID-19 and had to stay in their rooms for several days until the results came back. It was really unfortunate to see these residents having to stay in their rooms (or, as one resident called them, “their jail cells”), and they certainly weren’t even permitted to leave their residential wing. Morale had dropped precipitously – not only that there had been a COVID-19 case on their wing, but also that they had been told that visitations, the dining hall, and even the salon would be opening up the following week, but, instead, they had to be shut in their rooms for an unknown number of days and have those openings-up cancelled.

Fortunately, all of the remaining residents tested negative for the virus and in-person happenings were rescheduled.

Finally, last week, the facility was able to open up its assisted living dining room, was able to resume assisted living outdoor visitation with family, as well as for the first time in 5 months opening up healthcare family visitation outdoors, and even including some activities here, albeit with social distancing. This was some welcome good news for the residents.

The other week, I was beginning to feel optimistic, as I knew all these things were about to open up, even though no letters had been sent out to families, staff, nor residents, because the last time a letter was sent out, someone got COVID-19 and hopes for staff, residents, and their families had all been dashed, so no letter was sent out in advance of everything reopening. But, the other week, I was getting quite optimistic for the residents, even though there was still quite a down mood across the building amongst the residents. In conversations with residents, I was trying to impart optimism about things opening up, them getting to see a friends, and, after having 5 months of having meals served in Styrofoam containers alone in their rooms, they would be able to be served in a dining hall and getting to see their friends. Yes, I realize that they would be at least six feet apart, it would be hard to hear, be hard to talk, but at the very least they’re not cooped up in their own rooms.

A week and a half ago, I remember speaking with a resident before everything opened back up and she was quite concerned that we would have another COVID-19 case and have to close everything down again, so she didn’t want to get her hopes up about opening up again. Well, thank God, things went ahead – the dining room opened up last week and it was really exciting to see residents coming out and talking to their fellow residents. After these first two-and-a-half months of working at this facility and seeing the residents mostly in their rooms, it was really great for me to see the mood lighten up, as residents got to see their friends and talk to them, no longer needing to be confined to their rooms any longer. Sure, they need to maintain social distancing and face masks are required, but there is a sense of optimism in the air and a noticeable improvement in mood since I began.

I am looking forward to see how the mood continues to improve.

Gleaning Insightful Historical Contexts About Jewish Health-Care Chaplaincy [Chaplaincy Reflection]

Having mentioned previously that I am commonly asked by chaplain colleagues “Have you done CPE?”, I would be interested to engage in CPE training…when they become available to do so, as long as my current job allows me to do so. One thing I came across that I have found helpful for providing an historical context is Robert Tabak’s article, “The Emergence of Jewish Health-Care Chaplaincy: The Professionalization of Spiritual Care”, which appeared in the American Archives Journal (vol. 62, no. 2), on pages 89–109.

Tabak does an intriguingly good job tracing the history of Jewish health-care chaplaincy, which he contextualizes as there being “a long-term trend toward professionalization in a number of areas that were originally avocational” in Jewish life (89). He mentions that while “most professional Jewish chaplains in the United States are rabbis, a significant number are not, including cantors and professionally-trained Jewish lay people” (90).

One of the curious aspects of chaplaincy in America was that “the makeup of CPE, and its professional group, the ACPE, was changing by the 1980s. Established and led by white Protestant males, the field significantly shifted, as many women, Catholics, African Americans, other minorities, and eventually non-Christians entered CPE programs and some became CPE supervisors” (95). However, in 1990, the National Association of Jewish Chaplains (NAJC) was created in 1990 (98-99), which “represents Jewish chaplains and the Jewish community in health care and other wider audiences. It provides a Jewish organization that is a peer with other North American professional pastoral care groups” (101).

One of the interesting aspects is that, in 2003, NAJC

made the designation of CPE as the only recognized clinical path for becoming a Jewish chaplain. In that year, the NAJC and five other North American pastoral care organizations approved joint outlines for procedures for certification, education, and ethics. At the same time, the NAJC became more specific in the training requirements to become a professional member, a stage prior to certification. In earlier years of Jewish chaplaincy and the NAJC, various formats (often social work, but sometimes another area of psychology or marriage and family therapy) were recognized; but beginning in 2003, new chaplains would need at least two units (total eight hundred hours) of CPE as well as rabbinic or other graduate-level Jewish study, to become full voting members of the NAJC, the initial step for professionals. (99)

Certainly my lack of CPE units is something that is a curious hindrance, yet NAJC (which changed its name in 2014 to now stand for Neshama: Association of Jewish Chaplains, in a move to encompass those Jewish chaplains working outside of the US) does currently offer a general membership which does not require having any CPE units under one’s belt.

I was also fascinated by this historical observation:

Since the 1980s, two wider trends have occurred that have affected the field of Jewish chaplaincy. One is the greater societal emphasis on spirituality as well as on ritual aspects of religious life in health care; the other is that the emphasis on spiritual care is also reflected in regulations by accrediting agencies. (96)

Apparently, owing to this emphasis on spiritual care, hospice programs began to be “required to provide pastoral care” (97), which is incredibly helpful context for me working with residents who are currently under hospice care, as to why they have chaplains attached to them. Of course, I think it’s a wonderful offering.

There is much more to say about this article, but I found it a very helpful historical contextualization of my current professional field.

 

 

A Challenge With Developing Relationships [Chaplaincy Reflection]

Working with different generations in different stages in life is, as you can imagine, quite a different experience for a rabbi. Of course, there are similarities, including conversational skills and approachability, amongst others. Yet, having previously worked with those in the Millenial Generation while they were college students [and young adults] is quite different than working with the Silent Generation while in a senior living facility.

While there are perhaps many, many differences, one stands out to me at this moment, which is developing relationships with them. While working with college students and young adults, my ability to develop relationships with the people whom I was serving was considerable, as I would have conversations with them and we would speak and I would learn about them and they would learn about me and we would develop relationships. However, the demographic I am currently serving, residents at a senior living facility, it’s not the case. I can have a conversation with the residents, I learn about them, they learn about me, and the next time I see them, they’re meeting me for the first time, as they don’t remember meeting me and we have to start over. And this can happen multiple times, where every single time I speak with them, they are meeting me for the first time.

In fact, I have even experienced this within a single conversation with a resident who has dementia where they have asked me multiple times within the course of a conversation who I am. We haven’t even departed from the conversation and yet I’m being inquired as to what my name is, who I am, and what what my role is at the senior living facility. This is, as you can imagine, a deeply significant roadblock in developing relationships with the residents. Of course, I can get to know them and understand them and have a relationship with them, but it may not necessarily be reciprocated from there, and they may literally just meet me time over and time again.

This can be embarrassing to me, sometimes, when there’s someone else around and they say, “Oh, I have never met you”, and I feel embarrassed because it makes it seem to the other person as if I have never made the effort to have met this resident before this present moment, when I may have met them a half-dozen times and spoken with them.

And, yes, I acknowledge that part of the challenge is that I began working at this senior living facility amidst the COVID-19 lockdown, so residents may struggle in recognizing me due to me always wearing a surgical mask in their presence, yet, there are not many other people where I work who look much like me (and, yes, I’m one of only a few people in the building wearing a kippah, so that further serves to identify me).

Going forward, it’s certainly a stark contrast to serving this demographic, whose population is in contrast to the previous populations I’ve served. It will be interesting as I continue working with them, and figure out how to navigate these hurdles of developing relationships with them.

[The First] Tisha b’Av During Coronavirus Season

I don’t know what Tisha b’Av is typically like at the senior living facility where I am presently working, but I suspect that this year’s Tisha b’Av was certainly markedly different than any that had preceded it.

In my email to the department heads at the senior living facility at which I work, I mentioned that it was the saddest day on the Jewish calendar and a day in which we are not supposed to be involved in joyous activities. I then made the comment that it’s actually oddly and gloomily easier this year than typical, not only on account of social distancing, but due to our facility not having opened up to small group [and socially-distanced] activities (although the facility was to have opened up already, a surprise Coronavirus case happened at our facility). So, there were no activities at all, which was oddly appropriate for the somberness of the day.

Of course, as programs begin to take place and with social distancing, I’m quite confident that the mood will change amongst the residents, but, for now, it’s been it’s been still quite emotionally gloomy, especially as there had been a resident who recently contracted the virus, so there’s still a great deal of uncertainty moving forward – not only about residents’ physical health, but also their own mental and emotional health going forward.

To make Tisha b’Av even gloomier (on top of the literal gloom, as there was a gray and rainy day (that had broken through the many consecutive sunny days we had been experiencing)), there was even a death of a Holocaust Survivor in the building, which felt sadly appropriate for the day.

In future Tisha b’Avs, there will certainly be much more to deal with, including programming, but, for this year – the first Tisha b’Av in the Coronavirus era – it was gloomily quiet, and that felt uncomfortably appropriate.

Passwords [Chaplaincy Reflection]

Having written previously about technological issues in a broad sense when it comes to the Silent Generation, many of whom make up the generational demographic in senior living facilities, a specific instance of a technological barrier comes in the form of passwords.

Yes, passwords – that staple of contemporary adulting of knowing your login information – usernames and passwords – is a significant challenge to those in the Silent Generation. On the one hand, it is simply a matter of knowing what it is, where you can even track it down, and find such login information. And if someone has some sort of dementia or other memory loss issues, that becomes a further struggle in finding where these are.

I’ve visited residents in the senior living facility where I work and they have tablets, which is really great (since it’s not a common phenomenon for folks here to have such devices), and I mentioned you know getting onto a particular app (e.g. Zoom, Alexa) and they say okay. Yet when I ask them for their log-in information, residents (this has happened at least three times with completely separate residents) have gone to a notebook or Rolodex and looked where they have written these things down and, in these instances, have struggled mightily to find and figure out what their password was.

As mentioned in my earlier post, those in the younger generations – anywhere from Baby Boomers all the way down to Gen Z – tend to know login information, as it is an important part of living in this world. But, for those in the Silent Generation, who really haven’t had much of a need for most of their lives to deal with this accessibility, it’s a real challenge for them. Of course, let’s be honest: it’s been no minor frustration for those of us (myself included) who go and help them out with a very simple task using a particular easy-to-use app and getting something going functionally – whether it’s the Echo Dot or Zoom -and, yet, it takes so long, as these seniors do not know their passwords nor where they have written them down.

This aspect of helping out those living in senior living facilities with accessing technology under COVID-19 health precautions is a fascinating (and, let’s be honest, frustrating) limitation of accessibility for this particular generation, especially in connecting with their loved ones beyond their buildings.

Considering Elders’ Ages in the Thought of Yehudah, son of Tema

In my current position as a chaplain in a senior living facility, I have returned to a familiar text, about which I hadn’t considered a certain section (Avot 5.24):

הוּא הָיָה אוֹמֵר
בֶּן חָמֵשׁ שָׁנִים לַמִּקְרָא
בֶּן עֶשֶׂר לַמִּשְׁנָה
בֶּן שְׁלשׁ עֶשְׂרֵה לַמִּצְוֹת
בֶּן חֲמֵשׁ עֶשְׂרֵה לַתַּלְמוּד
בֶּן שְׁמֹנֶה עֶשְׂרֵה לַחֻפָּה
בֶּן עֶשְׂרִים לִרְדֹּף
בֶּן שְׁלשִׁים לַכֹּחַ
בֶּן אַרְבָּעִים לַבִּינָה
בֶּן חֲמִשִּׁים לָעֵצָה
בֶּן שִׁשִּׁים לַזִּקְנָה
בֶּן שִׁבְעִים לַשֵּׂיבָה
בֶּן שְׁמֹנִים לַגְּבוּרָה
בֶּן תִּשְׁעִים לָשׁוּחַ
בֶּן מֵאָה כְּאִלּוּ מֵת וְעָבַר וּבָטֵל מִן הָעוֹלָם

Yehudah, son of Tema, used to say:
“A boy of five years old to Scriptural study
a boy of ten years old to Mishnah study
a boy of thirteen to commandments
a boy of fifteen to Talmud study
a boy of eighteen to the marriage canopy
a boy of twenty to pursue
a boy of thirty to power
a boy of forty to discernment
a boy of fifty to counsel
a boy of sixty to old age
a boy of seventy to elderliness
a boy of eighty to strength
a boy of ninety to be bent-over
a boy of one hundred is as if he is dead and has passed beyond the world and gone.”

While this androcentric text describes various growth stages in a boy’s/man’s life, mostly in increments of decades, typically, I have seen a lot of written attention on the pedagogic aspects of ages 5, 10, 13, and 15 (and even 18), yet there is still quite a lot more to this statement of Yehudah, son of Tema’s. Indeed, while in recent years, I have been quite curious about 20, 30, 40, and 50, I recently have been thinking about ages 60, 70, 80, 90, and 100 due to my current position working as a chaplain with a senior living facility.

When it comes to 60, the phrase זקנה instantly makes me think of זקן – beard; someone reaching 60 sports a beard, but also seems to advertise their wisdom. Certainly, this seems to bridge the ages of 40 and 50 with their discernment and counsel – more intellectual/wisdom aspects with the ages of 70-100 as describing those on the physical [and mental] decline.

With 70, Yehudah, son of Tema, seems to reference David’s dying at the age of 70, when he died “בשיבה טובה a good old age” (I Chron. 29.28). With 80, Yehudah, son of Tema, seems to be referencing Psalms, which describes the length of our years being 70, but “וְאִ֤ם בִּגְבוּרֹ֨ת ׀ שְׁמ֘וֹנִ֤ים שָׁנָ֗ה eighty years with strength” (Ps. 90.10).

Beyond that, Yehudah, son of Tema recognizes that our frail bodies get physically bent by 90 and might as well be dead and done with this world at 100.

Working with the senior crowd, there is certainly something to be said for observing the physical frailties that come with age. However, one thing I have been surprised by is his observation about reaching 100 – until now, I thought it was somewhat humorous, as in “They might as well be dead; they’re no longer of use to society.”

While that may be true, in speaking with one particular centenarian who mentioned that her eyesight is mostly gone and so is a lot of her hearing and that she is largely done with this world(!), it was so fascinating to hear it from her that she is no longer really part of this world and should be gone by now. I had always thought Yehudah, son of Tema, meant that line as somewhat of a joke, yet hearing it from a centenarian was really quite shocking as to how insightful this statement really is.

As I continue working with these residents, I am curious as to how I will continue to gain more insights from this statement of Yehudah, son of Tema.

Lacking Historical Context: Covid-19 Lockdown as the Baseline for Knowing Residents

Generally, Lacking Historical Context Coming Into a New Situation
One of the interesting limitations of starting at a senior living facility is meeting residents where they are, without any historical context of their mental health, emotional health, or physical health. True, one could talk to people and gain a familiarity with how healthy they were prior to starting in that position, but it is not part the chaplain’s experience with the person at that time.

COVID-19 Lockdown Serving as My Baseline for Understanding and Knowing the Residents
The lack of historical context is something that is all the more curious having begun this chaplaincy amidst the COVID-19 lockdown. One thing I hear about certain residents is how much the lockdown and isolation have exacerbated their dementia. It’s a really tough thing to hear, as they may be able to leave their rooms and perambulate around the grounds of the senior living facility’s campus, but otherwise remain socially isolated (unless they write notes or call friends (or, for the minority of residents, FaceTime or Zoom with family)), mostly either staying in bed all day and/or watching television. Of course, there is widespread depression, which is acutely felt in the assisted living side, less so on the independent living side, and the least felt on the healthcare units, but still noticeable on certain units moreso than other units.

Catalyzing Concerns
Another thing that I had heard was that the rate of death was higher than pre-pandemic – not because any residents had died of COVID-19, but because of the lockdown, stoppage of programming, and the social isolation causing them to worsen. Furthermore, when there is a COVID-19 case on the floor and residents are really not permitted to leave their rooms, much less their unit/floor, then, as one resident put it to me, their rooms are “their cages” or “cells”. I can’t imagine that it helps their situation.

Looking Forward to Post-Lockdown
For me as a chaplain, I don’t have that kind I don’t have the prior context to know how the residents functioned pre-lockdown, as I have only known them in this era, which is my baseline for knowing who they are and how they function. It would be really fascinating for to see when the lockdown is lifted and the Coronavirus is no longer a problem on the horizon to see residents’ mentally, emotionally, and/or physically improve, which would be a really fascinating phenomenon. Until then, of course, there will still be limitations on what takes place in this facility. How much longer the safeguards will be in place and how much further decline in the mental, emotional, and physical health of the residents remain to be seen.

Using Technology in a Senior Living Facility Under COVID-19 Lockdown

Background
Having written previously about the challenges of those in the Silent Generation using wifi-enabled technologies to connect with their loved ones, it was fascinating to have come across an article on using technology in senior living facilities.

Introduction to Relevant Article
Having previously mentioned that I recently purchased and began reading Flourishing in the Later Years: Jewish Pastoral Insights On Senior Residential Care, edited by Rabbi James R. Michaels and Rabbi Cary Kozberg, one article that jumped out to me was Rabbi James R. Michaels’ “Technology to Enhance Religious Life” (pp. 183-190). “In the world of Jewish aging services,” Rabbi Michaels writes, “technology is often employed to make the traditional davenen (praying) and more liberal services more accessible and enjoyable to residents” (p. 183). Specifically, he discusses “some of the techniques Jewish chaplains have employed to enhance Jewish religious and cultural experiences in long-term care settings” (p. 183).

In the article, Rabbi Michaels discusses customizing prayer books, PowerPoint prayers, televised services, televising services from synagogues, using smartphones and wifi, and others, although my mind went straight to the limitations under the current circumstances of operating amidst the COVID-19 lockdown.

Prayer Services?
While the facility where I work does not currently allow for prayer services at this time, hopefully, in the near future, it will begin opening up and allow for them (with social distancing, etc.); nevertheless, the idea of streaming services from within the building is not an option. However, showing services is, as our facility has a dedicated channel for residents, which has technology that permits YouTube videos to be shown, as well as YouTube Live, which can be a great boon for residents wishing to have some sort of prayer service as an entertainment option, even if getting together in a physical space with others to do such activities is not a possibility.

Teaching Classes
One aspect I find that I provide a lot of value with is in teaching/leading classes/discussions and the lockdown does not currently allow for such a possibility. While I hope to be able to teach/lead classes/discussions in the near future in-person with residents, in the meantime, I have begun to utilize Zoom to do so.

In using Zoom, I give the residents a heads-up about the online discussions (for instance, in my weekly Shabbat Newsletter issues, I include a front-page section about it for the following week) with log-in information for the following week’s session. I then record the sessions, edit out any residents who have not provided me with written consent to include them in the video sessions for use online, and then I publish the videos to YouTube, whence they are then able to be broadcast on Friday afternoons for residents to watch on the internal broadcasting channel in the facility.

While this is a great model, the severe challenge is that while numerous residents have spoken to me of their interest in such discussions (the idea actually sprang from a conversation with a couple of residents who were yearning for intellectual and Jewish stimulation amidst months of dulling in the lockdown), the few sessions I have held during this month of July have only had a resident or two participating in the sessions. The reason why is crystal clear: lack of technological know-how. When I mention that accessing the classes is by Zoom, they say they don’t know what that is. Sometimes, they are open to me helping them with it, and sometimes, not. Those in the Silent Generation are struggling to stay connected with the world in the same way that younger generations are able to connect with the world.

Looking Forward
One thing that Rabbi Michaels nails on the head is his assertion that, “As long-term care continues to evolve, technology will probably play an increased role in serving seniors’ religious needs” (p. 190). And, amidst the current global pandemic, this assertion is certainly true. However, there are a couple of challenges.

One challenge is the lack of technology available for seniors. “It seems that a relatively small investment of capital on the local, regional, or national level would allow technology to bring religious services to people in long-term care”, writes Rabbi Michaels, and that “The only limits to this would be the community’s collective will and imagination, providing Jewish religious services for people in long-term care when it might be more significant for them than ever before” (p. 190). A small number of the residents have either computers or tablets, let alone smartphones, although they may mostly not use the various technologies at their disposal for the second challenge.

That second challenge is part lack of know-how, as well as lack of interest. Those in the Silent Generation never needed such technologies in their lives, whether vocationally or even avocationally, and why should they need to learn them now? They also are not used to thinking about navigating apps and connecting with these methods, while telephone calls and television-watching are much more in their way of thinking and living.

Anyways, those are some of my reflections and thoughts with technologies in helping seniors under this lockdown.