Rural counties such as Crawford and Vernon counties, have had to pivot in order to be able to provide crucial services to seniors who live by themselves since the onset of the COVID-19 pandemic. 

Nursing homes in these rural counties, which have grabbed national headlines for infections and deaths elsewhere, have done very well. 

According to Wisconsin Department of Health Services records, Crawford County had only one outbreak investigation in a long-term care facility, and Vernon County has had none.

“Early on, a nursing home in Prairie du Chien did have one positive test, and that individual was quarantined and recovered,” Crawford County Public Health Director Cindy Riniker said. “The positive test did cause a facility outbreak investigation, which lasted for 28 days with no further positive tests, and ended on June 23.”

Riniker said that the county’s other nursing home, Soldiers Grove Health Services, has had no positive tests.

“Nursing homes in the county are doing a very good job with basic hygiene measures, such as frequent handwashing and wearing of facemasks,” Riniker said. “However, nursing home staff should be tested every two weeks, but that is not currently possible because of a lack of testing supplies and statewide lab capacity.”

Brandon Larson of Vernon County Emergency Management confirmed that there have been no outbreaks or investigations in any of Vernon County’s three nursing homes.

“I think the reason for that is that all of the facilities were locked down right away after the ‘Safer at Home’ order was announced,” Larson said. “They have remained closed to all but staff since that time, and they’re doing a really good job.”

Larson said that all of the facilities have followed the lead of the county-owned facility Vernon Manor, requiring temperature checks for all staff upon entering or leaving the building. In addition, like the facilities in Crawford County, staff are following recommendations for increased handwashing and the wearing of masks.

On Wednesday, July 22, the U.S. Department of Health and Human Services announced that they were approving $5 billion to help protect residents and caregivers at long-term and assisted living care facilities.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes and assisted living communities across the country that provide care to approximately five million people each year, released the following statement after the HHS announcement:

“Overall nursing homes are making progress as data shows that new cases are down; however, the growing number of new COVID cases in states across the country is very concerning, which is why continued support is vital to helping long term care facilities keep this virus out of our buildings.”

“With the recent major spikes of COVID cases throughout the nation and recent independent research showing the level of COVID cases in the surrounding community serving as the top factor in outbreaks in long term care facilities, conducting more testing with reliable and rapid results is paramount.” 

Homebound seniors

While nursing homes in Crawford and Vernon counties have done quite well in comparison to facilities in larger, metropolitan areas, social isolation and food insecurity issues for homebound seniors in rural areas is a much harder situation to address.

In their June 11, 2020 statement to the U.S. Senate Special Committee on Aging, Meals on Wheels America provided the following introduction:

“The coronavirus pandemic has a disproportionate and devastating effect on seniors, with eight out of ten deaths caused by the virus occurring in adults age 65 and older.”

In addition to being more vulnerable to the health impacts of the pandemic, seniors – especially those living alone in rural areas, are particularly vulnerable to the impacts of social isolation and lack of caregiver services, combined with increased risk of food insecurity.

“As greater awareness of social isolation and its negative effects on physical and mental health have emerged in recent months, it is important to note that older adults in particular – especially those who were already homebound and/or living in rural areas – have long been at higher risk of isolation and loneliness and have unique challenges maintaining community connections. Before COVID-19, 43 percent of seniors age 60 and older reported feeling lonely and 34 percent lived alone.”

AARP guidance

The American Association of Retired Persons (AARP) released guidance on how to combat social isolation and loneliness in older adults during COVID-19 entitled ‘How to Fight the Social Isolation of Coronavirus and Seven Ways to Cope With Anxiety During the Coronavirus Outbreak.’

According to the AARP, Steps to address negative effects of social isolation include:

• Develop a plan to connect with family, friends or loved ones: Talk to family and friends to develop a plan to safely stay in touch during social distancing. This is especially important for people living alone.

• Limit news consumption: Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.

• Care for living things: Caring for pets or plants provides a sense of purpose and improved health.

• Take care of your body: Physical activity such as walking or light stretching helps calm tension; eat healthy, well-balanced meals, and avoid alcohol and drug abuse. It is also important to get adequate sleep.

• Listen to music, find activities that bring joy: Beyond the music and activities available in the common living area shared by residents there are music events and activities online, such as free livestreamed concerts. National Public Radio is maintaining a list of Live Virtual Concerts.

• Keep your mind active: Completing puzzles (e.g., jigsaw, crossword, sudoku), reading, and engaging in art projects helps to keep the mind occupied and can improve cognitive functioning.

• Use calming techniques: Such as deep breathing, stretching, meditation, prayer, taking a warm bath or shower, or sitting with a pet.

• Find ways to laugh: Watch a TV show, or chat with a friend or family member who brings joy.

• Create short personal videos that can be shared between family and loved ones and the older adult.

Caregiver shortage

Crawford County Aging and Disability Resource Center Executive Director Roby Fuller discussed some of the factors impacting seniors and their families during the pandemic.

“There is a severe shortage of in-home caregivers right now, and that is impacting the assistance that ‘natural’ or family caregivers receive in caring for their senior family members,” Fuller explained. “Not only is there a shortage, but seniors and their families are increasingly concerned about coming into contact with individuals outside their families.”

Fuller said that prior to the pandemic, the lack of caregivers was already recognized. For that reason, Governor Evers had established a special committee on the lack of in-home caregivers. She said that those issues have only increased.

“ADRC staff makes phone calls to homebound seniors to assess their situation and provide some interaction,” Fuller explained. “But even these efforts aren’t enough by themselves to bridge the gap, though they can help to pinpoint where problems may be developing.”

Fuller said that families previously receiving support are now less willing to allow caregivers into their homes.

“Because of COVID-19, there has been an increased reliance on ‘natural’ or family caregivers, and this is taking a toll and causing burnout,” Fuller explained. “Those family caregivers were previously receiving support in the form of bathing assistance, shopping, cleaning, and social interaction.”

Fuller said that ADRC can access programs that will pay for caregivers, but the lack of people interested in providing the services continues to be a barrier.

“The caregiving companies that provide these services simply don’t have the amount of staff needed available,” Fuller said. “We can help, but if there’s no staff available, it’s a moot point.”

Fuller also pointed out that there is still available placement opportunities in the county’s nursing homes. One issue, though, is that an automatic quarantine is required before a new placement can be made.

Food security

In their statement made to the U.S. Senate Committee on Aging, the Meals on Wheels statement went on to specify that one of the most concerning impacts of the pandemic on seniors, besides the threat of illness or death, is food insecurity.

With COVID-19, scores of additional seniors became at risk of food insecurity and social isolation in a relatively short amount of time. 

“A survey commissioned by Meals on Wheels America found that over half of Meals on Wheels programs surveyed reported that their existing waiting lists have grown by 26 percent on average, since concerns of COVID-19, and efforts to employ social distancing began, with most programs reporting that waiting lists have at least doubled. Survey results also indicated that new requests for Meals on Wheels services have increased for nearly all programs over the same timeframe, and as a result, programs are serving on average 56 percent more meals and 22 percent more seniors each week.” 

“Challenges to service provision have included widespread closure of congregate nutrition sites and shifting of community lunches to drive-through or grab-and-go meals and grocery pick-ups, moving congregate clients to home-delivered meal programs, increased food and transportation costs and drastic increased need for Personal Protective Equipment (PPE) and other supplies necessary to maintain sanitation, which, like certain food supplies, can be cost prohibitive and challenging to procure.”

Senior nutrition meal delivery sites in both counties have been closed for dine-in service since the beginning of the pandemic. They are both offering carryout service, as well and home meal delivery.

“The Crawford County meal sites in Soldiers Grove, Prairie du Chien and Eastman remain closed at this time, but carryout is available,” Fuller said. “According to Cindy Riniker at Public Health, it seems likely that those sites will remain closed for dine-in service through the end of the year.”

Vernon County operates senior meal sites in Coon Valley, DeSoto, Hillsboro, LaFarge, Readstown, Viroqua and Westby. Like the Crawford County sites, the Vernon County sites have been closed for dine-in service, but have offered carryout and home delivered meals.

A June 4 note from Vernon County ADRC Unit Director Tricia Clements said the following about the agency’s services now and for the forseeable future:

“Our senior nutrition program continues to provide meals for those in the community.  Congregate sites remain closed, and meals are served through a carryout meal or a home-delivered meal. The question we continue to get is where do we go from here? Two of the most asked questions are will things remain status quo or will congregate sites open up?  At this time, sites will continue to remain closed. Guidance from the Vernon County Health Department is for people to stay at home as much as possible, and to minimize physical contact with anyone outside of your household. If you have contact with others, it is recommended to maintain six feet of distance between yourself and others. We are unable to open up the sites at this time while complying with these recommendations, but are constantly re-evaluating the status. Our responsibility is to provide a safe setting for those over the age of 60 to have a healthy meal and to have the opportunity to socialize with others.  We will follow the guidelines of our Health Department and recommendations of the State. As changes happen, we will communicate the changes to our staff and the public.”

Crawford County’s Fuller said that ADRC is mailing information to home-delivered meal recipients, making more phone calls to check in with recipients, and distributing information with carryout meals as well.

“Carryout is a popular option, and even with meal sites closed, our meal delivery services are up by eight percent,” Fuller said. “Carryout was against the rules for meal sites in the past, but has been allowed during the pandemic. Given its popularity, we are hopeful that this may become a permanent feature through changes in the rules.”

While carryout may be popular, Fuller said ADRC staff looks forward to the day when the meal sites can reopen as well.