COVID-19 complicates nursing home care for Peoria area families

Nov. 8--Growing up in a tiny town, Vera Huffman wanted to see people and places.

She went from a one-room schoolhouse to nursing college, then spent decades mixing a career, family, friends, service and travel. Yet after eight decades of breezy life, ailments struck with a one-two punch.

Dementia slowly faded her over the past thee years. Then the coronavirus attacked with merciless speed.

"When it hit, it hit hard -- and quick," says daughter Rhonda Daum, 58. "In the end, she was just gasping for breath."

Huffman, 81, died Oct. 26 at Heritage Health Therapy & Senior Care in Chillicothe. Before and after she caught the virus, COVID-19 restrictions severely limited her family's ability to interact with her. But all the while, nursing home staffers -- described in her obituary as "caring heroes"-- consistently kept Daum abreast regarding the impact of the coronavirus on the facility and her mother.

"They were always helpful," Daum says.

Communication and education are a challenge for long-term care facilities as COVID-19 surges and spreads locally and nationally. Beyond battling to keep the virus away from residents, staff and administrators at facilities strive to update loved ones -- all the while discerning coronavirus protocols, terminologies, priorities and scenarios that can befuddle even experienced caregivers and administrators.

To get a glimpse of these evolving complexities, the Journal Star contacted 24 long-term care facilities in the Tri-County Area that have had COVID-19 outbreaks. Of those, only one-third responded to a reporter's questions.

Their challenges could become more acute as COVID-19 rages anew. More than 132,700 new cases were announced across the United States on Friday, according to the New York Times. The country also reported more than 1,000 deaths for the fourth straight day.

In late October, the state pushed past a grim milestone: Its 5,000th death in long-term care facilities, assisted living establishments and other congregate-care centers. The spike lifts the COVID-19 death toll tied to nursing homes for the entire pandemic to 5,253 residents, or 52.1% of total Illinois fatalities due to the coronavirus, according to WBEZ-FM.

That ratio is even higher locally. As of Friday, 167 Tri-County Area residents had died after contracting the coronavirus. Of those, 106 lived at assisted-living facilities, accounting for almost two-thirds of area deaths connected to the coronavirus.

The past week, Illinois recorded more than 2,412 cases among residents of long-term care facilities, according to WBEZ-FM. That's the highest one-week count since May 8, when nursing home COVID-19 infections peaked at 4,027, before a decline over the next two months. The daily tally of confirmed infections in the state exceeded 10,000 for the first time Friday.

On Wednesday, Restore Illinois Region 2 -- which includes the counties of Peoria, Tazewell and Woodford -- was moved to Tier 1 restrictions, joining the state's other 10 regions in mitigation measures that include, among other things, a halt to indoor dining at restaurants and bars.

"We are in the middle of a COVID storm that appears to be sweeping the entire nation, and our trajectory is only getting worse," Gov. JB Pritzker warned. "This is far from over."

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Born in 1939, Vera Huffman grew up in the Stark County burg of Duncan, a few miles north of Princeville. Her first eight grades of education came at a one-room schoolhouse before she attended high school in the nearby town of Wyoming. She studied nursing at Methodist Hospital in Peoria before marrying Ronald Huffman in 1959.

As the couple raised three children, she worked as a registered nurse. Their jobs would bring them to Springfield, where she enjoyed serving as a tour guide in her spare time, and Minnesota, where she managed a rehabilitation company before retiring in her mid-50s.

She used her newfound free time in part to make at-home visits to impoverished AIDS patients. But she found plenty of time to travel, often jumping into the couple's small RV and hitting the road.

"She loved to visit family and friends all over the country," says daughter Daum.

Not long after her husband died at age 77 in 2009, Vera Huffman moved back to the Peoria area to be near family. About four years ago, dementia began to creep in. She could no longer live on her own, so she moved in with Daum in Peoria. At first, she enjoyed visits by family and friends. But over time, interactions became a struggle.

"Her words starting going away," her daughter says. "So it was hard for her to visit with people."

She also needed more care than Daum could provide. So, in September 2019, Huffman moved into Heritage Health in Chillicothe. Her daughter and other relatives often would see her at the nursing home, until the coronavirus triggered a shutdown in March.

By that time, Huffman was having trouble using a phone. But Daum says the facility was always available for her calls about her mother.

Keeping relatives in the loop can be tricky during a pandemic. When needing to share pressing COVID-19 information about a resident or facility, staff will phone the individual who has medical power of attorney for a resident.

Sometimes that information does not get relayed to other relatives or friends, yet they might hear rumblings (reliable or not) from social media or word of mouth. At such times, it's not unusual for the Journal Star to get peppered with urgent questions and allegations about a purported outbreak at a particular facility.

In such instances, the public can access outbreak information via a dashboard set up by the Illinois Department of Public Health. By county, the web page tracks facility outbreaks, defined as at least two cases amid staff or residents,. For each facility, the dashboard lists total cases as well as deaths. Outbreaks are classified either as open (there has been an outbreak within the past 28 days) or closed (the last outbreak happened more than 28 days ago).

Dashboard visitors should take heed of the closed/open designation, says Melissa Beaver, vice president of the Bloomington-based Heritage Operations Group, which manages eight long-term care facilities and owns 26, including Heritage Health in Chillicothe.

Recently, she received multiple calls from reporters and others who had looked at the dashboard and spotted nine cases at one of the company's facilities in north-central Illinois. Amid anxious questions, Beaver had to assure them that the outbreak (per the closed designation that callers had missed) had occurred early in the pandemic and was no longer a threat.

Such coronavirus confusion isn't uncommon, Beaver says. It can be a head-spinning task -- for outsiders as well as longtime caregivers -- to wade through layers of available data and protocols. For instance, as Beaver points out, there are the state's 11 mitigation regions (which used to be four), three tiers in mitigation (with the highest being most restrictive), five phases to Restore Illinois (with the highest being least restrictive), three phases regarding outsider access to long-term care facilities and a red-yellow-green coding that defines the prevalence of COVID-19 in a facility.

Not only do facilities need to classify, treat and move patients according to many of those metrics, staffers also have to interpret and distill all that data to provide meaningful information to loved ones.

"Education is one of the biggest challenges," Beaver says.

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Despite an adjustment to moving into a nursing home, Huffman seemed to like her new surroundings. She especially enjoyed paying unannounced visits to fellow residents.

"She was very nosy," her daughter says with a chuckle. "She'd just cruise up and down the hallways in her wheelchair, pop her head into a doorway and start talking."

But at Heritage Health, as with all long-term care facilities, the coronavirus can compromise residents' interactions. At the onset of the pandemic, Apostolic Christian Timber Ridge in Morton shut down its dining room. Meals are a centerpiece for socializing at nursing homes, so in-room meals leave many residents lonely.

"It's very stressful," says Ron Messner, executive director of Apostolic Christian Timber, which has had six COVID-19 cases but no deaths.

When residents get cooped up in their rooms, staffers try to engage them one-on-one. But it's hard to find creative new ideas, day after day, month after month.

"It's just challenging to come up with individual activities," Messner said.

In late October, residents there were thrilled to learn that the dining room would be reopened.

"It was the greatest day here," Messner says.

Under the press of such restrictions and overall pandemic worries, some families remove residents from nursing homes -- or, for the same reasons, are reluctant to admit a loved one, even when short-term care might otherwise be prudent.

"There's a fear of admitting a loved one," says Heritage's Beaver.

Heritage's two Tri-County facilities have been hit by outbreaks, classified as still open. The Chillicothe facility has had 92 cases and seven deaths, while another facility in El Paso has had 40 cases and five deaths. Beaver says the pandemic has squeezed her company financially: The 106 beds in Chillicothe are only 60% full, while the 65 beds in El Paso are only 40% full.

In Peoria, Apostolic Christian Skylines also has faced a slight patient downturn. After an outbreak there in September -- 72 cases, seven deaths -- "several" families withdrew loved ones, says Matt Fyke, the facility's executive director.

"We were concerned how (the outbreak) would affect our name in the community," he said.

But an outbreak can be a simple matter of unfortunate circumstances. Early in the pandemic, Apostolic Christian Skylines followed county and state testing protocol, which starts at an initial test but can require further testing depending on a complex list of factors, some of which are direct (such as a facility outbreak), while others are more subjective (such as a local health department recommendations). Positive tests prompt interaction with the IDPH and county health departments, with a response plan determined by an outbreak's size, community positivity rate and many other aspects.

For the most part, nursing homes rely on federal, state and local protocols to keep residents safe. But early on, Apostolic Christian Skylines decided to test staffers and residents (about 115 in all) twice a week. The cost came to about $30,000 a week, which the facility hopes to recoup from the federal CARES Act and Medicare.

"The biggest thing we tried to do was keep it out of the building," Fyke says.

But, of course, that's not always possible.

* * *

Upon the initial pandemic shutdown at Heritage Health, Vera Huffman became cut off from her family.

Visits there were halted, so phones provided the only access to family and friends. Some residents, often aided by staff, would do FaceTime chats with loved ones. Daum tried that once with her mom, whose dementia was advancing.

"She was confused," Daum says. "We tried to do FaceTime, but she kept holding the phone upside down."

With some residents, health problems and coronavirus concerns can limit them to their rooms. With no visitors allowed in, residents can feel isolated and alone.

"It's like being in solitary confinement," says Gary Mack, spokesman for Generations at Riverview in East Peoria, which has seen 24 cases and four deaths. "The toughest thing (during the pandemic) is to be able to do compassionate-care visits with family."

Eventually over the summer, many nursing homes (relying on the state's metrics) eased restrictions to allow outdoor visits with loved ones, though just two at a time, with everyone required to wear masks. Still, upon a positive test, a resident is moved to a restricted area, sometimes called a COVID-19 wing. Visits are allowed only if a resident's health takes a serious downtown. In such cases, relatives can be clad top to bottom in PPE, what Mack calls a "moon suit."

But that doesn't always turn out well. In one case, an adult daughter put on a moon suit to visit her COVID-infected mother, who also had Alzheimer's disease.

"It really scared her mother," Mack said. "It didn't work."

End-care visits and other difficult situations make Heritage's Beaver marvel at caregivers. Plus, the challenges don't stop at the end of a shift. Some staffers (especially those in COVID-19 wings) don't simply go home and plop onto a couch. First, they carefully remove their work clothes before heading to the laundry and shower -- all the way being careful to avoid contaminating their homes and families.

"All around, it's very hard to navigate," Beaver says. "It's really a challenge. Would you be willing to go in every day and expose yourself, knowing there's an outbreak in the building?"

Daum is also impressed by caregivers, especially those who tended to her mother.

"They took very good care of my mom," she says. "They called every time someone tested positive."

She pauses, thinking back, then adds:

"Finally, one day, it was my mom."

Her mother's positive test occurred about seven weeks ago. Though physically healthy aside from dementia, Huffman quickly crumbled as the virus ravaged her body. She went downhill fast, so much so that staffers suggested Daum make what would be the last visit to see her mom alive -- in the COVID-19 wing, usually off-limits to all outsiders.

So, Daum and her sister, Jo Parker of Peoria, went to the nursing home and clad themselves in PPE from head to toe. The staff repeatedly asked her, just to be sure, "You do know you're going where every (resident) has COVID, don't you?"

Daum and her sister tried to talk to their mom. But she was unresponsive, mostly gasping for air. They just held her hands through protective gloves.

Days later, Huffman died. Her ashes will be buried at the old Stringtown Cemetery, the final resting place of her ancestors, not far from the former site of the one-room schoolhouse of her youth.

Phil Luciano is a Journal Star columnist. He can be reached at pluciano@pjstar.com, facebook.com/philluciano and (309) 686-3155. Follow him on Twitter.com/LucianoPhil.

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