From clowning to caroling: Idahoans rally to show nursing home residents that they matter

Red noses strategically placed above masks. Sock-covered six-foot social distancing batons. “We love you” signs. This is clowning in the time of coronavirus.

Residents at the Life Care Center of Treasure Valley nursing home in Boise discovered these unusual — but necessary —measures when a group of clowns arrived at their windows for an unconventional performance Aug. 29.

Hand puppets in tow, a cohort of members from the Clowns of Idaho broke into small groups that paraded around the perimeter of the facility for an hour, performing skits, jump roping and hula hooping for residents who peered out from 90 windows.

“We didn’t want COVID to stop us from bringing smiles and laughs to the people who need it most,” said Robert Franklin, who also goes by “Pop Tart the Clown,” and organized the window performance.

While the clowns always seek to be “ambassadors of joy,” as Franklin put it, the fallout of COVID-19 has made their role even more important. With nursing home visitation paused under Ada County’s Stage 3 order, Idahoans like Franklin are finding creative ways to entertain and comfort nursing home residents cut off from physical contact with friends and family.

As the pandemic stretches on, nursing home residents remain uniquely vulnerable to the effects of social isolation.

Social isolation and loneliness are associated with accelerated dementia, heart disease, and other health problems, according to a February report by the National Academies of Sciences, Engineering and Medicine. The report — sponsored by the AARP Foundation — said that social isolation presents a “major risk” for premature mortality.

Meanwhile, Idaho’s nursing homes, assisted livings and retirement communities are getting creative. With the heightened risk of coronavirus outbreaks, long-term care facilities must strike a challenging balance: run a tight and sanitary ship, while finding ways to lift the spirits of their residents during what can feel like an endless pandemic.

‘These are the people that raised us’

The Clowns of Idaho used to perform frequently at nursing homes, but when the pandemic hit, they canceled all their upcoming performances and began meeting over Zoom. After hearing that clown groups across the country were performing outside the windows of nursing homes, the group decided to take on the challenge.

They met in a park for a socially distanced practice session before taking their performance to Life Care.

“We did have to adapt to new circumstances,” Franklin said before the performance. “Our mouths are going to be covered with masks, so we’ve practiced being extra expressive with our eyes.”

Jane Gunter, another clown, said her goal in partaking in the performance was to bring some relief to residents who have been “stuck” in their facilities since March, scarcely able to see family members in person.

“It’s such a little thing that we can do to bring them some sense of joy,” she said.

Jake Alger, a member of Calvary Boise who used to visit regularly with the residents of Creekside Transitional Care & Rehabilitation, a nursing home in Meridian, was similarly mobilized by the pandemic.

“We asked, how can we still serve people that are now cut off from the world?” Alger said. “We had to get creative and figure out how to use the tools available to still serve people.”

Alger determined that screens might not be the most accessible form of outreach to residents, so he decided to shift his operation outside. Over the last month, Alger has organized two events bringing families from his church to the windows of residents at Creekside.

Once there, the group roves around the facility in socially distanced pods, the children hanging art on residents’ windows and singing hymns. At the events, Alger said, he recognized several of the residents, some of whom yelled “thank you” through the glass.

“A lot of times it’s easy to consider these people to be part of their own community,” Alger said. “But these are the people that raised us and raised our parents. We have to continue pouring love and attention into them.”

Gone fishin’ at Idaho nursing homes

Community support for nursing homes isn’t limited to clowning and caroling — a portable fishing pond is making its way around Treasure Valley nursing homes, thanks to a new initiative run by two Treasure Valley community members, Brandie Thomson and Roy Gilbert. Using equipment donations from the community— fish from the Schwartz Sturgeon Pond in Parma, tanks from High Country Plastics and Roto Mold in Caldwell, bait from AAA Bait in Caldwell, and Gilbert’s own fishing rods — the operation comes at no cost to nursing homes.

Gilbert, who works for Red Rock Pharmacy in Meridian, transports the fish between nursing homes in a tank set on a trailer. To assemble the operation, he runs a water pump between his trailer and a plastic pool of fish on the ground, around which residents sit.

Residents catch and release the fish with barbless hooks. There’s also a viewing tank with catfish, bass, bluegill, and the occasional turtle. At the end of the week, Gilbert returns the fish to Jim Schwartz’s sturgeon pond and collects new ones.

The trailer stopped by seven nursing homes just last week. Thomson, who works for Treasure Valley Hospice, has begun fundraising for continued operations, and a Facebook fundraiser started Aug. 28 had received nearly $800 dollars as of Sept. 2.

“We know kind of what we’re doing now, so we’re going to be masters of this pretty soon,” said Thomson. “We’re going to continue this project moving forward into the spring and summer.”

Gilbert and Thomson said that they’ve heard residents suffering from memory loss and dementia lucidly recall fishing stories from their youth.

Alger emphasized that creative programming can help make residents feel seen.

“Whether you’re young or old right now, it’s easy to feel like you’ve been forgotten because you’re home more and you’re not getting together with people as much,” he said. “ We don’t want anybody to feel like they’re forgotten, no matter what age they are.”

‘We’re doing everything we can to keep them busy’

Tammy Macklin, activities director at Life Care Center of Boise, is pulling out all the stops. Before the pandemic, residents at Life Care Boise could expect eight to 12 daily activities. Now, Macklin said, the nursing home offers 44 activities a day.

Under Macklin’s direction, staff members have placed easels in the rooms of residents who like to paint. Each resident has been tasked with decorating a square of a “COVID quilt.” Activity staff have dressed up like dinosaurs for “theme days.” Last month, the facility held “Christmas in July,” featuring Macklin as Santa Claus. “Takeout night,” where residents vote for the food of their choice — usually Chinese — is especially popular.

The facility has scheduled musical performances in the courtyard that residents’ rooms overlook. Employees teach residents to use smartphones and iPads, assist residents with video and phone calls, organize window visits with residents’ families and offer one on one activities.

When a resident said he wanted a prime rib for his birthday dinner, Macklin called around to restaurants in the area and found one. When a resident told Macklin that more than anything, she just wanted a hug, Macklin — who said her workdays generally stretch to 10 or 12 hours — spent her weekend searching online for a huggable teddy bear.

“Depression is a big concern,” Macklin said. “They’re not able to see their family, so we make sure to check up on them at least three times a day for a little bit of socializing. Even just talking with them for a few minutes goes such a long way for people starving for a little bit of human contact.”

In an email to the Statesman, Macklin wrote that staff “sit with the residents and hold their hands when they are crying, because they have not been able to be with their families.”

The continuous pressure to come up with new ways to keep residents busy and ward off depression is a challenge, Macklin said. The pandemic has taken a toll on residents, and on the health care workers who spend hours at their side. More than 200 of Idaho’s COVID-19 deaths were among people at care facilities, according to Idaho Department of Health and Welfare records.

Life Care Center of Boise had 75 cases of COVID-19 among staff and residents, and eight deaths, since the pandemic began. Macklin said her son and his Boy Scout troop play “taps” — the traditional U.S. military funeral bugle call — whenever a resident veteran dies.

“Who would have thought we’d still be doing this six or seven months later?” Macklin asked. “This is where life enrichment directors and activity directors across the country are all at right now. ... A lot of us are running out of ideas ... we’re doing everything we can to keep them busy.”

Combatting ‘COVID fatigue’

Shannon Skidmore is general manager of two facilities in Boise — retirement community Garden Plaza of Valley View and assisted living facility The Bridge at Valley View.

She started the job March 2. Eleven days later, Idaho had its first case of COVID-19 and soon went into shutdown mode.

As the coronavirus made its way into care facilities across the state, Skidmore says her company and staff worked to protect residents even as they — the residents and staff alike — have battled “COVID fatigue.”

The Bridge has 48 residents and about 25 staff members. Garden Plaza has 94 residents and about 75 staff members. No residents have been infected, she said. Five staff members at The Bridge have tested positive, but strict protocols kept them from spreading the virus, Skidmore said.

“Right around March 14, we started doing guarded isolation with residents,” Skidmore said.

They turned communal breakfasts into staggered meals in a spread-out dining room. They turned group activities into socially distanced outdoor events. They improvised “door exercises” to get residents moving and seeing each other safely — inviting residents to come out to their doorways and get some active fun in their day.

The facilities’ parent company ordered masks, gloves, gowns and other personal protective equipment early in the pandemic, she said. Skidmore got supplies of hand sanitizer and Clorox wipes. She stopped having staff go between facilities on the campus — one that Skidmore’s facilities share with a separate nursing home, which has experienced a major outbreak.

With one “very short-lived” exception in June, Skidmore’s facilities have been closed to visitors since April 1.

Skidmore in June started having staff at The Bridge and Garden Plaza sign a “hero’s pledge.” The honor-code agreement says they understand COVID-19 is a “serious threat” to their patients, that they have a responsibility to “take all steps necessary to protect myself from exposure” all day, every day, and to coach their family and friends to do the same thing.

“We educate our staff ... not to normalize, ‘Oh, it’s allergies,’ or, ‘Oh, I must have eaten something bad.’ They’re to call their immediate supervisor or call myself,” Skidmore said. “Once they’ve notified us that they’re having even a headache … we ask that staff member to not come out, not come to work.”

That staff member must get tested, then stay home for 14 days. If the test comes back positive, the employee can’t return to work until after they have two negative test results, 10 days apart.

It is a challenge to stay fully staffed, but allowing a sick employee to return to work would be far worse, Skidmore said.

Everyone has felt the impact of the pandemic, she said.

“COVID fatigue is very real,” she said. “These residents are in their apartments seeing the same four walls. … Not being able to see family and feel the touch of a loved one.”

Skidmore encourages residents to go outside for fresh air and sunshine. Staff help set up FaceTime and Zoom calls. And sometimes, a resident just needs to vent.

But it is taxing on the frontline workers, too. Many health care workers in care facilities develop relationships with their patients, getting to know them and their life stories and their families.

“Now we’re serving coffee in (plastic foam) cups door to door,” Skidmore said. “Everybody has a mask on. You don’t see those smiles. You’re looking for the cheeks to puff up above the mask a little, and the gleam in the eyes.”

Going door-to-door to bring residents music, activities, dancing and miniature ice cream socials “really makes you recognize the things that you miss,” Skidmore said.

“Back on Easter, when everybody was in guarded isolation, our business office manager ... got into a bunny suit, and we took a cart around to each of our residents,” with music and bubbles, she said.

In the middle of a pandemic that has turned daily life upside down, Skidmore said her job remains the same at its core: “finding ways to put smiles on residents’ faces.”