Alone and vulnerable (3/3): Fears rise that elderly may 'backslide' during lockdown

A nurse wears a protective mask as she speaks to an ill patient, on March 4, 2020, in an EHPAD (Housing Establishment for Dependant Elderly People) in Brest, western France, amid the spread of COVID-19.
A nurse wears a protective mask as she speaks to an ill patient, on March 4, 2020, in an EHPAD (Housing Establishment for Dependant Elderly People) in Brest, western France, amid the spread of COVID-19. © Loic Venance, AFP

Amid the coronavirus pandemic, social workers are continuing to work with the fragile populations in their care. Nicolas Bresse runs a facility for the elderly and is concerned not only about the spread of COVID-19, but also about the effects of isolation on his residents.


"We have to make decisions today. We don't know if they'll be good or bad," Bresse said. He and his teams are facing a twofold problem: inhibiting the spread of the coronavirus in the residence, but also preventing the required confinement from leading to a loss of autonomy for the elderly.

Bresse said he was initially able to anticipate and fulfill the facility’s needs.

"During the first phase of the epidemic we managed to stockpile by working with local pharmacies. So we were properly equipped with hydro-alcoholic gel and we had enough masks. Now we have allocations from the ARS (Regional Health Agency)," he explained, proud of the functioning of his facility – a Home and Residence for the Elderly known in France as a Marpa – as well as his team.

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Marpa facilities house people who are still able to live somewhat independently and are part of a network of 200 homes. This one in Val d'Arnon, in the Cher region in central France, has 21 residents; each have their own individual living spaces but also benefit from support services, including laundry and group meals. 

A small facility and nimble in its response

Unlike another type of assisted-living service known as an Ehpad (Residential Facility for Elderly Dependent Persons), Bresse explained, "We are not a medical facility at all."

"We don't have caregivers on site. Our residents remain autonomous, but they need to be together to feel secure and break the solitude. It's also a type of care that promotes ageing well. The offices of independent nurses and home helpers are involved in all aspects of personal care." 

Bresse believes that being a small facility made it possible to react quickly to the arrival of coronavirus; he was able to take the necessary measures without upsetting the residents' daily routines – at least at first. 

"Usually there are six of us working here regularly. We now do most of the cleaning and laundry ourselves so we don't have to come and go. We've limited interactions with families and professional visits. The staff who come from outside are equipped as best they can be. We had anticipated this and now we are moving towards a closed shop," he said.

The residents of the facility in du Val d'Arnon
The residents of the facility in du Val d'Arnon © Marpa Val d'Arnon

"Our role is to reassure. And many people have realised how dangerous this virus is for them," Bresse continued. "The coronavirus has changed the dynamics of the place a little bit. Without family visits, residents have less personal space. They turn more to other residents to compensate."

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Letters to break up the isolation

One of the aims of a Marpa is to enable older people to maintain a place in society. That is usually done by organising speakers or visits from primary school pupils. With coronavirus now preventing this, the Marpa of Val d'Arnon has found a solution in letters.

"Someone sent us a card saying they were thinking of us at this difficult time. We didn't know her. It was a nice idea. I put it on my personal Facebook account. The post was shared, so much so that other letters started coming in," Bresse said with a smile.

"We've received about 20 letters. Someone is in charge of going through them and then they're posted for everyone. It breaks the isolation," he said. "The idea is to occupy the minds of the elderly so they don’t grow anxious." 

Bresse also hopes to keep residents in touch with their families by helping them use webcams and smartphones for video calls. And he noted that the crisis has cemented local solidarity: families and local figures are volunteering to help, and the local tree nursery decorated areas around the building to brighten up daily life at the facility. 

Isolation and regression

An announcement by the ministry of health has, however, dealt a blow to the morale of this incurable "optimist", as Bresse calls himself. On March 28, Minister of Health Olivier Véran called for Ehpad-type establishments to move towards isolating each of their residents to protect the elderly against the coronavirus.

For Bresse, this solution has a downside. "We are certainly facing a health crisis, but there is a risk of having a traumatic crisis once this one has passed. The residents will have survived, but they will have lost their autonomy. We will have degraded our old people. If they let themselves go, they will regress. From there, it will be impossible to get back to the mechanisms of yesteryear." 

He continued: "Someone who hasn't been walking every day – he won't be walking again in two months if he hasn't walked in all that time. Someone who is cognitively degenerating – if we don't continue to offer him interaction, contacts, a rhythm, he's going to go out of kilter and let himself backslide ... And to let oneself backslide, for an elderly person, is death – nothing else." 

In the end, his facility was obligated to confine residents to their rooms. 

One step at a time 

Fortunately, Bresse has a team he can count on to help his residents overcome this challenge. 

"The work of the teams is to be commended. There's a huge workload and they're mobilised. In this kind of situation, the teams come together and we all move forward together for the well-being of the residents," he said.

"In the long term, it will be difficult to avoid wear and tear. But for now, we're moving forward one step at a time." 

Ever the optimist, Bresse concluded with hopeful vigour: "Everything's turned upside down, but we're going to make it. We have to remain active, positive and invested in order to reinvent ourselves." 

This story was translated from the original in French.

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