Nursing homes revisited: It was the saddest year in my life

Lockdowns and fear took their toll in the pandemic. Now, the sector faces post-Covid challenges

Ann Marie McEvoy (85) has been living in the Talbot Lodge Nursing Home in Malahide since she broke her leg in a fall more than four years ago. She's sitting in a wheelchair in the lobby, telling me about how her husband Barney died just over a year ago. He was 89 and was still living in their house. "He went into Beaumont with a little pain in his side. The next day, Tuesday night, they rang my children and said, 'You have to come, your father is in a coma.' They stayed with him all day Wednesday and he died on the Wednesday evening."

Ann Marie couldn’t go to him. “The fact I never said goodbye to him was the worst,” she says. “When I rang him, he was unconscious and my children were with him. He started to smile. So he knew it was me. I said, ‘I love you’ and a few things like that. . . And he died a half an hour after that.”

She met Barney more than 60 years ago at a dancehall in Malahide on a night the Clipper Carlton were playing. They loved dancing. Nowadays she likes watching dancing on the internet. There's a particular advertisement on the TV for Specsavers in which an older man dances. "You'd think he was my husband. It's the way he used to dance. . . Every time I see it my heart skips a beat."

Ann Marie couldn’t be at the funeral. She watched on a screen from her room. Debbie O’Reilly, one of the care staff, came in on her day off and they both dressed in black and watched it. Her granddaughter read a eulogy about how Barney would tell stories about how he and Ann Marie met. “He would tell them how much he loved me. It was quite sad for me, but it was lovely.”

“Debbie stayed with me all through it. . . She is without a doubt one of God’s special people. . . She even got into bed and cuddled me because I was so sad. . . It was the worst year in my life as regards sadness.”

That summer she was very ill and spent seven weeks in hospital. “I rang my children and said, ‘I’ve made my peace with God I am definitely going to die.” She laughs. “They always say, ‘Mother, it’s hard to kill a bad thing’.”

Ann Marie is stoical and kind-hearted ("Was it hard on you not seeing your own mam and dad?" she asks me). Her children and grandchildren all live nearby. In lockdown she passed her time reading – a history of India, a book about Phil Lynott whom she loved (she knew the family) – and writing to her two childhood friends who live in the United States and the United Kingdom. "We've known each other 76 years." In the early days of the pandemic her family came for "window visits" but it was tough on Barney being outside in the cold. "So we talked all the time on the phone instead."

Thanks to the staff of Talbot Lodge she says: “We never felt anything but safe.”

Talbot Lodge is part of the Brookhaven Healthcare group. It locked down two weeks earlier than most other places in March, 2020. Eveline Sheeran, the clinical director of the group, slept on a folding bed in her office as she grappled with changing guidance from public health authorities and explaining developments to staff, residents and their families. They had a good supply of PPE (a staff member recounts how in another nursing home he worked at they had to use painting overalls from a hardware store and gloves donated by an agricultural college).

The Brookhaven group avoided Covid-19 until January 2021 when its premises in Stradbally, Co Laois, had an outbreak. This was followed by outbreaks in its Castlebar and Galway homes. Talbot Lodge was spared an outbreak until a month ago, and then it only resulted in mild illness. "I had travelled through the [Brookhaven] homes with outbreaks," says Sheeran. "And it was very, very evident that the homes that had received the vaccination had very different experiences when it comes to outbreak to those that hadn't . . . I've spoken to people who had outbreaks very, very early on, and they felt really isolated and abandoned."

Things aren’t yet back to normal at Talbot Lodge. Two visitors can visit each resident, but here those visits have to be scheduled. What was formerly a cafe that could comfortably hold 20 people and contained couches, paintings and a play area for grandchildren now looks a bit empty with just four women chatting. “It looks a bit stark because there are no pictures or homey bits,” says Sheeran.

'The residents with dementia really struggled to understand what was happening. 'At first they would keep asking every single day, 'Why do you wear a mask?''

These residents are keen to downplay how hard it’s been. “Do you remember the very beginning though, two years ago when we had shut down completely and nobody was allowed down and we used to do the video calls?” asks Sheeran.

“At least you have company here,” says resident Rose Keane, who was an accountant before she retired. “If you were at home you’d be locked up alone.”

What did they do in lockdown? “I watched television and I read,” says Claire O’Donnell, who formerly ran a shop. “I’ve loads of books in my room. And I also used my phone a lot.”

“I got a phone bill today for €222,” says Keane. “I thought, I’d better stop using my phone.”

O’Donnell and Keane are good friends. They occasionally glance at each other and laugh after my questions. “We’re like sisters,” says Keane.

“If you can’t have a laugh in this world you might as well give up and die,” says O’Donnell.

As the photographer takes the photo, a woman named Marie Long sings I Have a Dream by Abba. She has a beautiful voice.

There's also a dog wandering around the lobby. He's a 15-year-old Labrador named Alfie, a gentle giant. "The patients love him," says team leader Debbie O'Reilly. "When they see him some of them say, 'Here's the horse!'"

What has this been like for staff? “There was pressure but because the residents were isolating from their families, you kind of feel like we’re their family,” says O’Reilly. “So you kind of forget about the pressure.”

"It was scary at the start," says clinical nurse manager Marija Reger, who is from Croatia. "But it stuck us together. A few of us are from abroad. We don't have families here so we would actually take comfort in the second family of co-workers and residents."

The residents with dementia really struggled to understand what was happening, she says. “At first they would keep asking every single day, ‘Why do you wear a mask?’”

“They learned to know us by our voices,” says O’Reilly.

They both think that the lockdowns have had a huge negative effect on some residents. “What they need is consistency,” says Reger. “If someone is getting a visit from the family every single day or every single week, if we take this away, they will start progressing downward.”

“One of the family members came in to us and the resident got really distressed and upset because they couldn’t really remember who it was. . . and they wanted me there,” says O’Reilly.

Staff were terrified of bringing the virus into the building. For two years, says O’Reilly, “I didn’t go anywhere, even to the shops, because. . . what if I bring it in here and someone catches it? I isolated myself from everyone.”

“We found comfort in each other,” says Reger. “Cracking jokes and having a laugh.”

'We were very much aware of the loneliness and the sadness they were experiencing'

They sometimes had to deal with angry family members who couldn’t understand why they couldn’t visit whenever they wanted. “People don’t understand that we were just implementing the restrictions,” says Reger. “Some families gave out to us. But it’s okay. We understand.”

I ask O’Reilly about when Ann Marie McEvoy’s husband died. “He was a gentleman,” she says. She recalls sitting with her and hugging her. Even thinking of it makes her feel emotional.

“I can’t even remember the normal days,” says Reger. “We became nurses, carers, hairdressers, makeup artists, a shoulder to cry on. We were everything for them.”

Why do they do it? “It could be my mum or dad,” says O’Reilly. It could be me one day. All they want is a little love. A little hug.”

Not every nursing home was as fortunate as Talbot Lodge in 2020. Lucy Flynn Grillet owns the Millbury Nursing Home in Co Meath. She outlines the terrible experience they had in March and April of 2020.

“There are just no words to describe what happened,” she says. “We had so many sick people. We had this classical list of symptoms and we were going through that. But I had residents saying they were very tired in the morning. . . and by mid-afternoon that person would have passed away. . . When the results came back we’d learn they had Covid. It wasn’t just the upper respiratory symptoms. . . This caused great anxiety for the team here. We didn’t know what was going to transpire in the day.”

Millbury is a single-storey building so window visits could be arranged if someone was very sick. “One particular day I remember being with four different residents that all passed away over a short period of time, [with their] families at the window. . . and we’re trying to explain behind all the masks and the gowns, who we were and that, ‘at the window there’s your daughter, your sister’. Really and truly, we were devastated. We still are. I’m sure you can hear the emotion in my voice. . . I find it difficult to even talk about.”

There were 66 residents in Millbury. About half of them contracted the virus. Many staff did too. They had 14 resident deaths in a period of weeks. “For 27 days, I stayed in the nursing home morning, noon and night,” says Flynn Grillet. “By the end of April, beginning of May, there was a sudden calmness within the nursing home. Did we imagine all this?”

From that point on they tried their best to keep residents occupied and upbeat through two years of restrictions. “We were very much aware of the loneliness and the sadness they were experiencing. We had very strict regulations regarding visiting but we always looked compassionately on each situation. Families were very grateful for even five minutes with their loved ones.”

Flynn Grillet feels relieved about the current situation but she’s also nervous about the end of mandatory mask wearing and what that means for infection rates. “We feel kind of in control at last of this pandemic and we don’t want to undo that good work. . . We’re emotionally shattered really. We listen to one another and we care about each other and that’s been our saving grace. . . Our sector was ravaged by the pandemic and nobody wants to revisit that.”

There are currently about 570 nursing homes in Ireland with about 32,000 beds. There will be big changes in the sector in the coming years. The State's Sláintecare plan aims for a social model of care, facilitating people to live longer in their communities. In the nursing homes sector people increasingly enter the system older and with more complex needs. Some staff I speak to feel that the experience of the pandemic has led to some families trying to care for people at home for even longer.

'You get used to not seeing him. The visits stop becoming part of your life [and] you don't think about them as much'

"We need to be careful that we don't become an overly clinical model," says Tadhg Daly, chief executive of Nursing Homes Ireland, the representative body for private nursing homes. "There's an expectation in some cases you become almost hospitals."

There's also an issue with smaller businesses closing. Daly lists off a number of smaller operators that have closed in recent months in Galway, Limerick and Monaghan. "We could lose more of the smaller homes. [They're] dotted all over Ireland and provide a very valuable part of the health fabric."

The nursing home managers I talk to regularly refer to the amount of official paperwork required after two years of Covid. A bigger problem is a high turnover of staff, exacerbated by the stress of the pandemic. "The end of last year was the resignation year," says Nicola Daly who is the PIC (person in charge) at Windmill Healthcare's Millbrook Nursing Home in Ferbane (which had no outbreak). "A care centre is run 24/7, 365 days a year. People wanted an easier life. They wanted nine to five jobs. Monday to Friday. The group increased everyone's wages here and that commenced in November. People are moving." Many service providers have increased salaries in an attempt to retain staff in the past year.

It has been an incredibly tough time for the families of nursing home residents. Eileen’s 86-year-old father William has been in a home in Dublin since he had a stroke in 2016. Shortly after the first lockdown William had to spend time in hospital. “They let me share the taxi back to the home from the hospital and that was the only time I saw him. And then I didn’t see him again for two months.”

He understood Covid but sometimes when she rang, she says, “He’d get a bit emotional. ‘Why aren’t you coming in to see me?’ He’s quite stoic but he was telling me he loved me on the phone. He’d never say that normally. So the lockdown had a bad effect on him.”

Lockdowns began and ended then began again. “I found that we fell out of the rhythm of chats. Today was the first day that I could go in with my brother and it’s really nice because as we chat you can see Dad likes having the two of us around chatting, even though he doesn’t want to chat.”

She knows she could never have looked after William at home, but still feels guilt. “When my mother died, I didn’t feel too bad because I got to spend lots of time with her and look after her ... I didn’t have the feeling of, ‘Oh, I didn’t get to see her enough’. This time I feel desperate ... And the weird thing is you get used to not seeing him. The visits stop becoming part of your life [and] you don’t think about them as much. And then when you do, you feel fourfold guilt.”

Eileen Broe lost her mother Maeve on December 16th, 2020. She had advanced dementia and was living in a nursing home in Kildare. "In her previous life she was a great storyteller," says Broe. "She had great humour and was never cross. [Later] there were episodes when she was very cross. She would cry and sob for three hours ... Sometimes she would think her brothers who were dead a long time had only just died."

Broe found lockdown extremely difficult because she couldn’t comfort her mother. Before the pandemic she and her sister would both visit every day. “While the nurses and carers were fantastic, they couldn’t sit with Mum and hold her hand twice a day ... Window visits were no good for Mum, because she didn’t have the capacity to look out the window and know who was at the far side.”

Things opened up and then shut down again. By December of 2020 her mother had deteriorated a lot. “You hoped and felt she could hear what you said but you couldn’t sit and hold her hand. You had to sit at a distance.”

The nursing home hosted a special outdoor visit so grandchildren could meet grandparents who hadn’t seen them for the year. “Mum never opened her eyes that day,” says Broe. Then staff facilitated a visit for Broe and her siblings, one of whom lived in the US and hadn’t seen her in some time. She died shortly afterwards in her sleep. “We were hoping to be with her at the end but that wasn’t possible. They say people who were dying hang on so maybe she hung on for my brother.”

They could only have 25 people at the funeral. Even then they worried that someone might catch Covid. “I have a lot of sadness about the time that was robbed from us.”

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