Learning to live with the consequences of decisions is part of learning to live well. But sometimes life throws so many curve balls, none of the decisions result in a desirable outcome.
That is the position in which Kathi Eisenbeis found herself last year. She was living with Parkinson's, a progressive nervous system disorder. Her husband of 53 years, John, was living with Alzheimer's, another progressive disorder which causes brain cells to degenerate and die.
For as long as possible, they managed in the home they had built to accommodate their health conditions.
"I just couldn't let go," Eisenbeis wrote in a narrative about her experience. "I had married him for better or for worse."
Eventually, though, the day came when she had to bow to the advice she had been receiving from both their children and their health-care providers. Eventually, she had to let go and allow her husband to move into a long-term care facility, Bethel Lutheran Home.
She remembers the date -- May 5, 2020. The COVID-19 pandemic had reached South Dakota earlier in the year after having a devastating impact on urban areas, and the state Department of Health was quick to provide guidance which would prevent nursing homes and other senior care facilities from experiencing the same losses.
Bethel was locked down. Eisenbeis was forced to leave her husband at the door and could only see him through the window of his room, could only speak to him by phone.
"I was not able to touch John for nearly eight months," she said. As a result of this separation, she has experienced guilt which has been nearly overwhelming at times.
"Many tears were and are still shed over that decision," she wrote. "How could I do that to him?"
Eisenbeis knew that decisions made at the recommendation of the state DoH were made to keep the residents safe, especially in light of the course the pandemic took in South Dakota, with the number of cases and deaths spiking at the end of the year. That knowledge did not make it easier for her.
"I stood outside the window each morning and watched him eat breakfast," she recalled. "I would come back each afternoon and camp out beside his bedroom window for an hour or so. I would bring my lawn chair and a car visor to shield the window so I could see through the reflection."
Eisenbeis also spoke repeatedly to Chuck Johnson, CEO and administrator, trying to find some avenue, some loophole, some exception which would allow her to spend time with her husband.
"I smile when I think about how annoying my persistence must have been for him," Eisenbeis said. "He was very patient with me."
As the situation changed and the state DoH, in keeping with CDC recommendations, eased restrictions, she was finally able to begin regular visits under a compassionate caregivers policy. Now she spends two hours each day at Bethel.
"Since then, I have spent from 5:00 to 7:00 each day in John's room, helping him eat supper, helping him shave, cleaning his glasses, decorating his room, massaging his back and feet, and -- yes -- there's a lot of smooching and hugging also," she wrote. "I believe that physical touch is important to John's mental well-being."
The visits have also been a comfort to her. At present, Eisenbeis looks forward to the day when the coronavirus no longer poses a safety issue, and she can come and go as she wishes.
Earlier this month, the Center for Medicare and Medicaid Services eased restrictions, indicating that nursing home residents who have been vaccinated can receive hugs from loved ones and that more indoor visits can be allowed. Masks and sanitizer are still recommended.
The Associated Press reported, "Government officials acknowledged that isolation deepened the misery for residents as long-term care facilities remained locked down much of last year." The loneliness which resulted contributed to both physical and mental declines.
At Bethel, like other nursing homes, balancing residents' safety with their socio-emotional needs has been an ongoing challenge for staff. Johnson, having been deployed to Afghanistan with the Iowa Army National Guard, knows from personal experience that a Zoom visit or FaceTime visit isn't the same as a personal visit.
"It's not the same as getting a hug, a peck on the cheek or a hand squeeze," he said. "In-person visits are super important. It's a basic human need."
Johnson noted the staff was happy to see the restrictions lifted but will be following CMS guidelines "to the letter." As part of this, the number of visitors in each wing of the building will be limited at any given time, so visits must be scheduled in advance.
"We don't want someone driving from Minnesota, and they get here and we have to tell them the next three hours are full," Johnson indicated.
The eased restrictions follow other policy changes geared toward addressing the socio-emotional needs of residents. Each was made in response to changed recommendations from the state DoH and CDC.
"As guidance comes out, we have to make it fit the building's capabilities," Johnson explained.
One which had an immediate impact on all of the residents came after they had been vaccinated. Earlier this year, with 98% vaccinated, they were able to dine together again rather than separately in their rooms.
"You could feel the change in atmosphere in the building," Johnson said.
He walked through the dining room on the first day, when residents were seeing one another again for the first time in nearly a year, and witnessed the many reunions.
"At one table, the ladies were holding each other's hands and crying," he recounted. Since that time, appetites have improved, fewer residents are depressed and moods overall have improved.
Late last fall, the compassionate caregiver program was implemented to help those residents whose family members had been actively involved in their care, and to provide support for those who were beginning to withdraw or experience emotional distress.
"As soon as they allowed it, we did it," Johnson said. "The care team had to look at each resident to see if they met the criteria for compassionate caregivers."
When the determination was made, families were contacted so that a caregiver could be identified. With this program, a single person was identified and could visit on a regular, even daily basis.
For many residents, though, staff remained the primary source of socio-emotional support through this difficult time. Johnson is quick to note that they have risen to the challenge.
"I have a great staff," he said.