A Tragic Tale of COVID-19

For Lori Pastro, Aunt Maria was more like a second mother than some distant relative. That’s why her death from COVID-19 in late May, in the same nursing home where Pastro’s mother had died of pneumonia only four months earlier, hit so hard.

The two older women were sisters-in-law. Maria Moore, whom Pastro affectionately called “Zia,” was Pastro’s father’s sister. Moore never had children, but she doted on Pastro and her three brothers as if they were her own. She regularly joined the family for holidays and vacations. Pastro went to live with her aunt briefly after her tonsillectomy and when she wanted to establish residency to attend a Catholic school in Arlington in 9^th grade.  Moore was also Pastro’s confirmation sponsor at age 13.

“She was really easy to get along with. Fun to talk to; very smart. Great sense of humor,” recalled Pastro, a federal communications official from Gainesville. “She was a very giving and generous person; always there to help us if we needed anything.” At one time when Pastro was between jobs and recovering from an injury, her aunt took her to doctor visits and paid her rent for several months.

During a career that spanned 35 years as a civilian employee for the U.S. Navy, Moore rose from the level of a GS-2 clerk to a GS-13 budget analyst. Many people at her retirement party recalled how Moore had helped mentor them in the office. At Christmas time, Moore was showered with cards and gifts from all over the country. Pastro said her aunt always sent cards, often with a bit of cash enclosed, to family members on birthdays, holidays and special occasions.

Pastro’s mother, Diane Pastro, had recurring health issues and Moore often pitched in to help. The two women were both fond of Italian cooking and the smells of their meals filled the kitchen.

About four years ago, Moore suffered a stroke. She’d injured her leg many years earlier and had difficulty walking. After the stroke, the family looked for a nursing home in Fairfax County that was centrally located to where Pastro, her father and brothers were living in Northern Virginia. Diane Pastro was already living in an assisted living facility in Alexandria. When her memory deteriorated, she was moved to the same nursing home in October 2018.

Pastro visited her mother and checked up on her aunt at the home nearly every other day. Her frequent presence allowed her to take an active role in ensuring that her mother received prompt care and attention when necessary.

Diane Pastro’s health deteriorated and she died in January at age 80. Moore, 84, who had mild dementia, had been moved from a unit on the nursing home’s first floor to a room on the second floor that she shared with three other women. Pastro said she believed the move was prompted by the nursing home’s concerns that her aunt would wander away from the home if she was on the first floor. The second-floor memory unit was more secure.

Pastro said her aunt was frustrated and bored in the memory unit because her cognitive impairment was less than that of most of the other residents on the floor. Still, Pastro was able to visit.

That ended in mid-March when the spread of the coronavirus caused a lock-down in nursing homes across Virginia. Suddenly everything changed for the residents and their families.

Residents were confined to their rooms. They could no longer eat in the common dining room or spend time in the common lounge. Group activities and entertainment stopped. Visitors were barred. Residents couldn’t even go outside in nice weather and sit socially distanced on the patio.

“We’re just sitting around here staring at each other. I’m bored out of my mind,” Pastro recalled her aunt saying during one of their daily phone calls.

To help her aunt pass the time, Pastro purchased several novels, a puzzle and a rosary. She took them home, wiped them with disinfectant and stored them for several days to allow any virus that may have been on the surfaces to die. She sent them to the home, with the home’s permission, and instructed them to store the items for several more days if the home felt it necessary. 

Moore was thrilled with the gifts. But it was short-lived. Several days after receiving the items, she told Pastro that they had all been removed. Pastro said a relative of another resident at the nursing home told her the same thing had happened to her relative.

Things took a turn for the worse on May 8. After an outbreak of the coronavirus at the home, residents were tested and Moore was determined to be positive for the virus. She was moved to another wing of the nursing home—without her family to assist her in making the transition. The move left her disoriented and anxious. It also denied her of the few personal items she’d had in the shared room, including her clothing. All of the residents in the coronavirus wing were issued hospital gowns.

Although her aunt’s infection was considered mild, with few or no symptoms, at one point a second woman with the virus was housed in the same room. Pastro said she and a brother who had Moore’s medical power of attorney were concerned that the other woman’s infection could exacerbate their aunt’s infection. After a few days the woman left the room. Pastro doesn’t know what became of her.

After the move to the coronavirus unit, Moore’s cognitive condition deteriorated rapidly. She was confused and depressed and didn’t understand why she was in that room. Pastro called daily, sometime more than once a day. She was able to arrange a virtual visit – where both people can see each other on a video screen using a conferencing platform like Zoom. A second virtual visit was scheduled, but the staff person facilitating the call wasn’t available at the scheduled time. Pastro said she phoned the home and was told there was only one person on the staff who was responsible for virtual visits. Another virtual visit was scheduled, but again the call wasn’t placed.

Pastro said staff help was necessary for a virtual visit because her aunt didn’t own a computer, tablet or smartphone and wouldn’t have been able to make the connection even if she did own the equipment.

Although her aunt had been an upbeat person most of her life, the isolation left her despondent.

“I’m going to die here alone in this room,” she cried to Pastro.

On May 27, Moore’s condition suddenly worsened and the nursing home warned the family that the end was near. A day later, after insisting, Pastro was able to have a “window visit”—she could talk to her aunt through a window that was opened a crack. The older women cried and was disoriented. Pastro told her she loved her and was praying for her. The next day, Maria Moore died from COVID-19.

Pastro blames her aunt’s isolation, more than the virus, for her death.

“I think it’s cruel and inhuman to keep these people away from their families for all this time. This is what killed my aunt,” Pastro said. “She died from a broken heart. She could have beat that COVID; I think the loneliness is what killed her.”

Even before her aunt died, Pastro had expressed her frustrations to local, state and federal officials. She advocated for limited access—with appropriate testing and protective measures in place—for family members to visit their relatives to relieve the isolation and ensure that they were receiving proper care, including meals, medication and bathing.

“At some point you need to think down the road and plan for the future and think ‘I can’t just leave these people trapped in their room for 12 to 18 months while we are waiting for a vaccine to be developed,’” Pastro said.

She would like to see some staff be housed within the nursing home for a limited duration rather than being exposed to the general population on a daily basis. Short of that, she’d like to see increased testing—beyond just daily temperature checks—of staff. She’d also like to see homes develop ways for residents to have more socially distanced interaction and family visits after visitors are tested and wear personal protective equipment. She also wants state inspectors to conduct inspections in person, rather than just take reports from the homes.

“I’m concerned about what’s going on behind closed doors,” Pastro said, noting that even when she was able to visit her mother and aunt before the virus she witnessed practices that raised concerns.

Her concerns are shared by thousands of people across the country and have prompted AARP to urge lawmakers in Congress and in state legislatures to take action to reduce the dangers of social isolation as well as the coronavirus.

Specifically, AARP is urging people to contact their members of Congress to call for:

• Regular, ongoing testing of residents and staff and adequate personal protective equipment for staff.
• Daily, public reporting of cases and deaths in facilities; communication with families about discharges and transfers; and funding accountability
• Access to facilitated virtual visitations, even when nursing homes begin allowing in-person visits again
• Better care for residents through adequate staffing, and access to in-person formal advocates, called long-term care ombudsmen
• No immunity for long-term care facilities related to COVID-19.
  

In Virginia, AARP Virginia will be focusing efforts in the General Assembly to require nursing homes to facilitate virtual visitations.

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