PHILADELPHIA — A year ago, the job of activities directors at nursing homes and assisted living facilities was to get people out of their rooms and into their communities.
People like Rachel Kaufman organized movie nights, card games, exercise classes, parties and happy hours. These activities directors, AKA life enrichment professionals or, in Kaufman’s case, escapades producers, tended to be outgoing, upbeat, infinitely patient people who could make the most of tight budgets, said Kirsten Jacobs, director of dementia and wellness education with the senior housing organization LeadingAge.
The pandemic upended everything and stress-tested all their skills.
Almost overnight last March, these under-appreciated workers became key players in the struggle to keep residents safe, but also happy. They visited residents’ rooms with carts loaded with things to do. They wore silly costumes and dispensed cocktails. They became technology whizzes who enabled virtual family visits and, also, witnesses to loneliness, suffering and immense love. They added arranging real family visits to their list of job duties and, more recently, helped organize vaccine clinics.
Jacobs has seen boundless creativity: a poem that began in one room and grew line-by-line as a worker visited other residents, hallway Bible studies, window visits from llamas, balcony singing.
“An already really intense role has become that much more intense,” Jacobs said. “It’s a lot.”
Kaufman wouldn’t disagree. “I worked much harder this year — much harder,” she said.
“I have felt every possible emotion there has been to feel over the course of this year, highs and lows. It’s almost indescribable. But I feel like we really took what could have been a horrible, horrible situation and made absolutely the best we could out of it.”
Kaufman, 52, is a former pre-school teacher who discovered her passion for older adults through inter-generational programming. She has been at Brandywine Living at Dresher Estates, a personal care facility in Montgomery County, for almost 10 years. A warm, enthusiastic woman, she led the “soup squad,” a group of senior cooks who chopped mounds of ingredients for soups they gave to needier elders, before the pandemic. Brandywine had organized activities from 10 a.m. until 7 or 8 p.m. every day. In January, when there were about 90 residents, programs regularly attracted 20 to 30 people.
Then, on March 13, as COVID-19′s terrifying ability to kill care home residents became clear, Brandywine locked its doors to outsiders. Later that month, residents were quarantined to their rooms. The center had a few cases in May, but got hit much harder later. “September was the worst, worst, worst,” Kaufman said. There was another outbreak in December. Overall, 45 residents and staff tested positive. Seven residents died.
Kaufman learned she had tested positive while serving ice cream outside on July 4; follow-up testing was negative. She thinks she wasn’t really infected, but was worried for a few days that she might have unknowingly endangered others.
While Brandywine has been in lockdown off and on, it now allows small, socially distanced activities involving no more than 10 residents. Family members who test negative can visit outdoors in a designated area near the lobby.
In the early days, Kaufman and the other seven members of her team took “escapades-to-go” carts loaded with supplies for activities to residents’ rooms.
“We literally reinvented our activity program overnight,” Kaufman said.
They had room-based tea parties and happy hours. On the Phillies’ opening day, they delivered peanuts, Cracker Jack and beer, along with baseball trivia. She picked movies — she has some serious John Wayne fans — and helped people watch them in their apartments. They did exercises, bingo and flower arranging in the halls. The escapades team sent snapshots in real time to residents’ families. They dressed as super heroes and characters from the Wizard of Oz. There were Eagles and Phillies spirit days. They had parking-lot concerts and watched the Philadelphia Orchestra and Metropolitan Opera online. Sometimes Kaufman would just stop and talk for 15 minutes with a resident. When some in the memory unit stopped eating, she brought them chocolate milkshakes in the afternoon. On a recent day, she made passion fruit-mango margaritas at happy hour.
In June, the men desperately needed haircuts after months without a hairdresser. Kaufman used a buzzer for the first time on Father’s Day, joking that she was offering a money-back guarantee for her cuts. “It actually went really well,” she said.
The pandemic has been a crash course in technology. Most of the residents need help with FaceTime. Families sent many Echo and Alexa virtual assistants. But, Kaufman said, “Zoom was the absolute star of the year.”
They used it for horticulture, art and exercise classes, for bingo at Thanksgiving, a service at Hanukkah, tree lighting and caroling at Christmas.
“They were really great programs,” Kaufman said. “It was almost like a sense of normalcy.”
There were also Zoom shivas and funerals.
Even during the less restricted periods, she had much more work than usual. Smaller meetings meant more repetition. The need for cleaning and restocking supplies was relentless. Whether residents were beading, knitting or playing dice games, everyone needed their own supplies. Brandywine now uses photocopied playing cards that have to be thrown away after a game. Kaufman mourns the trees that died for the paper they’re using.
She routinely works 9 a.m. to 7 p.m., then does more prep at home. She might buy flowers for arranging at Produce Junction on her way in.
Those three weeks in September when the virus was most intense were exhausting, she said. Kaufman is usually good at leaving work behind at night, but she couldn’t. Nightmares disturbed her sleep. They were always about losing control, being somewhere that seemed safe but wasn’t.
She was the activities representative on Brandywine’s “hot team” that went into the area where people sick with COVID-19 were quarantined. Anyone who works in senior housing is familiar with death and illness, but it was a new experience for Kaufman to be around so many who were sick at once. She found it “heartbreaking.”
It was “all hands on deck,” so she did everything from delivering meals to finding supplies. She often helped people who were getting better talk with their families, but one memorable conversation involved a resident who was dying. Her family told her that she had been a wonderful mom and wife. They talked of childhood memories. They also said, “It’s OK. You can let go. We love you.”
Kaufman was not afraid. Brandywine never suffered from a lack of protective equipment, and she was taking all possible precautions. “The families’ need to see way outweighed any hesitation I may have had,” she said.
The isolation has been hard on residents, but many are coping well. “Most of them watch the news,” Kaufman said. “They know what’s going on. They understand, but they don’t like it.”
This new way of working has made Kaufman realize how much she had missed before. One resident showed her a framed embroidered matza cover that had been her Russian grandmother’s. Kaufman learned that a woman who seemed quite proper had a taste for playful modern art. Another resident’s room was full of Catholic art objects. When she was dying, Kaufman helped arrange for a priest to visit her.
“We really got to know the residents in a really different way,” she said, “in a very personal way.”
Krissi Kressler, corporate director of program excellence for Brandywine’s 31 communities, said the past few months have brought many activities workers to tears. “They’re tired,” she said.
What sustains them is seeing that their work matters. “I think they see our residents need them,” she said. “They are the residents’ families right now.”
Jacobs hopes this appreciation endures past the pandemic. “My hope,” she said, “is that we as a field come out of this with a deep acknowledgement of the contribution that life enrichment professionals make every day.”
On Monday, Kaufman and her team helped plan Brandywine’s first vaccine clinic. They hung balloons, ordered special food and made a chart that tracked vaccines given. Kaufman compiled the playlist for the room where staff hung out for 15 minutes after their shots: Big Shot by Billy Joel, My Shot from Hamilton, I Shot the Sheriff by Bob Marley and 12 more. She got a shot herself and was in the room when many residents got theirs. She was touched by how happy and hopeful they were.
“Honestly,” she said, “the whole day was overwhelming, but in a good way. … I really hope that this is a turning point.”