Stephanie Emery wishes her grandmother, Mae Emery, a happy 101st birthday through the window of Market Square Health Care Center in South Paris on Thursday. Credit: Courtesy of Stephanie Emery

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Before Mae Emery turned 101 on Wednesday, her family had hoped to visit her to celebrate the big day.

Instead, they had to mark the occasion in a much more muted way. Using cellphones, they watched by video as the staff at Mae Emery’s long-term care facility sang “Happy Birthday,” helped her unwrap gifts and served cupcakes made in her favorite color: pink.

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A half hour later, Mae’s granddaughter, Stephanie Emery, drove to the 76-bed nursing home in South Paris. Wearing face masks, they conversed through the window of Mae’s room, and Stephanie held up a hand-drawn poster wishing her a happy 101st.

“She was excited to see me, and of course, I was excited to see her,” Stephanie said a short time later. “She is very aware that it’s her birthday today. She is a little bit of a celebrity, because she is one of the oldest folks at her nursing home.”

But while the Emery family was grateful to the workers at Market Square Health Care Center who helped arrange the celebration, its limited size was also a reminder of the challenges many Maine families are now facing as the state tries to limit the spread of the coronavirus.

As long-term care facilities have restricted outside visitors, residents have stopped receiving in-person visits from their loved ones. Instead, relatives must rely on staff to help arrange visits from outside a window or through the screen of a smartphone. The physical separation is taking a toll on families that crave connection during the current crisis.

“You make it all the way to 101 and your family can’t celebrate with you, that’s been difficult to deal with this week,” Stephanie Emery said of her grandmother’s birthday. “Even without her birthday, I just think it’s tough to not be able to check in. Even though the staff is very kind to her, it’s still not family. She does miss us, and on some level she knows we’re not there.”

The need for all the new precautions has been clear: at least five Maine senior centers have already seen outbreaks of COVID-19, the disease caused by the new virus, which is particularly threatening to the elderly.

The new isolation can be harmful for some — but not necessarily all — residents of long-term care facilities, according to Jabbar Fazeli, a geriatrician who works for the MaineHealth network and is a spokesperson for the Maine Medical Directors Association, which represents the physicians and staff of long-term care facilities.

Residents with severe forms of dementia may not be able to recognize any great changes to their routine, but those with lesser forms are more vulnerable, Fazeli said. He expressed particular concern for residents of independent living facilities who have much less regular contact with workers and whose typical social activities have been canceled because of the new restrictions on large gatherings.

Residents with mild dementia could be the most likely to become stressed about the separation from their families, while those with moderate dementia could become more traumatized by the new information on the pandemic that they learn from TV news, according to Fazeli.

“The 24/7 news cycle tends to be very repetitive,” he said. “What ends up happening for a moderately demented patient is they would look at this and feel that there is new information and everything is negative.”

Either way, that stress can exacerbate a number of other physical and mental health problems, Fazeli said. But he added that all the new measures meant to prevent the spread of the coronavirus could have some benefits for residents of long-term care facilities if it means they are receiving more phone calls from loved ones or attention from staff.

“It’s not all doom and gloom,” he said. “There are a lot of bright spots.”

To a “very astonishing” degree, he noted that nursing homes have increased their use of tablet computers and other technology to help arrange virtual meetings between residents and their loved ones, Fazeli said. But that may not change the fact that family members of long-term care residents could also suffer “anxiety” from the new isolation.

Market Square Health Care Center, the South Paris nursing home where Mae Emery lives, was one of the first long-term care facilities in Maine to make the decision to restrict visitors as a precaution against the coronavirus, according to administrator Joel Rogers. In addition, the facility has been forced to cancel a number of other activities such as live musical performances, movie screenings and bingo nights.

But Rogers said the facility is working to restart some of those activities in a way that preserves social distancing. He has also allowed some groups of residents to make short trips outside the facility to get fresh air and meet with relatives, so long as they understand the need to stay at least six feet from anyone they encounter.

The inability to hug their relatives has been difficult for some residents, Rogers said, but he also made sure to get buy-in for some of the new restrictions by asking a group of residents to vote on them before they were implemented.

“It’s their home,” he said. “They’re the Greatest Generation. They’ve been through Depression, wars, everything. They know how to process their thoughts. That got us to where we are. They’re happy because they feel safe.”

At least one resident of the facility agreed.

“We wanted to close it down,” said George Stickney Sr., a 62-year-old resident who lives there because of mobility challenges related to his multiple sclerosis. “Everybody is being pretty cooperative about it. They all understand.”

Stephanie Emery has been impressed with the efforts by the facility’s staff to arrange communication between her and her grandmother using mobile technology that Mae Emery may not ever have conceived of using.

But that’s still no substitute for an in-person connection.

“Your level of comfort is just eased when you see a familiar face,” she said. “Not to be able to give that to her once a day, or even a couple days a week, is hard.”

Watch: Should you remove loved ones from care facilities during the outbreak?

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