LACONIA — Nursing homes across the Lakes Region have scrambled to adapt resident life to pandemic conditions. But of all the adaptations and diversions carved out of necessity during COVID-19, hallway bingo has been the most popular – and it’s here to stay.
Staff and administrators say that when the game occurred in a large group in the community room, not as many residents joined – especially those who were shy, anxious, limited physically or uncomfortable sitting for long periods. Participation jumped by more than 30 percent when residents could recline in their rooms or sit in their doorways and listen to numbers called out by megaphone or announced over speaker systems – a combination of less pressure, and more privacy and personal service, coupled with a way to stay safe and comfortable.
For introverts, skeptics, newcomers and those who are most physically comprised, it’s been a happier way to engage. And it has provided a few clues about what makes resident life work.
“Hallway bingo isn’t going away. There will always be a hallway bingo, so we can get people who don’t want to come down,” said Brenda Twardosky, recreation director at the Belknap County Nursing Home. “I’ve been happily surprised that some of our less social people are now playing.”
The hallway version of the popular group game consistently draws 35 of the roughly 40 residents who are capable of playing it at the county nursing home, compared to 20 to 25 who used to gather like clockwork in the pre-COVID community room.
“This lovely lady who never played bingo now looks for us when we’re coming around with cards. Not everyone enjoys being in those large groups. It can be anxiety inducing for people,” Twardosky said.
The solution going forward is to hold bingo both ways, tailored to personalities and preferences, she said. Crafts, too, will likely continue in smaller groups when possible. “For myself, I’ve always been an advocate for smaller group settings. It’s not always attainable because you need more staff. But it’s something we’re looking to do,” said Twardosky. “We’re doing similar things while still staying safe.”
COVID ushered in a unprecedented world of solitude and distance, which has meant seismic shifts for staff and residents who were required to thwart contagion, while keeping life as normal-seeming as possible. The pandemic moved regular social interaction online – which is now returning in-person with limited, scheduled visits from family members, but no outside entertainment yet. At nursing homes, the challenge remains how to preserve social and emotional health while guarding physical wellbeing.
“It’s been a lot of trying to readapt things. I didn’t want to take away things they’re used to because that would be disruptive,” said Alexandra Cave, life enrichment director at St. Francis Rehabilitation and Health Center, where 18 residents passed away when the nursing home was infected by COVID in January 2021.
For nearly every nursing home, the most inspiring discovery to come out of COVID has been hallway bingo.
“People who weren’t willing to go to activities were willing to try it because it was right there,” said Cave. After the dangers of transmission subsided, many residents were still too hesitant or fearful to leave their rooms. For others, staying put has always been easier. Many older nursing home residents find large group socializing over-stimulating or tiring, or don’t like sit for long periods because it hurts. But hallway bingo presented an attractive alternative.
“We have one lady who stays inside her room in her reclining chair” while the resident who lives next door sits outside her doorway, repeating numbers that she can’t hear, and shouting ‘Bingo!’ when her own response is too faint to be heard, said Cave.
“She doesn’t come out of her room much, so I get right by her door,” said Bob Roy, 75, of Laconia, who helps his neighbor at St. Francis, and enjoys the role, which gives him joy.
“We’re like cheerleaders,” said Cave. “We have a megaphone we use. We’re doing similar things while staying safe.”
The continuing specter of COVID and its aftermath of uncertainty is like a tumbler of variables that have yet to line up. They will eventually determine what the new normal will look like for nursing homes, particularly when it comes to containing disease. At present, adaptations and resumption of pre-COVID life is occurring piecemeal in smalls steps. Some of COVID’s changes will stick, not because of coronavirus fears, but because they work.
Roy was transferred to Concord Hospital for two weeks when he came down with COVID when the pandemic hit St. Francis, which had survived for nearly a year without any cases. When Roy recovered he returned to quarantine, which was also required after he went to outside medical appointments to treat his Parkinson’s disease. For Roy and others, emotional survival has meant positive thoughts and self-talk, and immersion in safe group activities.
“What keeps me positive is thinking of my grandsons. I haven’t hugged them for over a year and they’re now five. A few of my friends passed away and that hit me hard. But we have great people here who keep you busy. My favorite thing is bowling, only because I win quite a bit.” The game involves rolling the ball down a makeshift alley lined by long foam “noodles” used by swimmers – a game that started before COVID, and continues now in small groups.
Roy’s other favorite pastime is being a roving ambassador of goodwill for residents who are more compromised than he is by their chronic conditions. Roy found a mission in raising spirits in midst of doldrums.
“I do make my rounds every morning, especially to the pretty girls. When I came in two years ago I said I’m not going to sit around and mope. You can tell when they’re very unhappy with some things. I tell them, ‘If you want me to take you, you can see if you like’” an activity they haven’t tried yet, or thought was too noisy or uncomfortable.
Some nursing home denizens miss the big meetings and getting to see familiar faces and chat, including Judy Wallace, 80, who has lived at the Belknap County Nursing Home for two years. The solitude “was getting to me. I got full of anxiety. It’s OK when we can go and do things. I’m an active one and it was tough. I like all the mix and mingle.” That includes playing bingo in a big room filled with group energy and the people she missed seeing, who live in a separate hospital wing. “We played bingo six to a table. Now we have to stay in our room. For a long time I was alone, and could only get up and go to the bathroom. We used to have wonderful entertainment that came in, and we all got together for that.”
In general, the resistant population seems more eager and at home when the same activity is offered in a smaller setting, including when required to wear masks and sit socially-distanced at separate tables. Instead of occurring once a week, the smaller groups occur twice a week or more, and draw more participants in total. In keeping with the culture of caution, but also personal circumstances and preferences, some activities are brought to rooms.
“Bringing activities to them, more people are taking part and able to do it in their own time,” said Twardosky. Small groups are also popular. “If you look at how we live in life, we don’t get together with 30 of our closest friends every day.” In the past, resident enjoyment has been calibrated by how many people show up for a group activity. “Getting it to be personalized, that’s gone over really well,” Twardosky said.
Overall, COVID-19 has required a mashup of accommodations, old favorites revamped to allow safety, or trials of new games and pastimes that seem to gel.
At Belknap County nursing home, "The Price is Right" remains a perennial favorite, second only to bingo. But now, instead of gathering in a room of 20 people, staff come room to room with "The Price is Right" cart, which contains appealing items that residents can no longer go to a store to buy. They guess the price of the things they like, including boxes of cookies or snacks, bottles of shampoo and conditioner, decorations for their rooms including small inspirational posters and picture frames, and pencil holders – things they would purchase if they could shop. The participant who comes closest to guessing the item’s price wins it. “They can bid on one or all of them,” said Twardosky – away from the scrutiny or pressure of peers, and without having to dress to show up somewhere. “We go room to room, resident to resident, and say, ‘Do you want to play Price is Right?’” and more frequently the answer is yes.
In the wake of COVID, more people seem to be enjoying crafts, now that they’re offered in smaller, more intimate settings, which seem to be more comfortable for personal expression. They also substitute ways of spending time that are out of the question for now, and the result has been more interest.
At Belknap County Nursing Home, crafts have shifted to making functional items that residents can use or enjoy in their rooms, including a painting a picture on a corkboard that can be flipped over to accommodate tacked-on photos, cards and mementos. They’ve painted pots to use as pen holders, and are about to learn tie-dyeing.
“We’re looking at what we’re doing not just as art, but how do we make it functional for them?” Twardosky said. “Having a lot of smaller groups has been advantageous. It’s kind of how we live.”
Another change has been the year-round celebration tree, which evolved when someone suggested keeping the nursing home Christmas tree up all year. Residents are coming up with different themes and seasonal ornaments they make themselves. “Whether it’s shamrocks for St. Patrick’s Day, or eggs for an Easter tree, it’s giving them a sense of purpose,” Twardosky said. They made butterflies and dragonflies for the spring tree now on display.
“The main thing is getting any sense of normalcy, even though we don’t know what normal is any more,” said Cave at St. Francis. “Anything that makes people feel normal again is just so important.”
The Sunshine Project is underwritten by grants from the Endowment for Health, New Hampshire’s largest health foundation, and the New Hampshire Charitable Foundation. Roberta Baker can be reached by email at Roberta@laconiadailysun.com