Kathy Absolon is watching her mother peer out the main-floor nursing home window.

Behind the glass, the 88-year-old is beaming.

Outside, Absolon, her sisters and niece are drumming, singing their mother’s favourites, The Cherokee Morning Song and, The Bear Healing Song.

Jennie Absolon lives in the Region of Waterloo’s Sunnyside Home while recovering from a fractured elbow. A few residents, her new friends, pop up behind her, ushered in by staff. They all stand, watching through the window.

On a dollar-store whiteboard, Kathy writes the words, “Can you hear?” Jennie and her friends nod yes, with wide smiles.

In normal times, Kathy and Jennie would be playing the hand drums side-by-side, like the Absolon women of the Bear Clan from the Flying Post First Nation have always done.

In an attempt to limit the spread of COVID-19, the Ontario government has told long-term care homes to ban all visitors, except for residents who are dying.

Like influenza or other outbreaks that fell the most fragile, the novel coronavirus quickly found its way into long-term care. Homes in Oshawa, Stoney Creek, Markham and in Toronto, at the Sunnybrook Veterans Centre and Seven Oaks, have reported cases. New cases are reported, almost daily.

Kathy Absolon, with her sisters and niece, drum for her mother, Jennie, in front of Sunnyside Home, a long-term care home operated by the Region of Waterloo. Jennie, 88, can't leave the home while she recuperates from a fractured elbow, so her family connects with her from outside the home.

Overseas, COVID has devastated nursing homes. Reuters reports that dozens of residents in Italian nursing homes are dying each day.

Seniors Advocate Laura Tamblyn Watts calls long-term care homes in Canada “ground zero” for COVID-19, because the people living there are so fragile.

And yet, to keep residents strong, the homes must be full of life.

In nursing homes across Ontario, the requirement of self-isolation is threatening residents’ need for emotional engagement to remain vital.

Absolon knows that for her mom, living behind locked doors cuts deep.

“When she was young, she was taken from her family and put in a residential school. She wanted to leave. And when she couldn’t, she cried and cried.”

After the government issued the directive to close long-term care to visitors, Jennie asked if she could go out with her family for the day. The nurse had to say no.

“I told my Mom, we will call you every day to have that connection and contact,” said Absolon, an associate professor in the faculty of social work at Wilfrid Laurier University and director of its Centre for Indigegogy of the Indigenous Field of Study.

“We want to stay in contact so that she knows she is loved.”

In homes across Ontario, staff are helping residents see their families from afar.

“Window visits are becoming a thing,” said Lisa Levin, CEO of Advantage Ontario, which represents not-for-profit, charitable and municipal homes.

Levin said her association launched The Bright Lights in Dark Times Project to share creative ideas from homes, like asking children to draw happy-face pictures with messages for residents. In Vaughan, a chef baked and delivered St. Patrick’s Day cookies to a retirement home. (The ministry allows home-cooked meals as containers can be sanitized.) Others have started writing letters. “Seniors love getting letters,” she said.

Levin watched a video of Absolon and her sisters’ window visit.

“It was so moving...The sounds of the chanting and the drumming to me shows the sorrow, pain and hope at the same time.”

Staff at homes like the Rekai Centres, with homes on Wellesley St. and Sherbourne St. in downtown Toronto and Primacare Living in St. Catharines, Brampton and London, are organizing window-visit schedules.

Families arrange a specific time for workers to bring their loved one to a window for visits with grandkids waving or dogs with noses pressed against the glass. Families are buying white boards or Bristol board and colour markers, making signs that say “I love you Grandma.” Homes are also working with families to schedule virtual visits, through Skype or Facetime.

Before COVID-19, staff at Primacare Living had been going through training inspired by the Butterfly model. Now called Meaningful Care Matters, the program teaches workers to focus on the feelings of residents and the importance of social connections and purpose in day-to-day life. That training is now on hold but workers, who are screened before every shift for a temperature above 38 degrees or other COVID-19 symptoms and exposure, are asked to continue hugging and holding the hands of people in their care.

“What we cannot do in our homes is stop touching people,” said Primacare’s Jill Knowlton. “We have to hug people. … This is human, dignified care. The touch, the hug, the moments that say ‘You matter.’

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“The essence of humanity is human connectedness. And when you are separated the way we are in this particular situation, it is devastating.”

Social isolation protects against COVID-19, but other than a deadly outbreak, loneliness is considered one of the most debilitating aspects of life in a nursing home.

That’s why Tamblyn Watts, of CanAge, a seniors’ advocacy group, wants the long-term care ministry to ask operators to find ways to keep people emotionally connected to families, staff and each other. She tweets daily tips for seniors, families and homes, like Tuesday’s suggestion for a social-distancing sing-a-long to big band hits, everyone two metres apart.

“I’m not saying don’t fight the virus with everything we do, but the next most important thing we need to do is to ensure we are emotion-focused and to ensure wellbeing emotionally and mentally, otherwise older adults in long-term care will suffer twice.”

Before COVID-19, many residents were settled into the trusting routine of eating and dressing with the familiar face of a loved one. Without their presence, Dr. Samir Sinha believes many residents and hospital patients will now feel lost, leading to agitation, depression or even delirium, an acute state of confusion.

“A non-essential visit actually is an essential visit when (a relative) is the only person that they will allow to feed them or to dress them,” said Sinha, director of geriatrics at Sinai Health and the University Health Network.

“I think right now the goal of the ministry of health is to make sure these people are protected as much as possible from COVID. I think family and residents and staff are realizing that these directives have unintended consequences.”

Sinha said that last weekend a 103-year-old man in the hospital became agitated when the people caring for him were strangers, not his daughter or the caregiver who normally stays with him at his home 24 hours a day.

“Most of the government criteria (for visitors) that I’ve seen across the country, that are being quickly implemented, don’t talk about an older person with advanced dementia who is at high risk of delirium or behavioural issues,” he said.

“If we can’t meet their care needs, we know all too well that things can get complicated very quickly and their overall care can be compromised.”

At Sheridan Villa in Mississauga, administrator Marianne Klein tries to calm people, moment by moment. One of five long-term care homes operated by the Region of Peel, Sheridan Villa had been transforming its care model through Meaningful Care Matters training.

“The other day I walked out the elevator and one of our residents was playing the piano for other residents,” she said. Moments like this happen because staff empower residents to find purpose for themselves and others. At the Davis Centre in Bolton, in the early stages of emotion-focused training, art therapy classes continue with the teacher connecting through Skype projected onto a large screen.

Klein is also turning her attention to staff, to support those who are trying to juggle jobs with families and keep everyone healthy. It’s a struggle in an industry that is constantly short-staffed.

“I came in this morning and talked to one of my staff and it almost brought me to tears, because she spoke about her situation and childcare,” Klein said.

“I told her, ‘I understand how you feel, because I have a 12-year-old daughter.’” Klein’s voice cracked. While there were no cases of COVID-19 in Sheridan Villa, Klein said she is living alone so there is no risk of cross-infection.

“For the last week my daughter has been staying with my parents who are also pretty high-risk and I am keeping pretty close tabs on all three of them.”

This week, the ministry of long-term care issued a temporary order allowing homes to redeploy staff as needed to different jobs throughout the home.

When the Region of Waterloo closed its three seniors’ day programs, those workers were sent to the Sunnyside nursing home to focus on resident engagement, including arranging window and virtual visits.

“We know there are a lot of people who don’t have family or friends or their friends are in the community and they can’t see those people anymore,” said Connie Lacy, the region’s director of seniors’ services.

Jennie Absolon knows she is blessed with daughters and a husband who visit her, holding window tea parties or drumming circles.

She loved watching her family performing outside. “I just feel so thrilled. I feel so good that I am holding it in my heart.”