No level 3 for the elderly: SA's old-age homes are ghost towns, stuck in hard lockdown

Surreal, surreal, our favourite new refrain: a tattoo in my mind as my mother and I held hands, I sniffled, and we followed an immaculately clad matron around the empty halls of the senior living facility we were exploring that day, behind our masks.

A huge, sparse, modern environ, its uplifting architecture could not detract from the fact that the place was bereft of the community that ordinarily enlivens it. Unable to congregate en masse in common areas, cut off from visitors and external personnel, the residents of this pretty, polished domicile are adrift in a weird Covid limbo all of their own.

My hardy little family's experience of the Covid-19 saga thus far has been manifestly coloured by the fact that my formerly indomitable grandmother is being eaten alive by Alzheimer's, a disease we can neither understand nor deter once it takes hold.

Hers is a foul fate, and it's making my parents' lives extremely difficult. She moved in with them a year ago, and since the beginning of the lockdown they have had to contend alone with her daily misadventures, in addition to working from home like everybody else.

Sometimes, rarely, we can laugh about it. I hear reports that she put the kettle in her handbag and tried to leave, she's hoarding Easter eggs, she's tried to pawn the pair of slippers my mother bought her an hour before.

Most of the time, though, it's only raw and horrifying, an interminable series of assaults on my grandmother's dignity and my parents' sanity. It's fast becoming apparent that they are in over their heads: all the love in the world can't compensate for their lack of training and experience in caring for someone with ever-worsening dementia.

As a family, we're privileged enough to have options, which is not the case for many South Africans. We're struggling, and we think it's time to move her. We're also in the throes of a pandemic.

There's still so much stigma associated with commending an aged relative to the care of strangers, especially given the monetised, fundamentally corporate nature of most elderly-care facilities. It's been my experience that people change their tune about the pitfalls of this solution very quickly, however, when they find themselves responsible for an ailing parent with certain medical and psychological needs.

A 2011 census indicated that there were about 2.2-million people living with dementia in SA. According to Alzheimer's Disease International, as at 2015 an estimated 46.8-million people were living with the disease worldwide, and this number is expected to double every 20 years.

Right now, most of our social infrastructure is simply not equal to our prolonged lifespans, which is where elderly-care facilities come into play. In SA, the good ones are expensive and excellent, veritable oases for the elderly in a world that otherwise outpaces and ignores them. Right now, though, even the best of these are undergoing a serious trial, albeit with grace and without much fanfare.

Since the outbreak of Covid-19 in a number of senior-living communities in the Western Cape in particular, most of these institutions have gone into hard lockdown, and are having to do without many of the experiences that ordinarily make their elderly residents' lives more pleasurable.

"We knew before lockdown began that our staff would probably be the highest risk in terms of entry and exposure," says Christel Vermaak, the HR manager at TotalCare, which boasts a variety of top-of-the-range "older person" facilities across SA. Their adaptation to the contingencies of the virus has been radical, efficient, and compassionate - none of which can entirely compensate for the terrible loneliness some residents are experiencing.

"In all our facilities now, all the care personnel stay on the premises. We provide beds and meals, and have adopted seven-day shift cycles," says Vermaak.

"Basically, we've stayed in level 5 lockdown. No visitors are allowed. Normally, entertainment is a core part of our model - we have daily wellness activities, entertainers, a dance school. We have a hairdresser. Now, our staff is doing its best to facilitate arts and crafts, to paint nails and blow-dry hair and host singalongs. But it's not the same, and of course residents miss their families."

To the best of their ability, these spaces are introducing virtual alternatives to daily or weekly visits, but, given the age demographic, it hasn't been easy.

In practice, these interventions on the part of staff and management mean that senior living facilities are shells of their former selves. Their doors are locked - miniature ghost towns where lobbies and common areas ordinarily pulsate with life. Gone are the agents of diversion, like piano players and lounge singers, who intermingle with and entertain a bevy of care personnel, residents and visiting friends and family members.

Whatever your preconceived notions about dreaded "old age homes", these spaces are in many ways sacred and precious because they foreground the needs and experiences of the elderly, rather than eliding them.

Now, in the best interests of this especially vulnerable contingent, they are all but barren, and quiet, and still. It's weird. And it's really sad.