The coronavirus pandemic has largely impacted the mental and emotional health of the masses. Residents in skilled nursing facilities (SNF) represent the vulnerable population that has been greatly affected by the excruciating effects of the COVID-19 outbreak, in terms of their psychological health and general outlook on life. Multiple surveys in developed countries have reported a significant number of deaths in nursing homes due to the outbreak of coronavirus disease. Due measures are in-practice to minimize the spread in nursing homes but its harmful psychological effects are mostly overlooked and attract very little attention.
Table of Contents
This situation demands the implementation of certain strategies to help residents maintain a good level of spirit and to promote a sense of safety and comfort in them. The administrators and staff in SNFs should ensure the effectiveness of these implemented measures from time to time, to maintain a healthy environment within facilities.
Here are the few key interventions for neutralizing the depressing and agonizing effects of coronavirus outbreak among residents in SNFs:
1- Reducing environmental stressors
The fact that most of the residents are old, incapacitated, enervated, and sometimes immunocompromised makes them more vulnerable to come in contact with COVID disease. Since the coronavirus has surfaced, a vast majority of people including the elderly, have been found to be consistently watchful of the strained hospital systems, saturated healthcare facilities, and the rising death toll. To maintain an optimal level of emotional health, this exercise has to be minimized in all the residents as well as staff. Especially, it has to stop from being practiced by chronic patients with serious illnesses. Stressful screen time should be reduced and replaced by simple healthy activities. It also includes limiting the intake of disturbing news whether regional, national, or international. Moreover, extra efforts might have been required to create a calm and pleasing atmosphere in SNF settings by the collaborative efforts of staff. In view of this, meeting agendas should be set for staff meetings and exercised efforts should be documented as well.
2- Frequent virtual family meetings
Although the need of bonding with family members augments during such uncertain periods of lockdown yet unnecessary visits from family have been discouraged to maximally prevent the exposure of virus in residents. This has resulted in an extra layer of melancholy among residents living in SNFs and nursing homes. To ease up the stress, drive-thru family visits or window meetings can be set up while maintaining all hygienic principles.
In all cases, virtual meetings should be adopted as a daily ritual for all the residents. Arrangements should be made to promote video chats and the resources should be upgraded so that the communication process can be smooth and effortless. An example of such an initiative was seen in New Brunswick in April 2020 where iPads were supplied to SNFs by their government, one per every ten residents, to facilitate connection with family members (McArthur et al. 188).
3- Organizational measures
In addition to offering emotional care to the residents, SNF administrators should also take due measures to minimize staff burnout since they play a key role in maintaining an ultimate caring environment. Redeploying the staff, offering incentives, and improving compensation are some tools among many others, to enhance their engagement for mitigating lockdown distress.
Secondly, therapists and counseling coaches should be hired for counseling and training sessions where the interaction can be made possible by either visiting SNFs or through telemedicine. Nursing students and internees can also be considered for empathetic and engaging conversation sessions with residents.
Lastly, SNF marketing teams should highlight the valuable actions that are being practiced (in view of COVID pandemic) in their nursing facility, to let the residents’ families know that their loved ones are receiving optimal care. For this purpose, additional FAQ sections can be added or video virtual tours of SNFs can be tailored according to the current scenario.
4- Group counseling and individual therapy
A study evaluated the effects of COVID pandemic lockdown on residents’ mental health in 765 residents in seven long-term care facilities in Canada. It concludes that the adverse psychological outcomes associated with lockdown can be lessened with thoughtful and timely interventions as well as through ongoing evaluation with clinical information systems (McArthur et al. 188).
SNF settings should be regularly visited by doctors and other therapy professionals. Regular visits should be ensured to offer in-person therapy sessions or via telehealth. Measuring scales for evaluating the symptoms of depression, delirium, and mood disorders in residents can be taken from such studies or can be created according to SNFs parameters. The above-mentioned survey used a ‘summary scale of depressive symptoms’ using mood evaluation through simple questions. Simple parameters such as changes in usual functioning, mental clouding, worsening health outcomes, episodes of disorganized speech, altered mentation,
lack of interest in activities, and other factors can be taken into account. Results can be evaluated by comparing these parameters for before and after pandemic onset.
Those requiring psychiatric or psychological consultation should be dealt with as early as possible to prevent long-term sequelae. Aged patients suffering from neurodegenerative diseases or psychiatric disorders should be given extra support and care.
5- Interactive and regularly updated activities calendar
In view of the virus outbreak, the residents’ annual calendar of recreational activities can be modified. The collective activities should be halted or practiced with utmost care based on the current pandemic scenario. However, individual entertainment and leisurely pursuits should be amplified. Comedy TV programs or social media plays involving humor and appeasing element, can prove beneficial in this regard. Interesting snacks, mini treats, and certain programs (e.g., meditation, or music therapy) are also some simple means to mitigate anxiety. Spiritual practices can also be emphasized among residents for attaining a state of calm and serenity. All virtual means should be adopted to promote engagement and confidence in residents.
Studies measuring the effects of isolation and sickness on an individual’s health have mentioned that social isolation can produce long-term fight or flight stress response that can negatively affect overall bodily functions. Thus, there is a dire need to change the perception of the drastic effects of social isolation on residents.
Effective and timely interventions can be very helpful for promoting a healthy culture in SNFs. Investing in such interventions and preventive measures is far better than the corrective actions necessitated by the poor mental health outcome in the elderly, caused by the tormenting effects of the COVID-19 pandemic.
McArthur, Caitlin, et al. “Evaluating the effect of COVID-19 pandemic lockdown on long term care residents’ mental health: a data-driven approach in New Brunswick.” Journal of the American Medical Directors Association 22.1 (2021): 187-192.