Nursing home residents are among those hardest hit by the COVID-19 pandemic: They make up more than 40% of those dying from the illness in the United States, according to the Centers for Disease Control and Prevention. To improve outcomes for these vulnerable older adults, in June, MITRE, a nonprofit organization that manages federally funded research and development centers, formed the Commission on Safety and Quality in Nursing Homes, a group of long-term-care experts charged with identifying ways to slow the spread of the virus in nursing homes and improve residents’ health and safety. The commission’s recommendations are expected out this fall.
The sole psychologist on the commission—which also includes infectious disease experts, nursing home directors, academics, state authorities and others—is Palo Alto University professor of psychology Lisa M. Brown, PhD, ABPP, an expert on the impact of disasters on nursing home residents. Based on her research and experience, she believes that psychological first aid principles—which focus on assessing and supporting people’s resilience—can enhance infectious disease control activities.
“Training all nursing home staff in psychological first aid just as they are in medical first aid and cardiopulmonary resuscitation can significantly benefit quality of care during this difficult time,” says Brown, who is also president of APA’s Div. 20 (Adult Development and Aging) and worked for the Florida Department of Health from 2007–14. Use of psychological first aid techniques empowers staff, supports positive communication between staff and family members and provides ways to appropriately assist residents who may be feeling anxious, depressed and lonely during this challenging time, she says.
The Monitor talked with Brown about how psychology research can help nursing home staff and residents manage the COVID-19 crisis with greater confidence and resilience.
Providing good mental health care in nursing homes is challenging at any time. What additional issues are facilities facing now?
Feeling connected is key to the well-being of long-term-care residents, and the ability to foster that sense of connection is one of the most important qualities of good staff. When you suddenly must maintain physical distancing and cut off family members who can’t enter these facilities—those are different issues than what you see in more typical disasters such as hurricanes.
Because maintaining connections is so powerful, using good mental health practices and psychological first aid can and should go hand in hand with evidence-based infectious disease control practices. If people don’t feel psychologically connected or cared for, they are less likely to cooperate with physical distancing and quarantining measures.
What are some best practices to help foster that sense of connection?
One is to keep in mind that words are very powerful. Certified nursing assistants, for example, are trained to provide physical care but not necessarily on how to interact interpersonally with residents from a range of backgrounds. Use of psychological first aid can help staff with no mental health training talk to residents in ways that could improve how residents react and cope with difficult situations.
That training can also teach staff how to integrate good verbal and nonverbal communication skills into infectious disease control processes. For example, rather than tell residents that they have to physically distance so it feels like an order with no end in sight, they can explain to residents that they know that isolation is difficult but that they are following evidence-based guidance to reduce the risk of illness to residents, their families, friends and staff.
What other strategies can nursing homes use to foster a sense of emotional connection right now?
Psychological first aid would also encourage staff and family members to keep in mind the power of perceived social support, which is essentially a measure of how residents subjectively appraise their situation, rather than a reflection of how much objective support is being given. For example, while regular phone calls or letters can’t replace in-person visits, they can provide perceived social support that buffers residents from many of the deleterious effects of quarantine or distancing.
On a smaller scale are little things that staff can do during a time when residents can’t meet together for safety reasons. Some residents might benefit from what I call “boredom busters”—easy strategies that aren’t terribly time-consuming or that depend on gathering with others. An example is setting up a tic-tac-toe game outside a resident’s window so that friends can play with the resident, who is safely inside. Another is setting up a bird feeder outside and encouraging residents to keep track of the types of birds that come to feed.
There are many different types of nursing homes and facilities. Does that make it difficult to disseminate and implement these ideas?
From my research and that of others, it is evident that most facilities, directors, administrators and owners are actively looking for evidence-based guidance. In my experience, most nursing homes strive to do the right thing. Most staff have close relationships with residents and feel a deep sense of responsibility for their well-being. And when you read the biographies of the people selected to serve with me on the commission, it’s clear that they too are invested in and deeply care about making the nursing home system work well for everyone. It is my hope that nursing homes, staff, residents and their families will be able to benefit from our recommendations very soon.
