Protecting nursing home residents during COVID-19

Many of the 1.3 million residents in U.S. nursing homes are already at risk for loneliness, which research shows can undermine their physical and mental health. Now, during the COVID-19 pandemic, these vulnerable adults are facing even more stress due to fears about contracting the virus — and those fears are exacerbated now that the support they typically rely on, like organized activities and visits from friends and family, are no longer available.

“Social isolation is impacting everyone, in every nursing home around the country because people are stuck in their rooms by and large,” says Eleanor Feldman Barbera, PhDopens in new window, columnist for McKnight’s LTC News and psychological consultant in New York-based long-term care facilities.

To improve residents’ mental health during this traumatizing time, psychologists are applying their research insights about aging adults and providing resources for residents, families and staff.

For nursing homes who have residents ill with COVID-19, there’s an even more urgent need for psychological support. Barbera notes that up to one-third of nursing homes in the country have been directly affected by COVID-19, and according to recent reportsopens in new window, upwards of 10,000 nursing home residents have died from the virus as of late April.

Barbera says psychologists have a responsibility to encourage facilities to flag residents most seriously affected by the virus so they can receive the care they need. “There are people coming in who have just lost a family member from the virus, or their loved one is still in the hospital,” says Barbera. “There’s an enormous amount of high-level trauma going on.”

Psychologist Karen Fingerman, PhD, a professor of human development and family sciences at the University of Texas at Austin, says the kind of family separation COVID-19 is causing isn’t just breeding loneliness, it can instigate grief for residents separated from children or spouses.

“Being separated from someone you love goes beyond isolation; it’s a loss of something that can’t be substituted,” she says. “The loss of connection is pretty profound.”

Psychologist Lisa Brown, PhD, ABPPopens in new window, a professor of psychology at Palo Alto University who researches trauma, stress and aging, encourages psychologists to brainstorm with residents’ loved ones to identify ways to connect when face-to-face options are not possible for the foreseeable future. She regularly sends cards, old family photos and inexpensive gifts to her father, who lives in an independent senior living community. She also calls him a few times a day and encourages her siblings to do the same, so that he has ongoing communication with loved ones. Variety paired with regular contact can help mitigate monotony, isolation and uncertainty, which Brown says can be toxic for nursing home residents.

Even though residents are grappling with increased stress, mental health care isn’t always available in nursing homes. In some long-term care facilities, Barbera says, social workers are under immense strain and outside psychologists aren’t being allowed in.

By using telehealth — or doing in-person visits wearing appropriate personal protection equipment — psychologists can focus on stress reduction, normalizing emotional symptoms and whenever possible, connecting residents with loved ones, says Barbera. It’s also important for mental health workers to prepare residents who will be released during or after the pandemic for the changes they will encounter in their communities, she adds.

If psychologists use telepsychology for nursing home residents, they need to be sure that older adults are not overwhelmed or unable to use it, notes Lisa Lind, PhDopens in new window, chief of quality assurance at Deer Oaksopens in new window, a behavioral health provider focused on providing psychological and psychiatric services in long-term care across the U.S.

As of April 30, the Centers for Medicare and Medicaid Services expanded Medicare coverage for audio-only phone services during the pandemic. This change is critical for residents who might not know how to operate video devices or residents with certain conditions whose symptoms could be triggered by a voice speaking through a computer. Telehealth is also limited by the availability of facilitators, as nursing home staff are already flooded with taking care of residents’ direct care needs.

It’s also important for psychologists to be vigilant about looking for more subtle signs of anxiety and depression in residents, working with staff to identify potential negative effects of the pandemic and determining the appropriate screening tools, says Lind.

“For depression, we normally look for isolation or withdrawal as symptoms, but since residents are quarantined and exhibiting these behaviors on a daily basis, mental health providers need to look for signs like increased negative thinking or worrisome thoughts,” she says.

Since facilities may not have the resources to flag patients who need psychological care, psychologists may also want to reach out to patients, both those with a history of trauma and mental illness and those who may simply be struggling with isolation or changes in routines.

“Older adults, and especially those individuals with a history of trauma, benefit from feeling safe and secure in their everyday lives, and when a normal routine changes, it can result in increased anxiety,” Lind says.

Beyond supporting residents and their families, Barbera says psychologists have a unique opportunity to support nursing home staff, who are stretched thin caring for residents. The first course of action, she says, is for mental health practitioners to help them address self-care and stress management so they can continue providing necessary care for residents.

When possible, psychologists should also offer best practices for compassionate care and de-escalation to nursing home staff, who may not be trained in these skills. “Since staff are likely doing their best to just cover basic care, psychologists can come up with innovative ways to give materials, supplies and support to them so they don’t have to build the airplane while they fly it,” Brown says.