Paul White, Ph.D.

The last 18 months have been brutal for virtually everyone and every position within long-term care. Long hours, isolation from family and friends, implementing new polices and procedures due to COVID-19, making deeper relationships with residents and then losing those friends, personal stress due to childcare and schooling issues, fear for one’s own safety . . . the list of stressors seems endless.

The seemingly endless nature of the challenges adds to the emotional drain.  Initially, what was viewed as three to six months of “crisis” turned into 12-15 months of survival. Then glimmers of hope arose with vaccines being given and the rates of infection declining – to the point that many facilities began to “open up,” resulting in friends and family being able to visit their loved ones.

But the initial light of hope has dimmed again – with the rise of the Delta variant of COVID-19 and the increase of individuals being infected by the virus and the potential for reinstating measures to stem the spread of the disease. The uncertainty of the future clearly increases the anxiety for all. 

What kind of race are we running? 

Fairly early on, we realized this season was not going to be a sprint and we tried to pace ourselves for a long distance event.  Somewhere between six to 12 months into the pandemic, the situation was looking more like a marathon.  But now it seems we are going to go beyond a marathon – but to what?  Some may say “a new way of life,” but I wonder if a “journey” may be the best picture of where we are and where we are going.

Journeys are accomplished day by day.  You get up, get ready for the day, take your bearings and head out toward your goal. Steadily. Persistently. Deliberately. 

Why determining what may lie ahead is important

No one who is personally acquainted with those who serve our elders and disabled questions the emotional drain experienced by the frontline staff, managers and administrators in these organizations.  But the reality (currently) is: the job isn’t done yet, and “we have to continue to serve, because if we don’t, who will?”

A key message to anyone in some form of leadership is: you and your team members are in the midst of a long journey and you need to think and plan for this.  Why? Because understanding the priorities needed and the decisions which will follow will likely determine whether you (individually or as an organization) will survive the trek.

Understanding stress

Understanding the nature of stress is key to surviving a long demanding journey.  Often, stress is described as the experience when the demands in one’s life are greater than the resources to meet those demands.  We experience stress when we have too much work to do in comparison to the time and energy we have. This can obviously occur in the social and emotional realm – we become stressed when the emotional demands of our job are greater than the emotional resources we have to cope with them.  Working long hours with challenging residents (and  difficult family members) would clearly overwhelm almost anyone.

The reality is – stress is more complicated than this definition.  In reality, stress is the result when perceived demands are greater than perceived resources. This perceptual component is important to understand if we are going to successfully manage the stress in our lives created by extraordinary circumstances (the pandemic) and also fewer resources to meet those demands (e.g. lack of adequate staff).

We can (and do) increase the stress in our lives when we create higher than necessary expectations for ourselves and those around us.  For example, if your organization historically has done “above and beyond” meals once a month in prior years, given the lack of available staff, you may need to reconsider whether this is a current priority.  Retaining the high expectation is the result of a perceived demand on resources rather than an actual demand.

Similarly, the stress we experience (both individually and corporately) increases when we don’t allow ourselves to access available resources to meet daily demands because of how we think about those resources.  For example, routinely not taking breaks (including lunch) because “there’s too much to do” will eventually wear a person down. 

Steps for reducing your stress

Incorporating this model of stress is vital for successfully coping with the daily demands in your life and how you lead others.  This model provides four different ways to reduce the stress we experience in our lives:

  1. Reduce perceived demands.  Take all of those expectations of “the way things should be” when life was “normal” (pre-pandemic) and critically evaluate them.  Are my expectations for myself and for others too high?  Are they realistic and sustainable given our current circumstances?

 2.Reduce actual demands.  This may seem impossible, but it’s not.  Yes, there are demands you have to meet (if you are going to continue to be a licensed provider of services).  But there are also activities, habits and traditions that have developed over time (and are good things to do when you have the resources) that currently are not needed in order for you to survive the current ordeal we are going through.  No, you don’t have to organize a field trip to the zoo or do the annual holiday pageant at the local theatre. 

  3. Increase perceived resources. Times and circumstances occur where we have access to resources, but we won’t allow ourselves to access them. The simplest example is asking for help.  Sometimes we have more tasks to accomplish within a time period than we realistically have the time or energy to do so.  One solution is to ask for some help from a colleague. But for some (including all groups – professionals, clinicians and frontline staff), asking for help is anathema – against a strong belief they hold that asking for help displays weakness on their part.  

But this limits accessing resources that are available.

 4. Increase actual resources.  Again, this may seem impossible – we all only have 24 hours in a day, and financial resources are limited.  But there are ways we can create additional resources.  We get more energy when we rest and sleep.  Recreational activities are designed to help us re-energize – listening to or playing music, engaging in artistic and craft activities, playing games, socializing with friends, laughing and exercise – all are ways we can create more resources to cope with the demands in our lives.

When we combine some aspects from all four areas, the results can be significant.  The stress we then experience then is, at least, manageable. 

Learning from those who have gone before us

The COVID-19 pandemic is not the first health crisis to threaten the health and ongoing existence of societies and countries.  Additionally, there are (unfortunately) numerous man-made disruptions that lasted for years which individuals and families had to struggle through in order to survive – the U.S. Civil War, the Thirty Year War in Europe, and World War II.  Fortunately, we can learn from those who survived these long-term tragedies.

Probably, the most poignant examples come from those who survived the Holocaust.  They were victims of long-term social denigration and ostracization, economic discrimination, isolation, emotional trauma and physical torture – to the point that millions lost their lives.  But some who survived the concentration camps shared how they survived, and the mental component was usually at the center of their strategies – maintaining hope, focusing on the “little things” that brought beauty into their lives and remembering those who were important to them. (A great example is the book Man’s Search for Meaning by Viktor Frankl.)

One lesson is this – while none of us are truly in control of the forces that shape our lives, we are in control of our daily choices and of how we choose to perceive the circumstances we find ourselves in.  One hallmark characteristic of those who survive difficult times is gratitude – being thankful for what you have now and what you’ve been blessed to experience in your life.  Being grateful helps us focus on the positive aspects of our lives rather than giving all of our time and emotional energy to negative circumstances over which we have no control.

Paul White, Ph.D., is a psychologist and co-author of several books, including the best-selling The 5 Languages of Appreciation in the Workplace and Rising Above a Toxic Workplace.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.