Dr. El

As the number of coronavirus cases increases around the world, providers may be worried about the emotional impact of the outbreak on residents and how to handle it. One would expect residents to be concerned, given that they’re at higher risk due to their ages, underlying health problems and residence in a communal setting.

Rather than mass panic, my experience and an informal query of my psychologist colleagues suggests that they may not be as worried as you’d think. As of last week, remarkably few of them have raised the issue in psychotherapy sessions (where uneasiness of every kind is discussed). 

My colleagues and I speculate that the majority of residents are not unduly alarmed about the situation due to a combination of factors: more pressing problems, successful passage through many prior hardships, fatalism (i.e., “At this age, something’s going to get me”), denial (“it’s happening far away”), and trust that the facility will keep them safe. 

Nevertheless, despite their general calm and resilience, it’s perfectly reasonable for residents to have questions and concerns. There will be some who are deeply unsettled by the prospect of the virus, particularly those with anxiety disorders and people struggling with depression. There may also be individuals who have had past traumatic experiences with hospital-acquired infections, isolation precautions, or communicable illnesses such as polio.

Facilities are no doubt reviewing infection control procedures and holding staff education sessions for their employees. To address the emotional needs of residents, add a brief segment to staff training that includes the following suggestions:

  • Limit the amount of time residents spend watching the news. There’s no need for them to be exposed to hours of alarming reports on the day room television. 
  • Reassure residents by informing them of the steps the facility is taking to manage the situation, such as limiting visitors who are ill, providing additional staff training on infection control procedures and screening new admissions. 
  • Provide similar information to family members to reduce the amount of anxiety within the family system.
  • Redirect residents from frightening “what’s ifs” to the current focus on prevention.
  • Increase resident sense of control by reminding them that they can follow Centers for Disease Control and Prevention recommendations to cough or sneeze into tissues or sleeves, wash their hands, use hand sanitizer and avoid touching their faces.
  • Remind staff members to refrain from having potentially anxiety-provoking discussions in front of the residents. An example of an anxiety-provoking comment would be something like, “If the coronavirus comes here, I won’t be coming to work.” 
  • Observe residents for symptoms of heightened depression or anxiety. In addition to typical signs such as tearfulness or increased neediness, look for repeated mentions of the coronavirus, excessive hand washing and escalating worry about dying.
  • Refer distressed residents to mental health team members, including psychologists and social workers and, if necessary, psychiatrists. 
  • Make good use of therapeutic recreation to engage residents in positive, absorbing activities.
  • Encourage anxiety-reduction strategies such as meditation, prayer, exercise (for example, stretches or chair yoga), contact with family and friends, and pleasant, private pursuits.

Following the above recommendations will help support the trust residents have in their nursing homes to protect them from the coronavirus and from the fear of contagion.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her award-winning website at MyBetterNursingHome.com or her new website at EleanorFeldmanBarbera.com.