Dr. El

We hear a great deal these days about those who have died from COVID-19, but thankfully there’s also a large group of people who have survived the virus. 

In New York, stable coronavirus patients have been discharged from hospitals to segregated units in nursing homes and I’ve had the chance to talk with many of these individuals in recent weeks. This column focuses on my clinical impressions of their mental health status.

Who they are

The residents with whom I’ve spoken were cognitively intact and referred for psychological evaluation due to symptoms of depression identified on the Patient Health Questionnaire (PHQ-9). Unsurprisingly given the circumstances, most new admissions have some signs of depression. 

While short-term rehab units often receive clients from assisted living facilities and group homes such as those for people with developmental disabilities, there are more of these folks than usual. They join the majority who come from private houses or apartments. As one would expect in New York City, it’s an international crowd. 

How they’re coping

While, of course, each person has distinct experiences, I noticed several types of responses to COVID-19. 

Some residents, despite their initial depressive symptoms upon entering yet another unfamiliar medical environment, are almost giddy with relief that they made it out of the hospital to recover from the virus. Others are calm and accepting of the situation, expressing a feeling that God has helped them through. I don’t find that they require psychological services, but they’re uniformly glad that support was offered and that it’s available during their stay should they feel the need.

My observation is that most of the people in the above category were those who were able to maintain contact with their loved ones via their cellphones during their hospitalization. Lack of telephonic contact, in addition to the imposed restrictions of visitors while in the hospital, almost uniformly thrust people into the following category.

The next group of residents are those who don’t have a history of mental health problems, but they find themselves understandably anxious and/or depressed due to the combination of the usual extreme stressors of nursing home admission, plus factors associated with COVID-19. 

In addition to sudden physical illness, hospitalization, transfer to a new location, roommates, insurance hassles, the challenges of the rehabilitation process, etc., there are coronavirus-related issues such as a lack of in-person contact with family members, the frightening diagnosis of a novel coronavirus and living through a worldwide crisis. These residents get a great deal of relief in discussing their experiences and they use the weekly sessions as a touchstone during an extremely uncertain time in their lives.

Individuals with underlying mental health problems find their conditions exacerbated by their illness and the pandemic, with worrisome levels of depression, anxiety, psychosis or acting out behavior that require close monitoring and, at times, psychiatric intervention.

Another group of residents, with or without a prior mental health history, has encountered severe trauma in addition to that associated with their physical illness and above-mentioned stressors. In an unfortunately typical scenario, more than one household member was hospitalized with the virus but not all survived. I’m therefore counseling several people who have recently lost spouses or other loved ones, find the rituals of mourning disrupted due to the pandemic, and are anticipating returning to a very different life upon discharge.

In addition to my formal caseload, I’ve “adopted” some people on the unit, who seemed in need of psychologically-minded TLC (tender loving care) but were not candidates for formal psychotherapy due to cognitive impairment. 

For example, the roommate of one of my patients arrived at the facility listless and withdrawn. He didn’t respond at all to my welcoming comments and subsequent hellos. A week or two later, he began to appear in the dining area in a geri-recliner and seemed to perk up when I waved at him. I snooped in his chart, discovered he was an artist, Googled his amazing work and printed it out to show him and the nurses. And so they could hang on his wall. Week by week, he got stronger in rehab, moved to a regular wheelchair, ate more food and could sustain a brief chat. It’s clear he’s well on his way to returning home and it’s been phenomenal to observe the hard work of my teammates and the strength and resilience of this man. 

In other cases, some of the residents seem to have adopted me, such as the lady with the lovely, wise eyes above her mask who sits in the now reopened common room and greets my daily, “Good morning, everyone!” with a hearty wave. (Psychologists, like everyone else, appreciate feeling seen and heard.) 

The more I do this work, the more apparent it is to me that mental health support is essential, regardless of whether or not there’s a global catastrophe. The devastation of COVID-19 can be an opportunity to rethink our priorities both individually and as an industry. If we seek to create a strong foundation going forward, we’d be wise to pay more attention to our own mental health and that of the residents, families and staff members who live, visit and work in our nursing homes. A good start, in my opinion, would be to refer all new residents for a psychological evaluation, rather than using the current piecemeal approach.

(I talk more about my Covid-19 perspective in this recent interview on The Nursing Home Podcast.)

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 andGold 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 at EleanorFeldmanBarbera.com.