Dr. El
Dr. El

I spent most of last weekend doing what I could to avoid the 9/11-related headlines in the news. With my Manhattan-below-14th-Street recollections of the event, last year’s immersion in the pandemic epicenter and the continuing pandemic, I didn’t have the bandwidth for it. 

What I did find the energy for was a Speaking of Psychology podcast interview of Roxane Cohen Silver, Ph.D., a psychologist who studies the effects of trauma on individuals and communities. 

She discussed the notion of “cascading collective trauma,” by which she means multiple catastrophes experienced by large groups of people, one after the other, each one compounding the impact of the prior stressor. 

In “Coping with cascading collective traumas in the United States,” she and her co-authors note that “each of these crises may independently have mental health consequences for exposed individuals, ranging from short-term anxiety to longer-term depression and post-traumatic stress disorder (PTSD).”

The stressors that have occurred in the last year and a half, “the COVID-19 pandemic, an economic recession, race-driven social unrest and weather-related disasters,” have had a particularly strong impact on long-term care staff, who were grappling with multiple stressors while having direct exposure to COVID-19 losses. 

Promisingly, Silver et al. cite a study of community trauma that found reduced levels of PTSD in an area that had “more community commitment, integration, strong social networks and instrumental and emotional support.” In a location with similar stressors, but no such support and “high vulnerabilities, including limited education, low income and immigrant status,” there were “substantial symptoms of distress and PTSD.”

This research suggests that there are actions organizations can take to reduce the impact of cascading collective trauma. Given the well-known connections between trauma, burnout and turnover, and the state of staffing in LTC, this is an urgent and important matter.

Reducing collective trauma 

Organizations can consider whether everyday procedures are helping staff cope or adding further to collective trauma. 

Hiring new employees who didn’t experience the intense losses and exposure of working in LTC during COVID-19 surges would reduce the level of trauma in the overall workgroup; asking long-time employees to cover additional shifts or responsibilities due to insufficient staffing would not.

Offering EAP services or other supports for the emotional health of staff would assist with coping; expecting individuals to manage stress levels on their own would not. Making efforts to foster a culture of well-being, such as reminders to limit media exposure to distressing events or offering “instrumental support” such as transportation assistance, would provide supportive benefits; reprimanding workers who are struggling would not.

The impact of the larger LTC system could be considered as well. For instance, I learned of a situation where state surveyors declined to postpone an annual inspection at a facility that had been flooded that day due to a hurricane, with staffing impacted by flood-related transportation problems. 

As a colleague pointed out, considering the facility in Louisiana where, to avoid the hurricane, the residents were transferred to an unsafe warehouse, there are clearly instances where immediate oversight is needed. On the other hand, attending to residents while simultaneously relocating essential offices, cleaning up from a flood and responding to surveyors, puts more stress on workers and is indicative of a punitive rather than collaborative approach between surveyors and facilities in the mutual goal of eldercare.

By columns such as this, I can offer suggestions to reduce the impact of collective trauma in the LTC community. On a personal level, I can take actions to minimize my own stress levels, such as the aforementioned reduction in distressing media exposure.

When I do scan the headlines, I try to focus on positive news, such as tennis superstar Venus Williams writing a New York Times guest essay, “The thing that has really made me tough,” about how taking care of her mental health helped her maintain her competitiveness. Perhaps if we want to tough it out in the changing healthcare environment, we need to follow her lead.

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, visit her at EleanorFeldmanBarbera.com.

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.