Gigi Acevedo-Parker

The elderly of our society were among our most vulnerable even before the COVID-19 pandemic, but those living in senior care settings might be most at risk.

It’s not just the heightened risk of contagion and perhaps death for seniors residing in close proximity, especially if they are already suffering from chronic underlying health conditions that have physically weakened them. The very fact of the pandemic has a significant psychosocial impact, causing anxiety, fear and apprehension. That’s worsened when a key strategy for blocking the virus’ spread, social distancing, exacerbates their isolation, loneliness and often depression.

The original health crisis has given rise to a “pandemic of despair” that is rampant among skilled nursing facilities. It poses a health issue that must be moved to the forefront of every organization’s care program. The importance of the correlation between mental and physical health can’t be underestimated. When the mental health of residents starts to decline, physical health outcomes follow the same path.

Responding to this particular pandemic forces a balancing act of every facility’s frontline staff. They must be able to recognize the behaviors that signal growing emotional issues among their residents so that mental and physical declines don’t go hand-in-hand. They must be aware of their residents’ needs. And they must respond with sensitivity.

It starts with education, and much of this will be fairly basic. The fact is that staffs know their residents. They know when behaviors are off. They just need to be coached and, importantly, they have to be trusted that their cues are on target. Here are some to think about:

  • Generally speaking, residents with declining mental health may become more withdrawn, less engaged. When they have opportunities to interact outside of their rooms, they may decline. They may seem less “connected.” Where they previously may have laughed and joked with other residents, staff or their family, now they barely meet others’ eyes.
  • Residents may be preoccupied with television, particularly with issues concerning the pandemic. The substantial stress generated by “information overload” can lead to paranoia and healthcare-related mistrust. Today’s environment is also rife with misinformation, which can add uncertainty that also has a negative emotional impact. 
  • In group settings, the staff knows the residents and can usually tell when behaviors or attitudes are off. Others, however, like supportive apartment residences, are inherently less well-equipped to identify issues. That makes education on signs of emotional distress important. Opportunities to observe also should be identified and shared. 
  • Another issue is recognizing cues in those with issues like Alzheimer’s disease or dementia. Here, exhibiting a totally unusual behavior, like a normally docile person physically striking out, is one sign that emotional pressures are building.

Every facility should have written protocols on how staff should proceed if residents are showing worsening signs of withdrawal or depression. Their first stop should be to take the cues they have documented to the resident’s medical provider, who is the best person to address what actions or treatments are necessary and who is best suited to step in.

Any number of specialists may be tapped to intervene. The residential setting will likely influence this decision.

Additionally, during the pandemic, telemedicine has become popularized as a care delivery mechanism. That has made it as valuable and relevant to seniors for physical and mental health services as it is to the general population.

Skilled nursing facilities are reopening and relaxing their restrictions slowly as the pandemic continues to advance. That’s a pace which is exactly what’s needed after being the epicenter of some 45% of U.S. [1] COVID-19 deaths. But what shouldn’t be neglected with the focus on resident health and safety is the need to make mental health integral to that mix. That includes sorely needed activities to stimulate residents and encourage them to re-engage again.   

Gigi Acevedo-Parker is national practice leader for Clinical Risk Management for Hub International. She is a nurse executive with more than 30 years as a healthcare clinician, nursing leader, healthcare consultant and educator with a focus on healthcare risk mitigation and patient safety.