Michael Fragala, Ph.D.

During the current pandemic, multiple concerns have come to fruition within the long-term care, post-acute care industry. Two major factors that have arisen are around infection control and staffing. Due to these factors, many changes have occurred almost on the fly within buildings to ensure the safety of both the residents and employees.

As a result, there have been separations within these buildings essentially running multiple care settings under one LTC roof, with only enough staff to run one of these settings. Much of the attention of caregivers has (and for very good reason) been given to those who are in COVID-19-positive areas.  This has led to decreased attention to those who have not tested positive and have been isolated to their rooms.

Short-term  effects may be minimal, but as we move towards our seventh month of this pandemic the long-term ramification may be significant. Socialization of seniors is one of the major benefits to living within a long-term community.  Simple activities such as card games, group therapy and music socials, to name a few, have gone away or been limited.  There have been many great articles and social media posts showing facilities attempts to keep some sort of normalcy, but the capacity at which many normal activities existed has ceased for the foreseeable future. 

These factors along with limited staff and decreased therapy sessions has limited the daily sometimes unconscious movement for these seniors. These seniors are no longer participating in normal activities: they are not able to walk down the hall to see a friend or family member, have a meal, meet with a group.

Nutritional intake for seniors may have been affected due to a change in their daily schedule. Not eating with friends and family could be associated with decreased intake as well as signs of depression. Residents may be confined to small areas leading to weakened muscles from lack of space to walk. They may have less supervision, which could lead to higher risk of falls. What they once were able to do with ease, such as independently use the bathroom, could now be a struggle due to many contributing factors.

So, what should we do?  There is still this whole pandemic thing. Well, just like the research that supports mobilizing Covid recovery patients (Steve R. Fisher, 2016 September), there should be a plan to reintroduce mobility programs for isolated residents. The likelihood of this population being able to pick up where they left off is slim. Considerations to slowly reintroduce mobilization with a program centric approach should be applied. Reevaluation to tolerance levels such as sitting up in bed, edge-of-bed sitting tolerance and standing tolerances should all be reevaluated to facilitate out of bed mobilization. 

As plans are developed to rehabilitate those who were treated for COVID-19, let us ensure there is also a plan to rehabilitate those who may have been inadvertently affected through social isolation.


Steve R. Fisher, P. P. (2016 September). Inpatient walking activity to predict readmission in older adults. Arch Phys Med Rehabil. , 97(9 Suppl): S226–S231.

Michael Fragala Ph.D., MBA, RN, WCC, CSPHP, regional clinical director for Joerns Healthcare, is also an adjunct professor for comparative health systems at New England College and program design & evaluation at Southern New Hampshire University.