Shot of a young male nurse treating an elderly patient in a nursing home

Nursing facilities are now highly skilled at preventing and identifying COVID-19 illness and staving off serious outcomes, according to geriatricians at a panel discussion on Tuesday. But the lasting effects of COVID-19 will be with residents and their healthcare providers for the foreseeable future.

“Our understanding of how to protect seniors in skilled nursing facilities has really changed since that first wave,” said Eran Metzger, MD, a geriatric psychologist at Hebrew SeniorLife in Boston in a webinar hosted by Kaiser Health News and The John A. Hartford Foundation. “We’re much better at rapid identification, at short periods of quarantine that are focused on people who are at risk, and at using agents like Paxlovid when necessary to decrease the likelihood of serious or fatal outcomes. In these settings, the numbers look much much better.”

Physical, mental trauma remains

But challenges remain. Older adults continue to have the greatest health risks from the SARS-CoV-2 virus, panelists reminded listeners. Some 40% of deaths from COVID are still occurring among people over 85, with 90% in people 65 and over, according to Kaiser data. And the physical toll of COVID on long-term care residents is only half the story, Metzger said. He related details of a 102-year old resident who asked him how to deal with her emotional terror of attending a family wedding, for instance.

“COVID is very much alive where we are. The trauma that seniors who were fortunate enough to survive the first wave of COVID [comes from] the isolation, from having neighbors die and from the uncertainty of whether they’ll live or die,” he said. 

Nonpharmacological therapies that could have helped to improve dementia patients’ quality of life were also put on hold upon lockdown, he added.

“We were making great progress in long-term care in this country with implementing non- pharmacologic measures to improve the quality of life,” he said. “Almost overnight we had to stop those expressive arts therapies, life enhancement therapies and other activities around socializations for infection control.”

Impaired communications

While facilities are getting back to normal activities, they’re doing so with physical barriers between healthcare providers and clients in the form of masks and other personal protective equipment. This has communication, Metzger noted.

“When you’re dealing with a population a large proportion of whom may have lost language skills, both receptive but also expressive, we depend a lot more on body language on expression, and when we have to cover those up with PPE we really impair our communications and our ability to implement these non-pharmacologic measures to improve quality of life,” Metzger said.

Staffing crisis

The sector’s staffing crisis also has intangible effects, panelists said.

“In long-term care, where I spend most of my time, we experience it as having a less stable, less consistent workforce of nurses and nursing assistants,” Metzger said. “Familiar staff who develop relationships with these patients are really key to the care we provide, so bring in rotating staff who are masked and you can imagine what happens to the client-caregiver relationship.”

The domino effect of low nursing home staffing reducing admissions causes a bottleneck in hospitals, and that’s raising the worst fears of Sharon Brangman, MD, chief of the geriatrics department of Upstate University Hospital in Syracuse, NY.

“We are starting to see what those of us in geriatrics have been talking about for years, which is how do you have a healthcare workforce that responds to the fastest-growing segment of the population, people over the age of 85, who are most vulnerable to any stressors, whether a pandemic or the flu or falling,” Brangman said. “They need more hands on deck. We are a reactionary society, we wait for a crisis to figure things out, and that’s the worst time.”

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