The pandemic has forced rehabilitation providers to re-examine their modes of practice as they deal with the effects of COVID-19 on nursing home residents and staff, two rehab leaders said recently during a special rehab symposium of the annual conference of the National Association for the Support of Long Term Care (NASL).
The isolation that has resulted from long-term care lockdowns, for example, has thrown off routines and restricted interaction with other residents and staff. This, in turn, has led to increases in weight loss, dehydration, urinary tract infections and depression. Because of this dramatic clinical impact, therapists need to practice an all-hands-on-deck approach, said Sabrena McCarley, director of quality for RehabCare.
“We have to think about absolut
ely everybody who comes in contact with the patient,” she said during the symposium last Friday. So “if they see something, they need to say something.”
Communication also is imperative, she said.
“It’s so important that we all overcommunicate … with residents as well as with family members,” she said.
Accurate documentation of residents’ changes is another key area during this challenging time. The MDS coordinator may be off-site but should still be part of conversations, McCarley noted. “We want to make sure we have an accurate picture of patient characteristics and burden of care,” McCarley said.
For those patients who have caught the virus, the clinical impact of it is far-reaching, affecting balance, gait, respiratory ability, cognitive function, behavior and other issues, explained Judy Freyermuth, director of quality performance with RehabCare.
Freyermuth provided various rehab strategies for approaching patients during the time of COVID-19. In the area of mobility, it is critical to make sure patients are moving as soon as possible, she said. Rehab may be able to partner with nursing on this. The two disciplines can also collaborate to create activities for patients with cognitive impairments that are “meaningful to that person,” Freyermuth said.
Therapists should approach those patients with depression with “kindness, patience and understanding,” Freyermuth said.
An interdisciplinary approach among staff and families will help in this regard. Families can help with window visits and bringing familiar objects, she pointed out.
“I can’t stress it enough,” she said. “We are one team in the facility, working together taking the best possible care of our residents.”
Staff also may want to get creative when it comes to treating the different populations — COVID-19 and non-COVID-19 patients. They can break into dedicated teams, for example, one working with the COVID-19 patients and the other working with the long-term care residents.
Or they can consider other arrangements, such as treating occupational therapy and physical therapy patients on opposite days.