A stressed nurse

An expanding program aims to address the moral injury suffered by frontline nursing home and aging services staff, whose struggles with pandemic-era care delivery are being illustrated in a growing body of research.

Volunteers of America, a nonprofit organization providing a range of housing and services for seniors, the homeless and people with disabilities recently added moral injury resources to its lengthy list of programming.

Mike King, president and CEO, announced last week that VOA would assist other providers in creating their own programs under the Resilience Strength Time, or REST, umbrella.

“The REST program really grew out of the pandemic and the fact that more people in the healthcare field and behavioral health field were truly suffering from moral distress, meaning they had just witnessed so much sickness and, frankly, death that they could not prevent,” King told McKnight’s Long-Term Care at the LeadingAge Meeting in Denver last week. “The guilt from that weighs on them, and it stays with them.”

VOA launched the program months ago, based largely on anecdotal concerns about healthcare providers’ ability to cope with impossible decisions they’d been faced with during the pandemic — and reports of spiking suicides among those providers.

While workplace stress and fear of COVID were known contributors to nursing home job losses, research continues to validate the serious mental health harms experienced by those on the frontlines both at the beginning of the pandemic and as it stretched on for relentless months and years.

A qualitative study of 52 care aides across eight Canadian nursing homes published this fall used interviews to understand how they operated under “extreme stress.”

“Care aides expressed profound guilt upon observing decline in cognitive status and mental and physical health of residents from prolonged isolation and immobility,” nursing faculty at the University of Alberta reported in the Journal of the American Geriatrics Society. “Most talked about the emotional toll of being unable to offer physical touch, comfort, and companionship. They were distressed by rushing care and limiting it to essential care only

Despite clear signs of weakening and less enthusiasm for the job, many tried to suppress their personal feelings to stay on the job.

“Unprecedented, untimely resident deaths from COVID-19 upset care aides who had long-term relationships with residents and families,” interviews indicated. “Care aides reported feeling like they had lost their own parent or grandparent. Returning to work each day became difficult as they wondered if residents would still be there. 

“This was worsened by truncated end-of-life and post-mortem rituals without family presence. Care aides rarely used terms such as depression, anxiety, loss, or grief. Even while recounting traumatic experiences, when asked directly about how they were managing they responded ‘I’m ok’ or ‘I’m fine.’”

King said addressing such attitudes now could help individual healthcare workers heal, as well as strengthen facilities that are struggling to retain staff as the pandemic eases. Like the military embracing its physically and morally injured soldiers, he said, it’s time for skilled nursing and other providers to embrace mental health and wellbeing programs that aim to reverse the damage done.

King, board chairman of LeadingAge, said the VOA REST moral injury program leans heavily on peer support and can work in virtual settings. The idea is to link people with shared experiences and workplace conditions to talk through their feelings and physical responses to the trauma.

“This helped them tremendously to be able to connect with other people like themselves, who were in similar situations, workwise, having these kinds of concerns and needed this support,” he said, noting that the program had been studied by Bristol Myers Squibb and was used among VOA’s own affiliates in the aging services field.

“I consider this our proactive mental healthcare for our people,” King said. “This is what we do for our most valuable resources.”