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Long-term care operators must provide more mental health and emotional support for nursing assistants in response to the psychological and physical toll the COVID-19 pandemic has taken on them, according to new research. 

“Given their pivotal role in long-term care, there needs to be better recognition of the enormous challenges they face, and more support of their well-being in order to improve the quality of care for the vulnerable residents they so selflessly serve,” corresponding author and geriatrician Rossana Lau-Ng, MD, wrote in commentary published Monday in the Journal of the American Geriatrics Society

The Boston-based research team found three emerging themes among area nursing assistants, whose experience ranged from months to more than 25 years, that continued to work in nursing homes throughout the pandemic.

Investigators found that constantly changing and challenging federal regulations, specifically those related to the use of personal protective equipment and other infection control requirements, led to a lot of “frustration and confusion” among frontline staff. Specifically, nursing assistants cited that scrutiny from state surveyors caused fear of being penalized.

The findings were issued as a separate report from PHI found poor job quality and low wages were among the top reasons COVID-displaced workers have shied away from direct care job openings. 

The Boston researchers also found workers’ portrayal as both heroes and villains by the media was unfair for many assistants, while another common source of frustration was the isolation and psychological stress caused by the pandemic. 

“Prior to COVID-19, NAs (nursing assistants) in nursing homes felt a sense of belonging and togetherness with each other,” the group wrote. “With infection control related restrictions, they felt that their sense of community at the facilities was affected due to separation from each other and residents by PPE, physical barriers and other environmental limitations.” 

Researchers also found employees would often report on each other for breaking protocol, leading to mistrust and increased anxiety among the group. The team recommended operators and officials develop a mutually-supportive learning community to support and train nursing home leadership on best infection control practices. 

“Interviewees felt that having an organized platform where they could learn together, and provide and receive support to each other would establish a sense of community and raise the stature and well-being of NAs across institutions,” the researchers said.

Lau-Ng told McKnight’s Long-Term Care News on Wednesday that operators can help this effort by showing more appreciation for the group, having better transparency and inclusivity, and empowering nursing assistants with more information and resources for their jobs. 

“[Showing appreciation] could be in the form of verbal or written appreciation, or even being thoughtful to the staff’s personal needs,” Lau-Ng said. “Some operators [and] administrators bought groceries for their staff during the early days of the pandemic so people didn’t have to worry about going to the market or taking care of another errand.” 

She added that addressing retention will require a discussion on wages. 

“In an ideal world nursing assistants and staff in nursing homes should be paid at least a living wage. Unfortunately, this is inextricably tied to the inadequate funding we have for long-term care in general,” she said. “But, higher wages mean financial stability for direct care workers, as well as attracting and retaining qualified candidates.” 

The full commentary can be found here.