The country continues to catapult deeper into the unknown consequences arising from the coronavirus outbreak. For the elderly who are confined to long-term care, the menace of COVID-19 reaches far beyond the threat of the disease.
For the more than 1.3 million people residing within the nation’s 15,600 nursing homes, CDC requirements essentially ended family visits, communal meals, and activities. As the elderly are among the most likely to become gravely ill and die from the disease, these restrictions are understandable.
The rules, however, are also psychologically devastating. Those living in long-term care facilities are the most vulnerable of our elderly, suffering from various stages of dementia or severe physical limitations that make care at home unsafe. Their reliance on interactions with loved ones and group activities serve as their only refuge from the institutional life they would never have chosen for themselves.
Deteriorating Conditions and Desperate Families
As the need for additional beds for coronavirus patients grows, the media has reported on nursing homes suddenly dispersing residents to other locations, with little or no notice to families. Staffing shortages have arisen from workers who have tested positive for COVID-19. And we have seen wrenching images of family members trying to communicate with their elderly parents through closed windows.
This ongoing loss of family visitors and the enforced isolation, and even dislocation, can lead to bewilderment, despair, and worse. Researchers at the National Institute on Aging have described the negative health impacts of social isolation and loneliness on the elderly as including heart disease, a weakened immune system, anxiety, depression, cognitive decline, and even death.
For families, the ban on visits is excruciating. Visits to loved ones in nursing homes serve as a crucial opportunity to observe the care being provided, and to intervene as problems arise. Even in normal times, facilities can be thinly staffed, leaving families to serve as the buffer, vigilantly checking for medication errors, insufficient attention to patients’ personal hygiene, food allergy mistakes, and other challenges that can arise in a context where over-burdened employees simply cannot meet the daily needs of every resident. Visiting families also help keep a watchful eye on other residents who they come to know.
These are all important roles in normal times. But with continued gaps in the health care system’s capacity to manage Covid-19 and the increased absences of workers exposed to the virus, the eyes and ears of loving family members have never been needed more.
Six Key Questions
As we face the unknown timing of this unprecedented national emergency, we also need to address the unintended consequences on vulnerable populations. Key questions must be addressed at every institution, and the answers must be communicated regularly to the families.
- Are sufficient staff available to provide vulnerable and frail residents daily hygiene, nourishment, and comfort?
- What mechanisms are in place to ensure that nursing home residents are given information about their circumstances?
- Are residents being locked in their rooms as part of the internal restrictions?
- If so, who is responsible for monitoring their mental health during this confinement?
- Can alternatives be implemented to allow families to address the needs of their confined family members, including the use of staff-supported face time with families?
- Can healthy families, subject to strict protocols, voluntarily rotate to check on the well-being of loved ones and their fellow residents?
The threat of this virus cannot be underestimated, but addressing the ramifications of each decision to fight it should be part of the mitigation measures wherever possible. For long-term care residents, we know that as their human interactions diminish, so, too, will their quality of life and health, even if they never contract the virus.
For these vulnerable elderly, protection from the consequences of the virus may need to be more than a clinical decision.
Lauren Stiller Rikleen, president of the Rikleen Institute for Strategic Leadership, speaks, trains, and consults on building a respectful and inclusive multi-generational workplace. She is the author of The Shield of Silence: How Power Perpetuates a Culture of Harassment and Bullying in the Workplace. and You Raised Us, Now Work With Us: Millennials, Career Success, and Building Strong Workplace Teams