Susan E. Mazer, Ph.D. Blog

Thoughts and ideas on healthcare

Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more. Subscribe below to get email notices so you won't miss any great content.

A Pandemic of Loneliness: Long-Term Care During COVID-19

May 20, 2020

To talk about long-term care (LTC) facilities during this pandemic calls for an acknowledgment of the many nurses, aides, administrators, housekeepers, and others that care for our most fragile elders each day. With this acknowledgment that LTC is now a high-risk environment, the intensity of exposure is highest for staff. With this comes deep respect and appreciation for the dedicated staff members across the country who are showing up and putting their lives at risk for those in the greatest need of aid.

COVID-19 & Loneliness

What is life like for residents living in LTC facilities during the pandemic? COVID-19 has changed everything. Each resident is now confined to their own room. Completely alone. They cannot see each other, their family, their friends, anyone but the person who cleans their room or brings their daily meals. If they are lucky, maybe they see a nurse who checks on them. But, that is it. 

In the best of times, isolation and lack of communication with other people adds to the decline of aging. However, with the COVID-19 quarantine, the impact may be increased. The other added issue is that many of those in nursing homes will not understand what is happening around them, what is different, or what it means. In many ways, they often have a childlike disposition, living in the moment, uninvolved or unconcerned with yesterday or tomorrow.

Risks of Isolation

The lack of cognitive stimulation and social interaction can contribute to ongoing decline or exacerbation of symptoms related to Dementia and Alzheimer’s disease. It can also cause depression and high anxiety.

Florence Nightingale described it well when she wrote, 

“To any but an old nurse, or an old patient, the degree would be quite inconceivable to which the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings during a long confinement to one or two rooms.”

I’ve witnessed this firsthand in my own life. My Dad had an infection when he was 85 and wound up in the hospital for three days. However, his decline in this short hospitalization was enough to send him to rehab where he was then confined for over a month. I remember thinking the oldest of the old may not be able to reclaim what they have lost. My father was not able to gain back the precious time that was lost during that confinement nor did he fully return to who he was prior to this event. 

Sheltering in Place, Means Aging in Place

The COVID-19 pandemic is lethal enough to make the “shelter in place” mandate feel like a prison sentence. For long-term care residents, “aging in place” may seem to be a reasonable option in long-term planning, but can lead to a default kind of isolation, causing depression or accelerated decline. During this pandemic, the risks related to the lack of social interactions merge with the risks of the virus itself. 

Right now, over 50% of the deaths in Europe from COVID-19 involve long-term care residents. 

Technology helps, but is not available to every resident in every long-term care facility. Video calls (using tools like Skype, Zoom, Messenger, Google) can bring family to the confined elder who is well enough to use it and who has access to high-speed internet. However, access to high-speed internet, cognitive capacity to interact within a digital environment, and the ability to use and manage a tablet or laptop cannot be assumed. 

Health Affairs published a blog last month that drew attention to two studies done by AARP, Harvard University, and Stanford University. These studies focused on social isolation and loneliness in older adults. Without question, loneliness and isolation are direct health risks leading to accelerated cognitive decline. Given that staff interacts with residents every day, training them to look for specific changes in the physical and mental status of their residents is critical to early interventions.  

Engaging Residents with Empathy

For long-term care, this suggests that each time any staff member enters the room of a resident, a conversation, even brief, should occur that is engaging and caring. Staff can engage with residents by doing the following:

  • Use the resident’s name when speaking with them
  • Inquire as to how they are and how they are feeling
  • Ask them what they might need at this time
  • Listen generously and empathetically 

Even this small outreach will have a profound impact on the resident in terms of their ability to communicate with others, their feelings of being cared about, and their ability to retain their identity. 

The Power of Positive Distractions for LTC Residents

In addition, each staff member can offer The C.A.R.E. Channel at times when it would help reduce stress and anxiety.

The television has been relegated to fulfill many roles for the confined elder: social needs, distraction, entertainment. Yet, research has shown that for a senior, well or otherwise, watching traditional television for more than 4 hours at a time can cause depression, anxiety, and cognitive decline. 

Talk television is particularly risky for frail seniors with hearing impairment as well as cognitive decline. The banter is heard as if it is a drama, thus it is difficult to separate louder commercials from the excited rant common to news and reality television.

Providing an alternative to commercial television, The C.A.R.E. Channel offers nature with beautiful, listenable music, over the full 24-hour-day. No commercials or interruptions. Demanding nothing of the viewer but to enjoy. It is specifically produced to play in the background, creating a soothing environment, while also being engaging. The C.A.R.E. Channel takes the viewer to the most beautiful natural landscapes in the world. 

Nature as a Healing Modality 

Access to nature, whether a garden outside or inside, whether a flower or a picture of a flower, has been shown over and over again, in study after study, to be life-enhancing and a major contributor to well-being. 

It is successful and effective with LTC patients and residents, easing sundowning, reducing agitation, and minimizing delirium. In addition, nighttime programming supports restfulness and sleep. 

Now what?

We have had to learn so much so fast during this pandemic. And, being aware of the inherent risks of any quarantine to the elderly is as important as ensuring their safety through quarantine.  

We know that access to nature is life-enhancing. 

We know that meaningful conversations, even brief, between the residents and those who care for them, are invaluable, since their families cannot fill that role at this time.   

And, whatever works now, will work post-COVID. Hopefully, we come out of this pandemic better than we were.

We are offering our online streaming portal to anyone who needs it during this pandemic. You can stream it today and learn more about our free COVID-19 resources here.