Few people, especially those within healthcare, are unaware that the COVID-19 pandemic hit the nursing home and long-term care areas of the care continuum harder than anywhere else. The skilled nursing environment, unfortunately, became a place where COVID-19 was easily transferred between patients, residents, family members, and staff, necessitating lockdowns, the prohibition of visitors, and elimination of resident gatherings. While some measures were successful in preventing additional widespread infection and loss of life, there were inherent challenges for this care environment in the face of the pandemic. According to a recent media briefing about nursing facilities and the COVID-19 pandemic, Duke University eldercare experts emphasized that "Nursing homes will continue to be COVID-19 hotspots until state and federal officials can institute sweeping testing of asymptomatic patients and workers." Even with reduced infection rates, unvaccinated residents are still at serious risk.
This blog post continues our series based on the HealthStream article, 10 Considerations for COVID-19 and Long-Term Care, which examines specific considerations and recommendations to improve the prospects for people living in this long term care, offered by three Duke experts in the eldercare and public policy space.
Staff members in nursing homes are already faced with multiple challenges that cause a great deal of stress. Many are so poorly paid that they work multiple jobs across different facilities. This combination is a recipe for exhaustion, and during COVID-19, also adds to the stress around possible sources and transmission of infection. Aging care expert Eleanor Schildwachter McConnell wants us to think about the additional time required for staff members to implement infection control procedures. In an industry like long-term care, "Time is very precious, and the needs are enormous." Another potential stressor is the barrier to providing compassionate care that arises as a result of masking and social distancing. McConnell laments how a caregiver may "feel the pain of the residents…" and experience hopelessness about "how to support a resident" when restrictions have limited that ability to comfort. Another source of stress is connected to the uncertainty about how long the pandemic will continue, as workers encounter risks from various jobs and places and continually worry about getting sick, not having paid time off, infecting their families, or even "making their client who they're caring for sick." It is a risk for serious burnout for a workplace under great pressure.
Nathan Boucher is an Assistant Research Professor in the Sanford School of Public Policy at Duke. He studies patients' and caregivers' experiences and expectations of health care delivery during advanced illness and near the end of life.
Eleanor Schildwachter McConnell is an Associate Professor at the Duke University School of Nursing. She studies factors that influence functional decline in very frail older adults. Her research has been funded by the National Institute of Nursing Research and the Department of Veterans Affairs.
Donald Taylor is a Professor of Public Policy who researches aging and comparative health systems, including Medicare, long-term care, and health policy. Taylor also directs Duke's Social Science Research Center.
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