For several decades, long-term care organizations have faced tremendous hardships in maintaining adequate financial resources, staffing, satisfying CMS requirements during Quality Indicator Surveys and following compliance protocols. Considering the challenges already being faced, who would ever think that a pandemic, Covid-19, would wipe out populations from long-term care organizations throughout the United States? While this sounds accurate and is exactly what the media and government would like Americans to believe, could these deaths be related to other chronic diseases and mental disorders such as depression? Or is Covid-19 solely responsible for the thousands of deaths among long- term care residents?
Loneliness and social isolation are distressful for many elders. According to Van Dyck et al. (2020), studies have shown that 33%-72% of the older adult population have reported feelings and symptoms of loneliness, and a majority of this percentage in residential homes. Loneliness fosters negative health outcomes such as cognitive decline, symptoms of anxiety, depression, morbidity, as well as mortality. Group activities were provided in long-term care settings to assist with social isolation such as outings, games and other physical activities. The benefits were often limited. However, many residents looked forward to participating in these activities which were discontinued due to Covid-19 infection control protocols. Prior to the Covid-19 pandemic, the Center for Disease Control and Prevention (CDC) stated that consumers of long-term care services had the highest prevalence rates for depression particularly in nursing homes – an alarming 49% of residents who resided in nursing homes and 35% who resided in home health agencies during 2011 and 2012 (CDC, 2014).
Research findings indicate a positive correlation between the leading causes of mental decline and physical decline due to the Covid-19 pandemic. Social isolation may lead to severe healthcare risks as a result of loneliness which negatively impacts many older adults. It is also evident that the prevalence of loneliness is very common in long-term care organizations, i.e. approximately twice the rate of loneliness in community populations. There are several deleterious side effects of loneliness which include the risk of depression, anxiety and impulsiveness. Other studies have also provided evidence that loneliness increases the risk for additional cognitive decline, re-occurring stroke, elevated blood pressure levels, advanced progression of Alzheimer’s disease, and mortality. Despite the fact that depression and loneliness may stem from social isolation, the severity of this issue is amplified. Many older adults’ health conditions were influenced mostly through their daily life activities along with medical interference. As a result of the Covid-19 social isolation protocols, there is evidence that the lack of exercise and inadequate physical movement lead to obesity, advanced frailty, increase in falls and declines in overall physical well-being.
While this pandemic has devasted the U.S. within a matter of a few months, limited research has been conducted in terms of providing further clarification as to whether mental and physical decline are co-factors of deaths related to the Covid-19 epidemic. Mortality rates are being tallied and reported. However, the prior mental and physical health conditions of these residents are not being acknowledged since their main diagnosis during time of death was Covid-19.
Implications for Health Administrators
The following questions were derived based on the data provided during this author’s research. Are health care administrators currently examining whether the Covid-19 social isolation protocols which evidently led to depression and increased physical decline weakened the immune system of these residents? Was the shortage of employees and resources, such as PPE’s and masks, responsible for the increased spread of Covid-19 in long-term care organizations? Yes, it is a fact that various states have diverted from lockdowns and certain social isolation protocols have been lifted. However, in an effort to reduce exposure to long term care residents, visitors are prohibited. How do we as health care administrators effectively address the side effects of social isolation? Are video-chatting and phone calls helping these residents deal with depression or is it killing them slowly? In order to effectively find a solution to these questions, health care administrators need to immediately analyze the risks of mental decline individually at each LTC facility to determine what resources or assistance can be provided to help decrease the severity of depression and its adverse effects.
Many older adults who reside in long-term care organizations are exposed to different levels of risk due to the preexisting psychiatric, medical conditions and compromised immune functionality. It is important that healthcare administrators provide access to mental and social health services for residents during the pandemic. Resources should be provided which further evaluate their mental health and provide counseling, not only during early stages of mental decline but as a routine protocol. Furthermore, it is important that training and education related to psychosocial concerns are provided for health care professionals and employees in long-term care organizations as they have direct contact with residents. The significance of health care administrators working together to develop, identify and communicate risk efforts and circulate evidence -based resources related to mental health will significantly assist with finding solutions to help decrease residents’ susceptibility to the side effects of Covid-19 pandemic protocols. These protocols have serious implications for residents, and they continually limit social functionality. As healthcare administrators, the lack of resources is evident when trying to provide medical care while also managing the psychosocial needs of residents. Therefore, it is important that these questions and concerns are addressed in order to help decrease the prevalence of mental and physical decline rates of residents in long-term care organizations.
References
Center for Disease Control and Prevention (2014). Quick Stats: Percentage of Users of Long-Term Care Services with a Diagnosis of Depression, by Provider Type – National Study of Long-Term Care Providers, United States, 2011 and 2012. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6304a7.htm.
COVID-19 Nursing Home Data (2020). Retrieved from https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/
Van Dyck, L., Wilkins, K., Ouellet, J., Ouellet, G., & Conroy, M. (2020). Combating Heightened Social Isolation of Nursing Home Elders: The Telephone Outreach in the COVID-19 Outbreak Program. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274114/
About the Author
Kerissa Marcellin, a Certified Medical Assistant, serves as Case Manager with Heritage Human
Services / NY. She has recently completed requirements for her M.H.A. degree at Saint Joseph's
College, Maine. This blog post was adapted from her graduate Capstone Research.
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