The Psychosocial Implications of COVID-19 on Seniors Living in Facilities

What a start to the New Year! COVID-19, also known as Coronavirus, is the new pandemic affecting everyone around the world. In any disaster, fear and uncertainty are common and may act as barriers to mental health interventions. Based on past global pandemics experience, experts agree that the psychosocial impact warrants the implementation of mental health assessment, support, treatment, and services (Jiang et al., 2020; Xiang et al., 2020).

In response to controlling the spread of the Coronavirus, social distancing and self-isolation have been implemented worldwide. So what happens to residents residing in skilled nursing facilities (SNF) or assisted living facilities (ALF)? Social distancing and self-isolation are likely to have an additional impact on the residents living in these facilities. The required isolation procedures can exacerbate already diagnosed with mental illness. If mental health services are delayed, affected residents may deteriorate, causing a psychological crisis.

What about residents diagnosed with dementia living in a SNF or ALF? Caring for a person with dementia can be difficult. A person living with dementia will most likely exhibit distress behavior, which is their way of communicating. Facility staff may observe the following behaviors (pacing, exit seeking, asking to go home, or increased restlessness or agitation). People living with dementia will often have difficulty understanding what is happening and they are unable to verbalize that they are scared, bored, or that they have an unmet need. They are trying to make sense of the world around them and they will see things differently than the person who does not have dementia.

Social distancing and self-isolation disrupts opportunities for residents living in SNFs and ALFs to connect with their usual support networks (support groups, group dining, facility activities, and visitation from families and friends). The longer social distancing and self-isolation is implemented the probability of residents having behavior and mood disturbance will increase.

Timely psychiatric treatments should be provided for those presenting with severe mental health and behavioral problems. For most residents and facility staff, emotional and behavioral responses are part of an adaptive response to extraordinary stress (Wang, Heffner, Anthony, & Lin, 2019). MediTelecare Nurse Practitioners, Psychiatrists and Psychologists are trained in using techniques based on the stress-adaptation model. MediTelecare clinicians are an essential healthcare team providing mental health support for residents living in SNF and ALF. During this current situation, face-to-face mental health counseling services may not be an option due to the high risk of potentially spreading the infection. However, residents living in a SNF or ALF may face more severe psychological crisis and secondary trauma after the disaster (Wang et al., 2019). Therefore, to ensure the ongoing provision of mental health services and reduce the risk of cross-infections, MediTelecare has made available MediTelecareGo! ™, which was designed to empower skilled nursing facilities with the resources and technology needed to provide exceptional behavioral health through medication management and psychotherapy services.

During this crisis, it is imperative that SNF and ALF organizational leaders and other clinicians give the same attention to the development and maintenance of the psychological well being of their residents in the face of serious illness, as they would residents with chronic medical conditions.

1. Jiang, X., Deng, L., Zhu, Y., Ji, Haifeng, Tao, L., Liu., L., Daoliang, Y., Weidong, J. (2020). Psychological crisis intervention during the outbreak period of new coronavirus pneumonia for experience in Shanhai. Psychiatry. doi:  https://doi.org/10.1016/j.psychres.2020.112903search, 28
2. Wang, X., Heffner, K. L., Anthony, M., & Lin, F. (2019). Stress adaptation in older adults with and without cognitive impairment: an fMRI pattern-based similarity analysis. Aging (Albany NY), 11(17), 6792-6804. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756885/pdf/aging-11-102204.pdf.
3. Xiang, Y.T., Yang, Y., Li, W., Zhang, Q., Cheung, T., & Ng, C.H.  (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet, 7(3), P228-229.  doi: https://doi.org/10.1016/S2215-0366(20)30046-8.