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Address Staff and Resident Mental Health Needs in a Pandemic

You are loved. You are appreciated. You are heroes!  No one in the nursing home industry hears this enough and you SHOULD EVERY SINGLE DAY! Nursing home healthcare workers have always adjusted well to the multitude of demands and have strong emotional defenses that carry them through to “get the job done.” However, the pandemic has pushed the limits on what any of us have experienced in our lifetime. Not only in our professional lives, but also our personal lives. This past year has been an emotional, physical, and mental roller coaster filled with stress, anxiety, fear, anger, and sadness. 

Our residents are also struggling. Residents were already at risk for loneliness. Now, due to the pandemic they are facing even more stress due to fears and even grief and those feelings are exacerbated now that the support they typically rely on, like organized activities and visits from friends and family, are no longer available. 

It is normal to have these feelings, but not for prolonged periods of time. Poor mental health can affect the way we think, feel, or behave and our experiences of poor mental health, symptoms and coping mechanisms will be different. It is critical to recognize what stress looks like, take steps to build resilience and cope with stress, and know where to go if you or someone else needs help. 
Prevent Chronic Stress and Poor Mental Health
  • Provide accurate and frequent communication to all staff and residents
  • Conduct well-being huddles (at the beginning and end of shifts) to learn about current pressing issues.
  • Encourage work breaks
  • Provide opportunities for staff to provide social support to each other
  • Ensure that all staff and residents are aware of where and how they can access mental health and psychological support services and facilitate access to such services.
Going home does not mean you switch off from the day’s events. The National Health Service (NHS) developed a Going Home Checklist Poster to help deal with work life stresses and strengthen mental health by using mindfulness.
Recognize Potential Signs of Poor Mental Health
Being able to recognize potential signs of poor mental health will help identify those who may be experiencing difficulties.

Potential triggers include:  long working hours; not taking breaks; unrealistic expectations; unmanageable workloads or lack of control over work; poor communication.

Burnout
We have all experienced burnout at some point in our career, but not to this extreme. The emotional and physical exhaustion caused by the prolonged stress of the pandemic has caused many to feel overwhelmed and unable to meet the constant demands of the job.

Signs of Burnout
  • Exhaustion
  • Overwhelmed
  • Feeling like a failure
  • Tearful
  • Depressed
  • Cynical/negative
  • Frustrated, easily agitated
  • Disconnected from others
  • Forgetful or unable to concentrate
  • Use/increase of tobacco, alcohol, or other mind-altering substances
  • Problems falling asleep or staying asleep
Compassion Fatigue
Also called “vicarious traumatization” are stress reactions and symptoms resulting from exposure to another individual’s traumatic experiences, rather than from exposure directly to a traumatic event.

Signs of Compassion Fatigue
  • Excessive worry or fear about something bad happening
  • Easily startled or “on guard” all the time
  • Physical signs of stress (e.g., racing heart)
  • Nightmares or recurrent thoughts about the traumatic situation
  • The feeling that others’ trauma is yours
Access our Simple Strategies for Staff for strategies to help staff manage stress.
Mental Health and Your Residents
Residents, especially those with cognitive decline or dementia, may become more anxious, angry, stressed, and agitated when experiencing feelings of fear and loneliness related to the pandemic. The emotional impact of isolation, quarantines, masks, gowns, special procedures, and new equipment my trigger traumatic reactions. Social connections are essential for health and well-being.
Recognize Potential Signs of Anxiety and Depression
It is important to look for subtle signs of anxiety and depression in residents to identify potential negative effects of the pandemic. 

Behaviors
  • Urge to perform certain rituals
  • Avoiding eye contact
  • Difficulty making decisions
  • Being startled easily
  • General slowing down or restlessness
  • Neglect of self-care
  • Withdrawing from family and friends
  • Decline in ability to function
  • Inability to find pleasure in any activity
  • Difficulty getting motivated
  • Behaving out of character
  • Denial of depressive symptoms
Feelings
  • Overwhelmed
  • Worried about physical symptoms
  • Fearing that something bad is going to happen
  • Constantly tense
  • Angry or aggressive
  • Hopelessness or emptiness
  • Feeling worthless or guilty
Thoughts
  • “I’m going crazy”
  • “I’m about to die”
  • “People are judging me”
  • Having upsetting dreams or flashbacks of a traumatic event
  • Finding it hard to stop worrying
  • Indecisiveness
  • Loss of self-esteem
  • Negative comments
  • Excessive concerns
  • Perceived change of status within the family
Physical Symptoms
  • Increased heart rate/racing heart
  • Vomiting, nausea or pain in the stomach, changes in bowel habits
  • Unexplained headaches, backache, pain or similar complaints
  • Feeling detached from their physical self or surroundings
  • Trouble sleeping (sleeping more or less than usual)
  • Agitation, hand wringing, pacing
  • Slowed movement
  • Loss or change in appetite
  • Significant weight loss or gain
  • Sweating, shaking
  • Dizzy, lightheaded or faint
  • Numbness or tingling
  • Hot or cold flashes
  • Memory problems
Access our Simple Strategies for Residents for strategies to help manage loneliness and stress.

Access our on-demand webinars listed below with Deer Oaks, a long-term care psychology service to learn about supporting our residents’ mental health and reducing the impact of social isolation and loneliness during the pandemic.
 
Supporting Resident’s Mental Health During COVID-19
Access the Recording Here!
The session will offer strategies nursing home leaders and care staff can implement to identify the risk factors for and prevalence of depression, anxiety, trauma history and related cognitive status changes among residents. Deer Oaks will also provide resident-centered responses care staff can use with those experiencing symptoms and behaviors indicative of these conditions. Comorbidities and the interconnection of emotional well-being to residents’ overall health outcomes will also be discussed.
 
Reducing the Impact of Social Isolation and Loneliness
Access the Recording Here!
This session provides education about the prevalence and impact of social isolation and loneliness. Deer Oaks shares comorbidities for loneliness, loneliness assessment measures and resident-centered strategies for reducing social isolation and loneliness.
 
Coping with Grief and Loss During COVID-19
Access the Recording Here!
This session addresses the impact and experience of grief during COVID-19, including the loss of loved ones, the loss of the life we knew and the uncertain future. Deer Oaks shares ways to manage our experience of grief, identify how this experience manifests in different ways with different people and identify personal and collective strategies to facilitate healing for your peers, your residents and your community.

Training Sessions

Advance Care Planning 201 Learning Session

January 27, 2021
11:00 AM to Noon EST / 10:00 AM to 11:00 AM CST
Register Here!

This session will cover the important principles guiding clinicians in carrying out advance care plans. It will discuss the difference between capacity and competency, shared decision-making, substituted judgement, and best interest principles. The session will conclude with a question-and-answer period.
 
Objectives
  • Apply principles of shared decision-making and substituted judgement
  • Compare and contrast capacity and competency
  • Clarify the role of the clinician as capacity diminishes
Intended audience: Physicians, mid-level practitioners, nurses, social workers and other health care professionals

Continuing education may be available from the Greater Kansas City Chapter of the American Society for Pain Management Nursing. Please check with your state for reciprocity.
Five Star System Unfrozen: What This Means for Your Quality Measure Domain

February 2, 2021
2:00 pm EST / 1:00 pm CST
Register Here!

Join the Health Quality Innovation Network (HQIN) and Judy Wilhide Brandt to learn about the Quality Measure (QM) Domain of the Five Star Rating System to explain what it means to be “unfrozen.” We will explain how the QM domain will be calculated beginning January 2021.

Objectives:
  • Examine how the QM Domain is calculated
  • Understand which QMs are used in the QM Domain
  • Discover how Five Star QMs are weighted and which ones count more than others
  • Learn precisely how to use the appropriate CMS manuals to determine how a QM triggers
Free COVID-19 Training Prepares Nursing Homes for Winter

The Centers for Medicare & Medicaid Services (CMS) is offering a free training to help nursing homes prepare for the winter months of the COVID-19 pandemic.

Developed to meet the urgent and ongoing needs of nursing home managers and frontline staff, insights gained during the COVID-19 pandemic have been used to create a series of scenario-based trainings to share knowledge around ways to protect, provide care and prevent the spread of COVID-19. These free CMS Targeted COVID-19 Training for Frontline Nursing Home Staff & Management learning intensives are hosted on the CMS Quality, Safety & Education Portal (QSEP). Nursing home staff members can earn certificates of completion while receiving the latest guidance from CMS on COVID-19 preparedness, resident-centered care and infection prevention and control.

Register on QSEP to get started.
About the Health Quality Innovation Network
Led by Health Quality Innovators and its quality improvement partners, the Carolinas Center for Medical Excellence, KFMC Health Improvement Partners and the Kansas Healthcare Collaborative, HQIN is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Kansas, Missouri, South Carolina and Virginia. To learn more about HQIN visit https://www.hqin.org.
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