I’m a Nursing Home Psychologist in the Pandemic Epicenter
I’m Worried About the Emotional Impact on the Staff
Mr. Davis used to sit in the lobby and greet staff members when they walked in the door of the nursing care center. His wife had friendly chats with other residents when she came to visit; his children brought plates of homemade cookies to the nursing station during the holidays. Covid-19 took him, them and every other family from nursing homes during this pandemic.
His bed is now occupied by Mr. Ward, who was transferred from the hospital two days ago with a coronavirus diagnosis. He hasn’t seen his relatives in the three weeks since they brought him to the crowded emergency room and his cell phone disappeared somewhere along the way. Lonely and in distress, he calls for help from overwhelmed nurses and aides many times each shift.
The care team swiftly referred Mr. Ward to me for psychology services. I’m able to sit down with him, ease his isolation and begin to process his traumatic experiences. I put my mobile phone on speaker so that he can talk with his children. His requests for nursing assistance have decreased.
For over two decades, I’ve tended to the emotional needs of residents, families and staff as a psychologist in nursing homes in the New York Metropolitan area. The mental health consequences of this pandemic on those who live and have loved ones in nursing facilities are profound. Tragic tales of family members unable to visit dying relatives are increasing, and, when the homes open up again to visitors, we will undoubtedly learn of many more heartbreaking experiences.
No less deserving of attention are the emotional pressures on the front-line workers caring for fragile and aging residents. On March 29, 2020, New York Governor Andrew Cuomo said that “coronavirus in a nursing home can be like fire through dry grass.” Less than two weeks later, an April 11, 2020 New York Times article reported that half of the nursing homes in New York have had residents with Covid-19, with nearly 2,000 resident lives lost thus far. Three days later, the New York Times put the national toll at long-term care facilities at over 3,800.
Despite the acknowledgment of the extreme vulnerability of nursing home residents and staff, communities haven’t rallied around nursing facilities the way they have for local hospitals. There aren’t shipments of personal protective equipment and Covid-19 tests, offers of food for hardworking employees or extra nurses and aides coming in from out of state to provide assistance.
Regardless of the political decisions that have allowed the long-term care industry to become overrun with companies more focused on short-term profit than on quality care, nursing home staff need help right this minute. They are trying to fend off a viral enemy they know will ravage their ranks once it breaches their doors and they aren’t succeeding, just as many cities, states and countries haven’t succeeded. Community support would help to mitigate feelings of lone, grueling efforts on the part of nursing home teams and it might make it more likely that long-term care facilities that don’t have Covid-19 cases will remain virus-free.
Nursing care centers that are currently dealing with active cases have been hard-hit literally and emotionally. Careers in nursing homes can be challenging in ordinary times, with low pay, high turnover and the loss of residents, but they’re also rich environments filled with compassionate people who pride themselves on their work. For every nursing home horror story, there are hundreds of loving, happy moments between residents and workers that don’t make the news. In facilities ravaged by the virus, staff members are simultaneously grieving multiple close relationships with residents that have been established over weeks, months and years. Even for those accustomed to loss, this is a shocking amount to absorb and it needs to be acknowledged as traumatic stress.
Nursing home teams, under normal circumstances, go to great lengths to ensure that their residents have “good” deaths, with comfort care or hospice services and with family members present whenever possible. Witnessing the sudden decline in beloved residents and sending them out to the hospital knowing that they may die unaccompanied by either relatives or familiar staffers is devastating to many workers. Mental health counselors treating nursing home employees will likely find that the trauma of losing many well-known residents suddenly, simultaneously and under these conditions is different than the trauma experienced by hospital staff inundated by coronavirus cases.
The mandate to accept Covid-19 patients discharged from hospitals may ease workers’ concerns that their decimated facility won’t survive the pandemic, but it creates other challenges, such as worries about ongoing exposure to the virus. It also leads to a large group of new, anxious, traumatized individuals coming into the facility at the same time, requiring extra attention when staff members are still grieving the loss of prior residents. This is complicated by the fact that most residents are in their rooms on isolation precautions, so there is less opportunity for the old-timers to reassure and befriend newcomers. The situation is further exacerbated by the lack of family visitors and by short-staffing due to coronavirus-related illness and quarantines.
At a certain point, if the situation continues, open beds will be filled with Covid-19 patients on special units, new residents will become old-timers who survived the pandemic and the usual activities and camaraderie will resume. Until then, those who work in long-term care settings need practical and emotional support from their communities as they assist the most frail and vulnerable among us.