To manage COVID-19 transmission among residents, nursing facilities had to enforce social distancing between residents, their family and friends, and in certain circumstances, even residents and caregivers. The extended quarantine caused social isolation with adverse effects such as depression, loneliness, and anxiety. Prior to the pandemic, researchers estimate 30% of nursing home residents suffered from acute depression along with 50-55% experiencing loneliness (Dichter, 2020). When these symptoms were coupled with prolonged lockdown, isolation, social distancing, decreased activity, and decreased caregiver interaction time due to staffing challenges, the incidence intensified (Dichter, 2020).
Unintended Consequences of COVID Prevention Measures
Facility group activities provide socialization opportunities for residents along with exercise that can slow the onset of muscle atrophy, decreased strength, and decreased mobility. Without group activities, the regular social interaction and physical function benefits they brought left a void. Additionally, many residents with dementia not only experienced difficulty understanding the need for distancing and isolation, but may have experienced advanced cognitive decline with the decreased mental stimulation and interaction required by COVID-19 prevention measures (Greco, 2021). Furthermore, researchers found that these declines were not limited to residents with a dementia diagnosis or to those with COVID-19 infection (Greco, 2021). Even now, over a year since the pandemic onset, vaccination status and other criteria affect in-person and indoor visitation and contact among residents per CDC guidance. Communal activities and dining currently require social distancing and wearing a mask if the resident is not vaccinated.
Assessing for Depression
It may be difficult to recognize typical symptoms of depression due to the longevity of quarantine and COVID-19 illness that caused decreased appetite, feeling down, decreased participation in activities, feeling tired or having little energy, etc. The PHQ-9 interview/staff assessment coded in MDS Section D is intended to identify indicators that could possibly point to depression with the severity of symptoms and depression based on the score. The results are useful for referral to the physician and/or the mental health provider, but also to provide care planning interventions to enhance the resident’s quality of care.
- Conduct the interview preferably the day before or day of the ARD. (Look-back period is 14 days.)
- Interview any resident when D0100 Should Resident Mood Interview Be Conducted? = 1, Yes.
- Conduct the interview in a private setting.
- If an interpreter is used during resident interviews, the interpreter should not attempt to determine the intent behind what is being translated, the outcome of the interview, or the meaning or significance of the resident’s responses. Interpreters are people who translate oral or written language from one language to another.
- Sit so that the resident can see your face. Minimize glare by directing light sources away from the resident’s face.
- Be sure the resident can hear you.
- If you are administering the PHQ-9© in paper form, be sure that the resident can see the print. Provide large print or assistive device (e.g., page magnifier) if necessary.
- Explain the reason for the interview before beginning.
- Explain and /or show the interview response choices (i.e., cue card).
- Interview the resident.
Activities & Socialization
Presently, the focus of providers should concentrate on returning to “normalcy” in the daily lives of our residents’ while also promoting wellbeing and safety. While visitation may continue to be somewhat limited, telephone and video calls can still be used to augment contact between residents and their family members and friends, as well as lower- risk outdoor visits. Recognize and address any fears about contracting COVID-19 as well as trauma experienced as a result of the pandemic while encouraging the return to pre-pandemic life as much as safely possible. Post-COVID trauma informed care considerations include realization of a history of pre-existing trauma and how this trauma effects them, providing interventions & prevent re-traumatization (Jain, 2021). Looking forward may include activities and events that acknowledge the difficult period that the staff and residents went through. For example, some facilities have had themed celebrations and made “Coronavirus” pinatas or dart boards to celebrate overcoming the virus. Encourage a positive outlook for residents, staff and visitors through engaging activities that encourage safe socialization and comforting routines.
Contact Proactive for consultation related to mindful activity programming. Access our Trauma Informed Care Toolkit
- Centers for Disease Control and Prevention. (2021, April 27). Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination. https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-home-long-term-care.html
- Center for Medicare and Medicaid Services. (2019, October). MDS 3.0 RAI Manual. Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html
- Dichter, M. Sander, M., Seismann-Peterson, S. & Kopke, S. (2020, October). COVID-19: It is Time to Balance Infection Management and Person-Centered Care to Maintain Mental Health of People Living in German Nursing Homes. International Psychogeriatrics, 10, 1157-1160. doi: 10.1017/S1041610220000897
- Jain, Shalll, 2021, May 11. 4 Steps Toward Building a Trauma-Informed Post-COVID Society. Psychology Today. https://www.psychologytoday.com/intl/blog/the-aftermath-trauma/202105/4-steps-toward-building-trauma-informed-post-covid-society
- Marco Canevelli PhD, et al., 2020 June 19, Facing Dementia During the COVID-19 Pandemic, American Journal of Geriatrics, https://doi.org/10.1111/jgs.16644
- Greco et. al, 2021 February 22, Increase in Frailty in Nursing Home Survivors of Coronavirus, JAMDA, https://doi.org/10.1016/j.jamda.2021.02.019