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Easing COVID-19 Restrictions: Going Forward…Moving Ahead?

June 4, 2020 Leave a comment

The Centers for Medicaid and Medicare Services (CMS) recently released recommendations for state and local officials to gradually reopen nursing homes. The CMS recommendations guide officials to evaluate the feasibility to ease COVID-19 restrictions. State survey agency and state and local health departments participate in the decision-making process. CMS provides questions to answer to assess next steps.

Decision-making questions to answer

The key questions to answer are:
What is the COVID-19 case status in the surrounding community?
What is the COVID-19 case status in the nursing home?
Does the nursing home have adequate staffing?
Does the nursing home have access to adequate COVID-19 testing?
Is there universal source control (e.g., residents and visitors wear a face covering)?
Does the local hospital have the capacity to accept transfers from nursing homes?

Also, the recommendations include additional criteria for implementation, visitation and service considerations, and surveys that will be performed at each phase.

Easing COVID-19 Restrictions

AARP provides additional information about the next steps in reopening nursing homes. Fortunately, progress is already taking place in some states. For example, in Massachusetts, visits are allowed in some communities when scheduled in advance and must take place outside. Also, visits must include an employee. Additionally, only two people can visit a resident while wearing face masks.

In some ways, the new recommendations offer a glimpse into the new normal. It is likely that infection control procedures will continue indefinitely. The CMS recommendations only address protection for older adults and staff, not the effect of the COVID-19 restrictions. As a result, it is mandatory to implement plans that focus on the long-term effects of the COVID-19 quarantine.

Supporting Staff and Residents

We must address the effects of the COVID-19 quarantine on residents and direct care staff. Residents’ routines are disrupted. For example, residents cannot participate in group dining. Also, family and friends are unable to visit. As a result, residents are isolated. Furthermore, staff members work overtime to compensate for residents’ additional emotional needs. Also, staff members cope with exhaustion and compassion fatigue. Furthermore, direct care workers are not valued but are unquestionably invaluable.

Going Forward – the Next Steps

Now is the time to learn from the COVID-19 restrictions experience. We must support residents and staff to cope with the after-effects of the COVID-19 quarantine. Moreover, we must provide higher wages and more respect for direct care workers. Most importantly, they provide critical care and compassion to older adults in long-term care. As Julie Boggess’ blog emphasizes, “these workers and the residents they care for deserve better – much better.”

Kathy Dreyer, Ph.D., is the Director of Strategic Projects at AGE-u-cate® Training Institute, which develops and delivers innovative research-based aging and dementia training programs such as Dementia Live® and Compassionate Touch®, for professional and family caregivers; kathy.dreyer@ageucate.com

Family Caregiver, Senior Care Professionals, The Family Caregiver

Compassion Fatigue: Watching for Symptoms, Finding Solutions

June 1, 2020 Leave a comment

As summer approaches, there is a gradual easing of COVID-19 restrictions in some states. Unfortunately, caregivers at home and in long-term care still continue to face repetitive days of providing care and support. These individuals are at risk to develop compassion fatigue.

Compassion fatigue involves a caregiver’s taking on the trauma and distress of others. Risk factors include exposure to suffering and empathic response. According to the American Institute of Stress, it is a process that takes time. With the advent of COVID-19, things are different.

THE EFFECT OF COVID-19

How does COVID-19 play a role? The rapid onset of the COVID-19 quarantine has accelerated the compassion fatigue process. Other factors include changes in residents’ routine, and the addition of infection control measures and personal protective equipment. The multiple effects of additional work loads and caring for residents living a new, restricted lifestyle, can and will take its toll.

SYMPTOMS TO WATCH FOR, WAYS TO COPE

Caring for loved ones and residents can be difficult. With the presence of COVID-19, the caring load is greater. The effects of continued care for extended time are troubling. The American Institute of Stress lists compassion fatigue symptoms such as loss of morale, depression, exhaustion, and anxiety. COVID-related compassion fatigue can develop quickly in long term care workers. They take on additional work hours and multiple roles to care for residents and family members. It is important to find ways to cope with this challenge.

Meditation and mindfulness can help ease compassion fatigue. Self care is critical. As the saying goes, “You can’t fill another person’s cup if yours is empty.” Self care can be talking to others who are going through the same challenges. Sharing frustrations can help. It might be watching cat videos or taking a hot bath. Whatever method is used, compassion fatigue needs to be identified and addressed in those most at risk.

Senior Care Professionals

Putting Empathy to Work to Improve Communication

May 28, 2020 Leave a comment

According to the National Institute on Deafness and Other Communication Disorders, approximately one-fifth (20%) U.S. adults will experience a significant problem with communication (e.g., speech, language, voice) and other conditions that affect balance, taste, and smell.

May is Better Speech and Hearing Month. While speech and hearing problems are not a condition that only affects older adults, age may play a role in making persons more likely to experience challenges with hearing, smell, taste, and balance. Experiencing a stroke can certainly increase the likelihood of challenges with mobility, speech, and comprehension. Dementia also affects the ability to communicate and understand. It is very important to provide support by wanting to communicate with a person in a way that works for them.

HOW DO WE IMPROVE COMMUNICATION?

A genuine desire to understand what a person is telling us is a start. Empathy is also a critical factor in cultivating caring support and communication. Several years ago, gerosensitivity classes were used to help people understand some of the age-related changes in vision and hearing. In some cases, those classes might have unintendedly caused more misunderstanding than support. To engender empathy, you must understand a person from how they see their world. This is especially true for those with Alzheimer’s disease.

Dementias like Alzheimer’s disease rob a person of their ability to interpret their environment. Sensory challenges contribute to this problem. My grandmother had Lewy Body Syndrome in addition to macular degeneration and severe hearing loss. It was difficult to know what was causing her challenges, her vision, hearing deficit, or her dementia. It took time and effort to help support her through the visions and fear. Thinking about what it must be like to struggle to hear, see and speak, it was a little bit easier to support her, guide her, and, most of all, support her.

WHERE DO WE START?

Thinking about the challenges faced by those who experience effects of dementia and visual and auditory problems is a start. Walking a mile in their shoes helps. It’s helpful at a time when it’s easier to think that they are doing things on purpose. By trying to interpret a world through cloudy eyes, decreased hearing, and puzzled thoughts that are scary and unnerving, we can help those who cannot communicate in a way that our world requires. We can come to their world, which is important, in May, and in every other month of the year.

Senior Care Professionals

Memorial Day: Honoring Heroes, Past and Present

May 25, 2020 Leave a comment

Memorial Day is an annual remembrance of the brave, heroic individuals who gave their all in service to their country. We also remember their families who lost loved ones. During this time of COVID-19 quarantine, reflecting on heroes is even more appropriate.

WHAT IS A HERO?

During this COVID-19 quarantine, there are heroes among us who are brave. Health care workers serve tirelessly to provide care to those infected with COVID-19, in hospitals and long-term care. Family members, caring for loved ones at home. There are staff members in nonprofits working to provide support, both food and financial, for persons affected by COVID-19 through job loss or furlough. While these individuals are the obvious choice for hero status, other types of heroes are emerging.

A NEW BRAND OF HERO

While not as apparent, there are other heroic individuals less obvious and perhaps not considered as brave. There are the delivery drivers who are bringing food to families in order to help flatten the COVID-19 curve. People have been staying at home to minimize risks for contracting or spreading the corona virus. Grocery store employees have been working constantly to keep supplies on the shelf to support those staying at home. People are ordering meals to help support restaurants in staying open. There are many opportunities to be heroic.

BEING BRAVE

While there are many types and categories of heroes, on this day, we remember those who have given all. We also can reflect on those still serving in a different type of challenge. Those still supporting those who ill and vulnerable. Those individuals find a reason to keep on, who continuing to find the strength to be brave. With gratitude to Josh Groban, we thank you for being brave and for continuing to serve.