The presence of family and treasured people in a nursing home resident’s life is incredibly important.
– Anne Montgomery

COVID-19 has turned the whole world upside down, including the lives of nursing home residents. While nursing home residents only account for 8% of total COVID cases in the United States, they account for more than 40% of  all deaths. The response to this nationally was to lock down all 15,600 nursing homes for over six months. 

While mainstream media has commented on their plight from an outsider-in viewpoint, in this episode, Anne Montgomery shares a new special report by Altarum released in October 2020 with insights into what matters to nursing home residents.

Part One of ‘What Matters to Nursing Home Residents with Anne Montgomery from Altarum’

Social isolation and loneliness are not new phenomena for nursing home residents, but COVID-19 has amplified the distress and harm residents have ensured since the beginning of the pandemic. In mid-March of 2020, the federal government, the Centers for Medicare and Medicaid Services, issued a prohibition on visitation in nursing homes of family members, immediate relatives to keep residents safer. 

To check the extent of social isolation and loneliness, a survey has been conducted from July until the end of August, although nursing home residents are not easy to survey. 

Residents were asked “key questions about their daily life before Covid-19 restrictions were imposed and afterward, including how often they had visitors, left their nursing home for routine activities, went outside to enjoy fresh air, where they ate their meals, and much more. The findings are stark, showing a drastic reduction in social activities and a steep increase in reported feelings of loneliness.”

Part Two of ‘What Matters to Nursing Home Residents with Anne Montgomery from Altarum’

Here are some of the comments from the residents living in nursing homes during COVID:

  • I have depression—why keep living? It’s not living, and it’s barely existing.
  • I feel like I’m living in prison literally!
  • I feel like I am in prison. The prospect of weeks or months more of isolation makes me feel like giving up on life. This is not living at all.
  • Workers keep bringing the virus into the building, so tell me why my family can’t visit me in my room?
  • I have become more anxious and depressed due to the separation from my loved ones. I have little appetite and am losing weight.
  • I feel worthless, and most days, I feel like giving up, and I’m usually an upbeat, positive person. The facility needs to create a safe way to see my spouse and not keep me locked up in my tiny room. Hopefully, I won’t die from the way I’m now being treated.
  • I miss hugs and touch, especially from my family members! 
  • I am very lonely. I miss socializing with other residents. I miss getting out into the community and having visitors.
  • We can’t even come out of our rooms for activities or meals. This is awful.

You can’t help people remain safe, keep them closed
off from the world, and expect them to thrive.
–  Anne Montgomery

The hardest part for families and residents with the social distancing piece is the inability to touch or hug someone. CMS did finally lift this restriction on September 17, 2020. Now each state, nursing home corporation, and nursing home is moving towards finding ways for families to connect to their loved ones with safety precautions in place.

But we can do better … 

The report points out that “under current CMS guidance featured in the State Operations Manual, social isolation is identified as a possible risk for some residents in the context of falls, PTSD, urinary and fecal incontinence, mental disorders, placement of a feeding tube, side effects of certain medications (i.e. antipsychotics)”. 

Some of the recommendations to identify and reduce risks associated with social isolation and loneliness from the report include (see full report for all recommendations starting on page 17):

  • Assess each resident for loneliness and social isolation, and create practical approaches to reduce this in their care plan.
  • Make isolation and loneliness a focus of QAPI Performance Improvement Projects.
  • Create visiting plans for residents who want to see family and friends, and document this in resident care plans. Assign a specific staff member to be responsible for arrangements for visits that comport with CMS guidelines on visitation, most recently updated on September 17, 2020.
  • Weather permitting, allow residents to leave their room every day and go outside if they wish.

Nursing homes are encouraged to apply for funding to provide residents with tablets to keep them connected.
– Anne Montgomery

Nursing homes are encouraged to apply for funding to provide residents with tablets if they don’t have a smartphone or laptop to keep them connected with their families. Congress is now paying attention again to nursing homes’ difficulties and providing opportunities for improvement.

There are a lot of online, virtual tours that residents can access – virtual tours of museums, natural parks, etc. Even if a resident only has access to a phone, one program I recommend is Well Connected. It’s free and open to anyone in the US aged 60 and older.

Resources for Nursing Homes and Families:
*From the Altarum Report pages 20-24

Recommendations to Allow Nursing Home Residents to Have Increased In-Person Contact with Family and Friends During the Covid-19 Pandemic: The National Consumer Voice for Quality Long-Term Care. September 4, 2020. Offers CMS recommendations for nursing home visitation requirements during Covid-19 that will promote and protect resident welfare.

https://theconsumervoice.org/uploads/files/general/FINAL_Visitation_Recommendations_to_ CMS_9.4.20_w_Collaborators.pdf

VDH Nursing Home Guidance for Phased Reopening: Virginia Department of Health. September 8, 2020. Virginia specific guidance aimed at providing practical strategies for nursing homes to implement phased and safe reopening plans.

https://www.vdh.virginia.gov/content/uploads/sites/182/2020/06/VDH-Nursing-Home-Guidance- for-Phased-Reopening-6.18.2020.pdf

Coronavirus in Long-Term Care Facilities: Information for Residents and Families: The National Consumer Voice for Quality Long-Term Care. September 2020. Consumer Voice has created a special COVID-19 resource page including the latest information about its impact, changes to facility requirements, and recommendations for advocating for yourself or your loved one.

https://theconsumervoice.org/issues/other-issues-and-resources/covid-19/residents-families

They’ve also set up a webpage for you or your loved one to share experiences with your long-term care facility during this pandemic.

Other News Related to Improving Quality and Safety
in Nursing Homes …

In 1986, the Institute of Medicine released the seminal report Improving the Quality of Care in Nursing Homes that led to the 1987 Omnibus Reconciliation Act (OBRA ‘87). Despite three decades of efforts to improve the quality of care in nursing homes, significant challenges still remain and COVID-19 has amplified a myriad of long-standing issues that still need better solutions for aging Americans.

Announced in October 2020, a new Committee on the Quality of Care in Nursing Homes will examine how our nation delivers, regulates, finances and measures quality of nursing home care. The primary sponsor for the new study is The John A Hartford Foundation with additional support provided by the Commonwealth Fund.

About Anne Montgomery:

Anne Montgomery has in-depth experience analyzing and developing policy and research projects focused on aging issues, community issues, long-term care, Medicaid, Medicare, and family caregiver support. Ms. Montgomery served as a senior health policy associate with the Alliance for Health Reform in Washington, D.C., as a senior analyst at the U.S. Government Accountability Office, and as a health care legislative aide for the Ways & Means Health Subcommittee. In 2001-2002, Ms. Montgomery was an Atlantic Fellow in Public Policy based in London, where she analyzed family caregivers’ role in developing long-term care policies in the United Kingdom. During the 1990s, Ms. Montgomery worked as a health and science journalist covering the National Institutes of Health and Congress. A member of the National Academy of Social Insurance and Academy Health, Ms. Montgomery has an M.S. in journalism from Columbia University and a B.A. in English literature from the University of Virginia and has taken gerontology coursework at Johns Hopkins University.

Concerning awards and civic activities, Ms. Montgomery is a member of the National Academy of Social Insurance, Academy Health, and the American Society on Aging. She serves on the selection committee of the Congressional Fellowship Program, Health, and Aging Policy Fellows, American Political Science Association.

Ms. Montgomery was awarded a research fellowship by the British Council as an Atlantic International Public Policy Fellow in 2001-2002 and has received awards for outstanding public policy service from the National Adult Protective Services Association, National Consumer Voice for Quality Long-Term Care Public Policy Award, and the National Association of State Long-Term Care Ombudsman Programs.

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About Melissa:

Melissa Batchelor, PhD, RN, FNP, FGSA, FAAN. I am a nurse, nurse practitioner, nurse educator and nurse researcher with over 25 years of experience in the aging and long-term care healthcare space. You can visit my website at MelissaBPhD.com to learn more about me, how you can work with me directly,
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