SNFs have made major strides in preventing and treating COVID, doctors say

According to geriatricians at a panel on Tuesday, care facilities are now highly skilled at preventing and detecting COVID-19 disease and staving off serious consequences. But the lingering impact of COVID-19 will rest with residents and their healthcare providers for the foreseeable future.

“Our understanding of how to protect seniors in skilled care settings has really changed since that first wave,” said Dr. Eran Metzger, geriatric psychologist at Hebrew SeniorLife in Boston, in a webinar hosted by Kaiser Health News and the John A. Hartford Foundation. “We’re much better at rapid identification, short quarantine periods that focus on people at risk, and using agents like Paxlovid when needed to reduce the likelihood of serious or fatal consequences.” The numbers look a lot better on these settings.”

Physical, mental trauma remains

But challenges remain. Older adults continue to face the greatest health risks from the SARS-CoV-2 virus, the panelists reminded the audience. Around 40% of deaths from COVID still occur in people over the age of 85, with 90% in people aged 65 and over, according to Kaiser data. And the physical toll of COVID on long-term care residents is only half the story, Metzger said. He shared details of a 102-year-old resident who, for example, asked him how to deal with her emotional anxiety about attending a family wedding.

“COVID is very much alive where we are. The trauma experienced by seniors lucky enough to survive the first wave of COVID [comes from] the isolation, of neighbors dying and not knowing whether they will live or die,” he said.

Non-pharmacological therapies that could help improve the quality of life for people with dementia have also been suspended in lockdown, he added.

“We have made great strides in long-term care in this country with the implementation of non-pharmacological interventions to improve the quality of life,” he said. “Almost overnight we had to stop these expressive art therapies, life-enhancement therapies, and other activities around socialization for infection control.”

Impaired Communication

As facilities return to normal activities, they are doing so with physical barriers between healthcare providers and customers in the form of masks and other personal protective equipment. This has communication, Metzger noted.

“When you’re dealing with a population, a large proportion of which may have lost language skills, both receptive and expressive, we depend much more on expressive body language and when we have to mask that with PSA, we really detract our communication and our ability to implement these non-pharmacological quality of life interventions,” said Metzger.

personnel crisis

The sector’s workforce crisis is also having intangible implications, the panelists said.

“In long-term care, which is where I spend most of my time, we’re seeing it with a less stable, less consistent workforce of nurses and nursing assistants,” Metzger said. “Familiar staff building relationships with these patients is really key to our care. So bring in masked staff in turn and you can imagine what happens to the client-carer relationship.”

The knock-on effect of low staffing levels in nursing homes reducing enrollment is causing a bottleneck in hospitals, and that’s raising the worst fears of Sharon Brangman, MD, chief of the department of geriatrics at Upstate University Hospital in Syracuse, NY.

“We’re beginning to understand what we’ve been talking about in geriatrics for years, which is how you have a healthcare workforce that responds to the fastest growing segment of the population, people over 85 who are most vulnerable to stressors, be it a pandemic or the flu, or a fall,” Brangman said. “They need more hands on deck. We are a reactionary society, we are waiting for a crisis to sort things out and that is the worst time.”

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