When Caitlin McArthur began researching the pandemic’s effects on mental health in long-term care, she was surprised to find that it wasn’t all doom and gloom.
“Certainly there were terrible things that happened (in long-term care). But we actually found when we dug into the literature that the results (regarding mental health) were very mixed. Some people did find that their mental health decreased. People became more anxious, more depressed, had a worse quality of life,” McArthur said.
“But we also found that in some homes there wasn’t actually that big of a measurable change. Those homes had implemented some unique strategies. There’s two sides to the pandemic, and I think we’ve all experienced this in our life. There’ve been some good things and some bad things.”
One of the positives according to McArthur was the opportunity it provided for people to develop creative strategies to overcome pandemic-related challenges in long-term care homes. Those challenges included lockdowns, staff shortages, increased fears of severe COVID-19 infections, and impaired communication due to personal protective equipment worn by staff.
Exploring strategies that helped
An assistant professor in Dalhousie University’s School of Physiotherapy, McArthur recently co-authored a chapter in a new book titled COVID-19, Frontline Responders and Mental Health: A Playbook for Delivering Resilient Public Health Systems Post-Pandemic by Jennifer A. Horney at the University of Delaware.
While the book focuses on the pandemic’s impacts on responder health, it also highlights the inequitable impacts on workforce sectors and vulnerable populations.
When addressing lockdowns in particular, McArthur said visits mediated through windows, via technology, or outdoors were among several strategies that helped mitigate negative mental health consequences.
Also notable was the positive impact of increased access to volunteers and supports for families.
“Some homes actually hired people whose job it was to help people connect with their loved ones. They would facilitate, like setting up the time to call, setting up the time to meet outside, holding the iPad if that was needed. Or being a little bit of an intermediary in the conversation,” McArthur explained.
“Sometimes it’s hard to engage with somebody if they’ve never used a computer before and now you’re trying to talk through a computer.”
Other things that helped residents’ mental health as found in the literature included digital activities ranging from music therapy to exercise and support groups. She said many homes also assigned someone to support each resident.
“Somebody within the home that family members could contact or residents could say, ‘You know, I really want to talk to my daughter,’ and then that person would facilitate that,” she said.
The book chapter McArthur co-authored, Mental Health and Quality of Life in Long-Term Care During the Pandemic, focused specifically on the pandemic’s effect on mental health and quality of life in long-term care.
Naive to think a pandemic won’t happen again
“I think we would be probably naive to think it’s (a pandemic) not going to happen again, so it’s good to have these strategies in place,” she said.
Some homes, she said, have continued with pandemic strategies even if people can now visit in person. She pointed to the benefits of online visits in particular for those whose family members might live far away.
“If somebody is here and their loved one’s in Newfoundland, they could still face time with them, whereas that wasn’t really a norm before. Now it’s making its way into being a bit more normal,” McArthur said.
“I think homes that were able to get some supports to implement some of these strategies were able to mitigate some of those bad things that happened elsewhere.”
McArthur said having more volunteers in long-term care homes could also help provide socialization that improves residents’ quality of life. She said because they often experience poor health and a decreased ability to make decisions for themselves, studying the pandemic’s impacts on this population is critical.
“It helps us understand, first of all, what has happened in the world and especially in the world of long-term care during the pandemic. We can learn from these should we have to employ similar strategies in the future,” McArthur said.
“Hopefully we don’t. But if there are other waves of this pandemic, if there’s another future pandemic, we do have some strategies that seem to be helpful and that we can learn from and even build on for future use if we need.”
Always room for improvement
Cautioning that there’s “definitely always lots of room” for improvement in long-term care, McArthur said she was pleasantly surprised to learn that there were implemented strategies that proved helpful. She said mental health and quality of life are key to ensuring long-term care residents can enjoy their remaining months and years as much as possible.
Although the pandemic exposed many longstanding cracks in long-term care, she said it also led to the evolution and testing of creative strategies.
“While it wasn’t the same as being able to visit in person, there was this ability to still mitigate some of the negative outcomes for mental health,” McArthur said. “That wasn’t necessarily universal, where everybody had those same experiences. But in places where they were able to be creative, it seemed like that was able to help.”
Evolving public health crisis
McArthur said she’s continuing to explore this subject, adding that “we’re not out of the pandemic yet.”
“We’re still here…It’s an evolving public health crisis. So how does it continue to affect mental health and quality of life in this particular setting? The factors at play have changed,” she said.
“Maybe it’s not so much that it’s a physical lockdown now, but maybe staffing issues and limited support that way can contribute to mental health and quality of life as well.”
Examining how things are evolving and changing, she said, will help determine how to best optimize strategies that can help mitigate negative mental health consequences for long-term care residents going forward.
“Some (strategies) are still in play, and so can we continue to use those going forward? How can we continue to use technology to support communication even when we’re out of the pandemic? What’s that going to look like?”
Portions of the work was funded by the Canadian Frailty Network, Canadian Institutes of Health Research (CIHR), the Government of Canada’s New Frontiers in Research Fund for the Horizon 2020 research and innovation programme, Individualized CARE for Older Persons with Complex Chronic Conditions in Home Care and Nursing Homes.