Author: Edwin Trinh
Editors: Naomi Cassel, Raayan Dhar
The COVID-19 pandemic has placed long-term care homes, their residents, and their staff into a dire situation. Families are torn apart by the strict quarantine and physical distancing measures enacted to curb the spread of the deadly virus. As a result, residents of long-term care homes lose their only connections to the outside world. With a significant proportion of the long-term care resident population feeling depressed or lonely, it provides a cause for a global concern regarding the absolute state of the long-term care system.. Particularly affected by social isolation are dementia and Alzheimer’s patients, who will likely forget even more than they have, wreaking havoc on their personal family affairs. In Italy, residents have adopted nihilistic attitudes on life, and alarmed the general population, as their increased suicide rate has become one of the biggest concerns with regards to the pandemic. Although there are many issues plaguing the global long-term care system, solutions exist to these issues; it is up to politicians and leaders to put them into fruition.
COVID-19: Effects of the Pandemic in Long-Term Care Homes
In a report published at the start of the COVID-19 pandemic, titled The Coronavirus and the Risks to the Elderly in Long-Term Care, described the aged residents of long-term care (long-term care) homes as “a high-risk population in a high risk setting (Gardner, et al., 2020).” As the pandemic progresses, one can see the stark accuracy of this description. As lockdowns are enacted on populations across diverse geographical levels of jurisdiction, the effects of the pandemic on the elderly are amplified. Measures included as a part of such lockdowns, such as physical distancing, isolation, and travel bans, play a critical part in the damage that COVID-19 is causing on the aged population in long-term care homes.
Prior to the pandemic, it was not uncommon for residents to feel lonely- whether that is the physical inability to converse with fellow residents due to a physical disability, or that they are isolated from the outside world loneliness has been a common experience in long-term care homes. As a result, residents of long-term care homes have been long considered a marginalized population. As the effects of COVID-19 lockdowns took place, the isolation of long-term care residents have only been amplified, on top of the adverse effects of the additional coronavirus safety procedures. Family members are useful tools residents can use to connect themselves to the outside world. Family members are representatives of the resident’s best interests within the long-term care home system and as a result, are a source of emotional stability for the residents. With the increased complications that the pandemic entails, the role of the family connection grows even larger. As a result, the isolation from family members during the pandemic is more catastrophic than once expected.
Many long-term care residents are elderly and socially isolated; they depend on frequent visits from family and friends to socialize with them. Without these visits, residents may feel increasingly lonely, abandoned, and despondent. That’s a medical problem in its own right, leading to depression, weight loss, and disruptive behavior. (Gardner, et al., 2020)
To put this into perspective, close to half of long-term care residents in America report being lonely, nearly double the rate of loneliness in the general aged population (Simard, et al., 2020). With these people facing more social isolation than ever due to social isolation measures, their lonely selves are subjected to a wide range of harmful effects, such as depression, alcoholism, and suicidality. Prolonged loneliness fosters the deterioration of cognitive performance, and also fosters the development of cognitive illnesses, such as Alzheimer’s and dementia (Simard, et al., 2020). Residents already plagued with the effects of cognitive illnesses like dementia and Alzheimer’s experience particular trouble. To reduce the adverse effects of these illnesses, social interaction is critical. For instance, residents with dementia may forget about their family, forget about their friends, and lose the few remaining connections with the outside world. With such a drastic change, from seeing their family members and friends on a daily basis to being in a perpetual state of loneliness, the symptoms of cognitive illnesses are bound to develop and cause havoc within the familial circles of residents.
Although the issue of social isolation in long-term care homes seems out of control, as health measures give people no other options, there is hope that enough investment from various parties can help remedy the issue. Although the simplest methodology to protect residents from COVID-19 coming from outsiders is to physically isolate them, an alternative solution for residents to get the familial connection that they direly need is through virtual means. By introducing “virtual visitation” (Hado, et al., 2020) as a means to facilitate a connection between residents and family in a virtual environment, the issue of loneliness as a result of social isolation measures has been treated, but not completely alleviated.
Although hope still exists for residents experiencing loneliness in the wake of the pandemic, reports in Italy show that the situation may be more dire than once expected. Although the symptoms and outcomes of the coronavirus itself is devastative enough, the fears and stigmas against certain entities in the wake of the pandemic only amplify pre-existing issues, which can be described as a domino effect. For instance, it has been reported that some residents of long-term care homes in Italy feel a sense of overall despair, one more than usual. With their days filled with only sedentary activities, like watching television, residents are adequately aware of the risk and outcomes, and as such, are inclined to pray more than usual, and to adopt nihilistic worldviews (de Leo, et al., 2020). The adoption of these worldviews is especially concerning since residents have lost a sense of value in their lives, and consequently, might contemplate suicide. It has also been reported that residents’ behaviours have dramatically changed to what is described by de Leo as “psychomotor agitation” - violent behaviours requiring drug sedation for treatment. These symptoms of social isolation are apparent when residents need treatment for pre-existing conditions. With their value of life deteriorated, residents may decline the opportunity for hospital treatment, and instead, accept the fact that death is to come. In fact, some residents have become so nihilistic that they contemplate suicide, and in some cases, follow through with it. An increased suicide rate causes more concern, especially with the fact that enough people are dying as a result of the virus itself. The additional deaths, and the feedback loop that is caused by these deaths, is why the increased suicides have become one of the most feared outcomes of the crisis (de Leo, et al., 2020). The accumulation of these tragic situations only procures more evidence that the long-term care home system is in great need of overhaul to better care for the elderly.
In hard-hit Italy, it is estimated that about a quarter of all long-term care home residents have died as a result of COVID-19. This number is stark, and provokes an inquiry into the long-term care home system and its efficacy. Coupled with a lack of government interest (de Leo, et al., 2020), and a lack of staffing (Gardner, et al., 2020), long-term care homes become a breeding ground for inefficiency and corrupt operation. One only needs to look at the dire state of long-term care homes in Italy for evidence that reform is needed. Luckily, people have stepped up to this challenge, including some government authorities, and administrators. Some solutions that Gardner proposes is introducing paid sick leave for ill personal support workers, so as to minimize the risk of infection. If employees are prioritizing money over the health of their patients, then the risk of staff to resident transmission is great. More government intervention is also needed in this regard, as the result of lax government efforts to not only contain the spread, but also administering long-term care homes is tragically witnessed in the case of Italy.
Gardner, W., States, D., & Bagley, N. (2020). The Coronavirus and the Risks to the Elderly in Long-Term Care. Journal of Aging & Social Policy, 32(4-5), 310-315. doi:10.1080/08959420.2020.1750543
Hado, E., & Feinberg, L. F. (2020). Amid the COVID-19 Pandemic, Meaningful Communication between Family Caregivers and Residents of Long-Term Care Facilities is Imperative. Journal of Aging & Social Policy, 32(4-5), 410-415. doi:10.1080/08959420.2020.1765684
Leo, D. D., & Trabucchi, M. (2020). COVID-19 and the Fears of Italian Senior Citizens. International Journal of Environmental Research and Public Health, 17(10), 3572. doi:10.3390/ijerph17103572
Simard, J., & Volicer, L. (2020). Loneliness and Isolation in Long-term Care and the COVID-19 Pandemic. Journal of the American Medical Directors Association, 21(7), 966-967. doi:10.1016/j.jamda.2020.05.006