How to maintain social connection in long-term care facilities during pandemics
The COVID-19 pandemic has had a huge impact on Canadians from all age groups with more than 100,000 confirmed cases of the virus. In long-term care homes across Ontario and the country, staff have faced the tension of balancing residents’ safety from the disease with their ability to maintain social connections with family and friends.
Just a few months into the pandemic, a large portion of Canada’s COVID-19-related deaths — over 80 per cent — were among residents of nursing or retirement homes. During Ontario’s early response in March, the Chief Medical Officer of Health recommended that only essential visitors be allowed into long-term care facilities and issued directives prohibiting residents from leaving to visit family and friends. Family visits in long-term care homes were allowed to restart in late June, but included rules such as outdoor visits and physical distancing.
The importance of relational care
Relational care is the care that addresses the importance of human connectedness for overall well-being. In the case of residents living in long-term care homes, family and friends can also offer insights about the life, health and well-being, and care preferences of the older person to health-care providers. Because of the global health crisis that has been created by the Covid-19 pandemic, providing relational care has been a challenge.
Two Ryerson researchers from the Daphne Cockwell School of Nursing have teamed up to examine these challenges and to find out how health-care providers have overcome them. Sepali Guruge and Lori Schindel Martin, along with a team of researchers and partners, will identify innovative strategies that can be deployed to create opportunities to maintain relational care as the Covid-19 global health crisis continues and in the event of future outbreaks.
“It’s the background story of the older person that’s absolutely critical,” says Schindel Martin, adding that family members help to provide that background story for the older person living in long-term care. Relatives have often developed skills in caring for their loved one, which has frequently gone untapped during the pandemic as access to one other was limited. Even before the Covid-19 outbreak, the researchers say, the impact of good relational care and how it is provided was misunderstood.
It’s sometimes perceived that relational care is a happy accident instead of a result of the complex standards and competencies that are part of the skill sets of health-care providers such as gerontological nurses. “The public may not be aware of the skills and research-informed best practice knowledge that these wonderful interpersonal strategies are based upon,” says Schindel Martin.
80%of Covid-19 deaths were among residents of nursing or retirement homes
Social connections aren’t just nice to have for residents living in long-term care homes. They are critical to their well-being. “We can’t ignore the powerful impact that social isolation has on people in general, and older persons in particular. Social isolation can result in a range of short and long-term physical and mental health problems that can lead to early death,” says Guruge.
There can be difficulties in providing relational care during the pandemic. Many residents of long-term care homes may have cognitive impairments that affect their ability to initiate social engagement, which means staff, friends and family need to initiate or facilitate these engagements. Staff working in long-term care homes have had to try and balance allowing residents to socialize with each other and their family members and friends while keeping residents safe from those who may be infected and asymptomatic, a process Schindel Martin says can be complex.
There’s also the potential confusion stemming from a visitor’s need to wear personal protective equipment, something Guruge says can make residents wonder if they’re having a bad dream when they cannot recognize their loved ones or their voices. This study will help to identify strategies, for example methods families have successfully used to make themselves known and understood by their loved ones when PPE makes them unrecognizable.
The pair says many health-care providers and family members are still striving to create meaningful moments of connection for long-term care home residents. “What we’re trying to understand is how we can do more of that,” says Guruge. She and Schindel Martin aim to capture the approaches that have brought such moments about, as well as highlight areas for improvement.
Creating guidelines for future pandemics and outbreaks
As part of their research, Guruge and Schindel Martin will interview health-care providers and family members of older persons in care. Their findings could influence future policy directions as well as provide strategies for health-care providers to maintain relational care. Additionally, they seek to develop resources for health-care providers to help safeguard their own mental health and well-being during the pandemic. These resources may assist in future retention of health-care providers in long-term care homes or in other settings that focus on the care and well-being of older persons.
We can’t ignore the powerful impact that social isolation has on people in general, and older persons in particular. Social isolation can result in a range of short and long-term physical and mental health problems that can lead to early death.Sepali Guruge, Professor and Daphne Cockwell School of Nursing Research Chair in Urban Health
The strategies will aim to go beyond the individual health-care practitioner and family level to create best practice guidelines that could influence how facilities and even cities and neighbourhoods consider relational care and help to avoid some of the challenges that took place in the early months of the Covid-19 pandemic, such as visits being cancelled or some residents being restrained.
Their findings will be applicable both during the Covid-19 pandemic, as well as during future disease outbreaks, whether it’s another pandemic or the annual influenza season that can lead to closed doors. “Every fall, there are long-term care homes where there is an outbreak because of the flu,” says Schindel Martin.
The work they are undertaking will examine the creative strategies used to deliver relational care during this global health crisis to help ensure that during the ongoing pandemic and in future disease outbreaks the residents of long-term care homes can continue to have the social connections that are crucial to their health and well-being.