Long-term care COVID restrictions took toll on families' mental health, reveals study

Restrictions on social access had a direct impact not only on the well-being of older adults in long-term care (LTC) but also their family members during the COVID-19 pandemic, according to a new study by Western researchers.

The study, published in the Canadian Journal on Aging, was conducted by faculty members from the Arthur Labatt Family School of Nursing and the University of South Carolina's College of Nursing. They conducted in-depth interviews with the family members of older adults in Ontario LTC facilities between November 2020 and January 2021 coinciding with the second wave of the pandemic and re-introduction of increased public health restrictions in the province.

The findings indicate an urgent need to improve and re-conceptualize long-term care, say the authors of the study.

"There is a profound need to continue developing evidence-based strategies to support the health and well-being of older adults and their families as well as the health providers who work with this vulnerable population. In developing this evidence, the health system, funding agencies and researchers must be open to exploring alternate care models," said professor Anna Garnett of the Arthur Labatt Family School of Nursing, and lead author of the study.

"Implementation of these models must include a strong program of research using approaches such as co-design to accurately assess the impacts and outcomes of these models," she said.

Co-design involves design by multiple stakeholders in a system or process. In this case, it would mean engaging family members in the research process.

In-depth interviews with family members revealed that many residents experienced profound feelings of sadness, loneliness, fear and frustration while family members felt powerless to help them.

Family members also explained that they felt invisible and that they struggled to trust that their older adult relative was being adequately cared for in their absence. Their own distress and concern for the older adults' well-being undermined their ability to find closeness during visits that occurred outside or via a window.

Closeness, in relation to the study, was defined as the perception of the bond felt between the older adult living in long-term care and their family member. Involvement was defined as the family member's perceived level of involvement in social engagement with their family member living in long-term care.

Governmental social distancing mandates meant family members and older adults living in long-term care were "abruptly cut off" from one another. They were expected to find alternative means to connect, and many family members turned to tablets and smartphones.

These approaches were not without challenges, the study authors noted. Older adults were left to navigate new technology with limited assistance from staff at the facilities. Technology also could not adequately replicate familiar social bonds.

Changes in the emotional and mental health of older adults included accelerated disease progression, depression and anxiety. Many family members believed this was related to an absence of stimulation, social connectedness, and love from family.

"For people in long-term care, it's not about the quantity of time they have left, it's the quality of the time they have left…. I said to my mother, if it was a difference between you living a longer time or having us in there, what would you prefer? She said, 'well, I prefer to have you in here,'" said a family member quoted anonymously in the study.

The study findings highlight the importance of balancing psychosocial health with physical health when developing and implementing infection control measures. The study also highlights the need to explore technology implementation within long term care to support social connectedness in this vulnerable population.

The researchers also felt the findings of the study, along with other research related to COVID-19, highlight the need for a comprehensive approach to infection control measures.

"There remains important work to be done to enhance preparedness for pandemics and yearly outbreaks that balances physical safety with long-term considerations for health and well-being. The older adult care sector has been under-resourced and under-funded in Canada for many years. Going forwards it will be important to use the experience of COVID-19 to bring about meaningful change. This means addressing the health human resources crisis, improving working conditions and exploring novel ways to deliver care and engage residents and family members," said Garnett.