The Other Nursing Home Epidemic – Depression
Depression is a common issue for nursing home residents. This is understandable given that residents have deteriorating health often with physical limitations, lack meaningful daily interaction with loved ones and friends, and experience extended times of relative isolation.
COVID-19 has not only magnified but escalated this issue, driving an “epidemic of loneliness” according to a recent article in Forbes. Because of the potential severity of the virus on the elde rly and the ideal virus incubator of care facilities, an overwhelming percentage of COVID related deaths have been in adults 65 and over. By state, these percentages have ranged from a low of 70% (Texas and the District of Columbia) to a high of 94% (Idaho). Nursing homes have also been recognized as “super spreaders,” prompting states and administrators to impose severe lockdowns that have stretched into months. For residents, this has translated into greatly diminished socialization, participation in group activities, and in-person visits with loved ones.
A study conducted by Altarum revealed that with the sharp decrease in activity, ability to leave the facility, or see family, 76% of residents felt lonelier than usual. Even the daily ritual of gathering in the dining room was sacrificed (only 13 percent reported doing so vs. 69 percent before the outbreak).
Several significant problems may result from resident loneliness and depression, such as negative effects on their physical health (depressed individuals are at greater risk for heart disease, digestive issues, and a host of other conditions) and an increased risk for abuse by nursing home staff. Nursing home abuse can range from physical and verbal to neglect and is a well-known area of concern for nursing homes. Caring for residents is not a simple matter, especially if there are physical, psychological or cognitive challenges. Staff can often be undertrained, overworked, and underpaid. COVID-19 has placed even greater stress on nursing home staff, and oversight may be lacking as well. The active presence and advocacy of family members can go a long way to spotting and raising the alarm on suspected abuse, but what happens when family is not in a position to observe and intervene?
Understandably, nursing homes instituted many restrictions and limitations in an effort to minimize the contraction and spread of COVID among its residents, which eliminated in-person family visits and group activities among the residents. Residents have now been subject to these restrictions for nine months. CMS (Centers for Medicare and Medicaid Services) issued new guidance for safe visitation that stresses outdoor visits and indoor visits under certain conditions. There are also certain “compassionate care situations” where exceptions can be made. You can read the full text here. However, given the impending winter season and cold weather coupled with the recent uptick in the spread of COVID, restrictions will likely be tightened again. The threat of serious depression (and abuse) will continue, if not worsen over time – at least for the foreseeable future.
For families and friends, finding ways to meaningfully connect and communicate remain key, especially if personal visits are not yet possible. Frequent contact with staff to get updates will help in letting the nursing home know you are proactive and concerned. If you suspect depression, please alert an administrator, and follow up on securing diagnosis and treatment. If you suspect abuse or neglect, we may be able to help.
