Informal Caregivers Provide Considerable Front-Line Support In Residential Care Facilities And Nursing Homes

Coe, Norma B.; Werner, Rachel M.

doi:10.1377/hlthaff.2021.01239

Cited by 37 publications

(37 citation statements)

References 13 publications

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“…The challenge related to lack of respite care is not new but in fact has been reported in past research on the VA MFH program [ 33 , 34 ]. Similar to our findings that caregivers’ family members provide needed respite support, recent research shows that informal caregivers provide significant support to formal caregivers in nursing homes and assisted living facilities [ 40 ]. However, with a rapidly aging population—[ 41 ]—it is even more critical to continue to actively apply our study findings to visualize the future of LTC both in the VA system and beyond, with more formalized respite policies and programs.…”

Section: Discussionsupporting

confidence: 88%

Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program

et al. 2022

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The onset of the COVID-19 pandemic made older, homebound adults with multiple chronic conditions increasingly vulnerable to contracting the virus. The United States (US) Department of Veterans Affairs (VA) Medical Foster Home (MFH) program cares for such medically complex veterans residing in the private homes of non-VA caregivers rather than institutional care settings like nursing homes. In this qualitative descriptive study, we assessed adaptations to delivering safe and effective health care during the early stages of the pandemic for veterans living in rural MFHs. From December 2020 to February 2021, we interviewed 37 VA MFH care providers by phone at 16 rural MFH programs across the US, including caregivers, program coordinators, and VA health care providers. Using both inductive and deductive approaches to thematic analysis, we identified themes reflecting adaptations to caring for rural MFH veterans, including care providers rapidly increased communication and education to MFH caregivers while prioritizing veteran safety. Telehealth visits also increased, MFH veterans were prioritized for in-home COVID-19 vaccinations, and strategies were applied to mitigate the social isolation of veterans and caregivers. The study findings illustrate the importance of clear, regular communication and intentional care coordination to ensure high-quality care for vulnerable, homebound populations during crises like the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 88%

Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program

et al. 2022

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“… 26 The informal caregivers provided help with needs related to mobility (e.g., getting out of bed or across a room), self‐care (e.g., eating, bathing, toileting, and dressing), household activities (e.g., making meals), and medication use. 26 Informal caregivers may have also experienced their own distress related to changes in care in their care partner with dementia. 27 An analysis of sentiments from social media indicated increased emotional distress, such as depression, loneliness, and stress, among family caregivers of patients with dementia.…”

Section: Discussionmentioning

confidence: 99%

Behavioral symptoms, depression symptoms, and medication use in Michigan nursing home residents with dementia during COVID‐19

Coe

Montoya

Chang

et al. 2022

J American Geriatrics Society

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Background The COVID‐19 pandemic significantly disrupted nursing home (NH) care, including visitation restrictions, reduced staffing levels, and changes in routine care. These challenges may have led to increased behavioral symptoms, depression symptoms, and central nervous system (CNS)‐active medication use among long‐stay NH residents with dementia. Methods We conducted a retrospective, cross‐sectional study including Michigan long‐stay (≥100 days) NH residents aged ≥65 with dementia based on Minimum Data Set (MDS) assessments from January 1, 2018 to June 30, 2021. Residents with schizophrenia, Tourette syndrome, or Huntington's disease were excluded. Outcomes were the monthly prevalence of behavioral symptoms (i.e., Agitated Reactive Behavior Scale ≥ 1), depression symptoms (i.e., Patient Health Questionnaire [PHQ]—9 ≥ 10, reflecting at least moderate depression), and CNS‐active medication use (e.g., antipsychotics). Demographic, clinical, and facility characteristics were included. Using an interrupted time series design, we compared outcomes over two periods: Period 1: January 1, 2018–February 28, 2020 (pre‐COVID‐19) and Period 2: March 1, 2020–June 30, 2021 (during COVID‐19). Results We included 37,427 Michigan long‐stay NH residents with dementia. The majority were female, 80 years or older, White, and resided in a for‐profit NH facility. The percent of NH residents with moderate depression symptoms increased during COVID‐19 compared to pre‐COVID‐19 (4.0% vs 2.9%, slope change [SC] = 0.03, p < 0.05). Antidepressant, antianxiety, antipsychotic and opioid use increased during COVID‐19 compared to pre‐COVID‐19 (SC = 0.41, p < 0.001, SC = 0.17, p < 0.001, SC = 0.07, p < 0.05, and SC = 0.24, p < 0.001, respectively). No significant changes in hypnotic use or behavioral symptoms were observed. Conclusions Michigan long‐stay NH residents with dementia had a higher prevalence of depression symptoms and CNS active‐medication use during the COVID‐19 pandemic than before. During periods of increased isolation, facility‐level policies to regularly assess depression symptoms and appropriate CNS‐active medication use are warranted.

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“…Research and policy analysis have highlighted the immense value of family and other informal caregivers as a resource for community-dwelling older adults and persons with disability ( Feinberg et al, 2021 ; Reinhard et al, 2019 ). Fewer studies have examined the substantial contribution of informal caregivers in residential care ( Coe & Werner, 2022 ; Gaugler & Mitchell, 2022 ). Spurred by the “natural experiment” that removed this resource from the nursing home, future research should delineate the value provided by family members and other visitors in the provision of nursing home care, especially for residents experiencing distressing symptoms.…”

Section: Discussionmentioning

confidence: 99%

Nursing Home Palliative Care During the Pandemic: Directions for the Future

Ninteau

Bishop

2022

Innovation in Aging

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Background and Objectives Palliative care addresses physical, emotional, psychological, and spiritual suffering that accompanies serious illness. Emphasis on symptom management and goals of care is especially valuable for seriously ill nursing home residents. We investigated barriers to nursing home palliative care provision highlighted by the COVID-19 pandemic and the solutions nursing home staff used to provide care in the face of those barriers. Research Design and Methods For this descriptive qualitative study, seven Massachusetts nursing home Directors of Nursing (DONs) were interviewed remotely about palliative care provision before and during the COVID-19 pandemic. Interview data were analyzed using thematic analysis. Results Before the pandemic, palliative care was delivered primarily by nursing home staff depending on formal and informal consultations from palliative care specialists affiliated with hospice providers. When COVID-19 lockdowns precluded these consultations, nursing staff did their best to provide palliative care, but were often overwhelmed by shortfalls in resources, resident decline brought on by isolation and COVID-19 itself, and a sense that their expertise was lacking. Advance care planning conversations focused on hospitalization status and options for care given resource constraints. Nevertheless, nursing staff discovered previously untapped capacity to provide palliative care on-site as part of standard care, building trust of residents and families. Discussion and Implications Nursing staff rose to the palliative care challenge during the COVID-19 pandemic, albeit with great effort. Consistent with pre-pandemic analysis, we conclude that nursing home payment and quality standards should support development of in-house staff capacity to deliver palliative care while expanding access to the formal consultations and family involvement that were restricted by the pandemic. Future research should be directed to evaluating initiatives that pursue these aims.

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Informal Caregivers Provide Considerable Front-Line Support In Residential Care Facilities And Nursing Homes

Cited by 37 publications

References 13 publications

Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program

Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program

Behavioral symptoms, depression symptoms, and medication use in Michigan nursing home residents with dementia during COVID‐19

Nursing Home Palliative Care During the Pandemic: Directions for the Future

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