The Adverse Effects of the COVID-19 Pandemic on Nursing Home Resident Well-Being

Abstract

Objective: Quantify the effects of the COVID-19 pandemic on nursing home resident well-being. Design: Quantitative analysis of resident-level assessment data. Setting and participants: Long-stay residents living in Connecticut nursing homes. Methods: We used Minimum Data Set assessments to measure nursing home resident outcomes observed in each week between March and July 2020 for long-stay residents (eg, those in the nursing home for at least 100 days) who lived in a nursing home at the beginning of the pandemic. We compared outcomes to those observed at the beginning of the pandemic, controlling for both resident characteristics and patterns for outcomes observed in 2017-2019. Results: We found that nursing home resident outcomes worsened on a broad array of measures. The prevalence of depressive symptoms increased by 6 percentage points relative to before the pandemic in the beginning of Marchdrepresenting a 15% increase. The share of residents with unplanned substantial weight loss also increased by 6 percentage points relative to the beginning of Marchdrepresenting a 150% increase. We also found significant increases in episodes of incontinence (4 percentage points) and significant reductions in cognitive functioning. Our findings suggest that loneliness and isolation play an important role. Though unplanned substantial weight loss was greatest for those who contracted COVID-19 (about 10% of residents observed in each week), residents who did not contract COVID-19 also physically deteriorated (about 7.5% of residents in each week). Conclusions and Implications: These analyses show that the pandemic had substantial impacts on nursing home residents beyond what can be quantified by cases and deaths, adversely affecting the physical and emotional well-being of residents. Future policy changes to limit the spread of COVID-19 or other infectious disease outbreaks should consider any additional costs beyond the direct effects of morbidity and mortality due to COVID-19.

“Be Their Advocate”: Families’ Experience with a Relative in LTC during the COVID-19 Pandemic

“…More so, given the surveillance of their relative by family members, one can conclude that the impact of restrictions on residents was also having consequences on their physical and cognitive health. This is not surprising, because the presence of family members not only improves the quality of life of residents in LTC (Levere et al, 2021;Stall et al, 2020;Tupper et al, 2020) but also supports the role of staff (Bouchoucha & Bloomer, 2021). Based on our comparison of phase I and phase II results, our study clearly illustrates the positive influence of families' continued presence in LTCFs on multiple aspects of older adults' health and that they are essential members of the care team.…”

COVID‐19 disease trajectories among nursing home residents

“…We found that nursing home residents will have a low symptom burden but will still have some indicator of infection. The long symptom burden necessitates prolonged isolation, extensive use of PPE and can significantly impact the quality of life of this patient population 24 . Although the disease course of COVID‐19 may be difficult to predict and leads to increased mortality, most residents infected with COVID‐19 can be managed in the nursing home with appropriate staff and resources, including abundant PPE and testing capacity.…”

Lessons learned in preventing COVID-19 within a skilled nursing facility during the early pandemic

“… 23 , 24 Residents’ social relationships with each other, staff, and visitors provides a sense of belonging and significance and social relationships are important for overall well-being. 25 , 26 , 27 By removing physical relationships with visitors and replacing this relationship with a virtual option, some residents might have felt a lost in their relationships and had a decreased sense of well-being.…”

“…Studies examining resident's perspectives of video conferencing could assist SNFs with understanding the sustainability of continuing this intervention. 24 Finally, more research is needed to capture the SNF communities’ stories or lived experience 26 during this pandemic. Capturing stories from residents, staff, and visitors would add compelling descriptions of what it has been like to live in and survive the COVID-19 pandemic within one of the most high-risk settings.…”