Over a year has passed since the first known case of the novel coronavirus in the United States was reported in Snohomish County, Washington on January 20, 2020. During that time, essential workers — including frontline workers in senior housing and long-term care — have not gotten a break, continuing to work every day to keep basic needs fulfilled.
The protracted fight against Covid-19 is laying the foundation for an emerging mental health crisis among essential workers, psychotherapist Doris Klinkhamer told Senior Housing News. Many essential workers are being asked to perform jobs that pay at or slightly above minimum wage, and are at risk of being exposed to the virus while on the job.
This comes with added physical, mental and emotional stress. People are more prone to anxiety and depression during extreme events, and susceptible to increases in alcoholism and substance abuse. A new study from the NYU School of Global Health published in the journal Preventive Medicine revealed that people suffering from anxiety and depression are drinking more during the pandemic.
The pandemic may also be contributing to an increase in suicides. Japan’s health and welfare ministry reported nearly 20,919 suicides in 2020 — a 3.9% increase after a decade of decline, with women and children notably taking their own lives at higher rates.
Labor has been one of the biggest challenges and expenses that senior living providers have faced during the pandemic, and a mental health crisis among the industry’s workforce could extend these challenges by resulting in higher rates of absenteeism and turnover.
Compounding matters, 2020 was a year full of extreme, stressful events, including Black Lives Matter protests across the country and a contentious election and its aftermath including an insurrection at the Capitol in Washington, D.C..
“The past year was a constant trauma,” Klinkhamer said.
Senior housing providers have been proactive to protect the mental health of frontline workers throughout the pandemic. Many have provided enhanced benefits such as flexible scheduling, additional personal time off and sick leave, and “hero pay” wages. Others, such as ALG Senior and Miami Jewish Health, have taken extra steps to ensure the wellbeing and good mental health of their workers, such as by establishing call-in hotlines, and implementing protocols and smaller group meetings for staff to check in on each other and better identify signs that they need a mental health break.
This will be necessary in the coming months, as the Biden administration lays the groundwork for a more concerted federal response to the pandemic, Miami Jewish Health Senior Vice President for Behavioral Health, Dr. Marc Agronin, told SHN. A geriatric psychiatrist, he is also chief medical officer for the MIND Institute at Miami Jewish Health.
The organization provides senior health care services and living options including independent living, assisted living, home health and long-term care, affordable senior housing and a program of all-inclusive care for the elderly (PACE).
With the total death count from Covid-19 expected to exceed 500,000 by the end of February, he sees a protracted response even as the vaccination effort continues.
“We are in the midst of a surge in the [outside] community, similar to what happened last spring,” he said. “It’s important for people not to let up their guard.”
With many senior living and care settings already struggling to recruit and retain when the first wave of positive cases swept through the country last spring, frontline health care workers have not had a break.
In parts of the world where the coronavirus first hit hard, there are already signs of PTSD among health care workers. A study of nurses in China exposed to Covid-19 released last June revealed a PTSD incidence of 16.83%.
In August, the Centers for Disease Control and Prevention (CDC) released the results of a nationwide study conducted at the end of June which found that 40% of respondents reported symptoms of anxiety, depression or increased substance abuse. More than 10% indicated thoughts of suicidal ideation over the past 30 days, versus 4% in 2018.
Frontline workers in long-term care must contend with stress from actual and feared exposure to coronavirus at work, and financial loss if they miss extended time from work due to quarantine or other illness. Moreover, while frontline staff have adapted to wearing personal protective equipment (PPE) as the pandemic endures, the current surge in positive cases and deaths dovetails with concerns expressed by some segments of the population about getting vaccinated, Agronin told SHN.
“The challenge [now] is addressing many of the concerns people have about the vaccine, especially with frontline caregivers,” he said.
In the early weeks of the pandemic, Miami Jewish Health took several steps to address the mental and emotional wellbeing of its staff. The provider established a staff hotline to field workers’ concerns, whether related to medical conditions or mental health, Agronin said.
Miami Jewish Health has a mental health staff on its campus, consisting of two psychiatrists, two psychologists, and a nurse. This team regularly circulates among the workforce to develop relationships and touch base with staff, remind workers that the mental health team is available for any questions and concerns, and to urge frontline workers to share when they might feel they need more intense clinical contact, at which point they will be referred to the provider’s employee assistance program for counseling.
Another strategy that made a difference in staff wellbeing and controlling anxiety is assigning a full-time doctor to communicate with anyone who has questions about Covid-19, and assists staff members who test positive for the coronavirus with managing their quarantines and organizing when they can return to work.
“This doctor has played such a key role in reducing the routine anxiety people will have regarding testing and general management of Covid-19,” Agronin said. “He’s an amazing resource for anyone who has questions or concerns.”
ALG Senior also sprang into action to protect the wellbeing of its staff, Chief Human Resources Officer Mary Raddant told SHN. The Hickory, North Carolina-based operator — formerly known as Affinity Living Group — supports a number of communities across the southeastern U.S.
ALG Senior did several rounds of resilience training for its leaders to make them more self-aware on what actually is useful and helpful for them to elevate the mood of workers. Pastoral counseling is offered for interested groups and individuals. And ALG Senior improved its employee assistance program, so that every employee and their families, including part-time staff, can have up to three counseling sessions for free.
“With what everyone has been going through — not just in our local communities but in the entire world in this last year — it’s been a very different experience, and one that has been challenging for all of us,” Raddant said.
A war with no winner
What is not in doubt is how frontline workers have risen to the challenge during the pandemic.
As communities across the country went into lockdowns, frontline staff became the primary connections to residents, and served as conduits between residents and their families during Covid-19’s early weeks while residents learned how to handle communication tools such as tablets to keep in touch with their loved ones.
The stress employees continue to endure is undeniable and in many instances, cannot be placed into words. One frontline worker at Revera Senior Living compared caring for residents during the pandemic to “a war that had no winner” in a report detailing the provider’s Covid-19 response.
“[Each day] seemed very much the same. Keep working. Keep going. Comfort the sick and dying. Care for the families. Care for the staff. ‘Bag’ another body. No time to cry, no time to say goodbye, no time to rest, just no time… We are broken and we are sad. I do not feel.”
That compassion and fatigue is constant across the industry, ALG Senior Chief Medical Officer, Dr. Kevin O’Neil, told SHN. This is why the operator consistently reinforces to its staff the importance of self-care and wellbeing.
“You can’t help others if you’re emotionally and physically depleted yourself,” he said.
To that end, the human resources departments at ALG Senior and Miami Jewish Health frequently collect data and conduct surveys among staff to gauge their job satisfaction and identify signs of burnout.
Agronin believes these check-ins reinforce workplace relationships, and the feedback received enables leadership to take immediate action.
“Surveys work really well, because then we can take our time to analyze it and go through [the data],” he said.
Vaccinations not a reset
The arrival of vaccines to long-term care signal that the fight against Covid-19 has turned a corner. But it will still be months before a post-pandemic landscape is clear.
Attention will now turn to educating staff on the benefits of vaccines. Many nursing homes, and to a lesser extent hospitals, are seeing staff reject being vaccinated. Some administrators have taken to incentivizing staff to get vaccinated. Still, in some instances, 80% of staff are rejecting vaccinations.
ALG Senior is undertaking educational initiatives to educate its frontline workers on the benefits of receiving the vaccine as a moral imperative to protect themselves, their families and the residents in their care, O’Neil told SHN. Once those efforts have been exhausted, ALG Senior will make staff vaccinations mandatory, similar to how the organization requires all staff to receive flu vaccines every year.
He compares this approach to seat belt laws: flouting those jeopardize the driver as well as others.
“We all value our autonomy to refuse or consent to medical treatments,” he said. “But your autonomy ceases when your actions can jeopardize others in the population.”
Miami Jewish Health is also undertaking an educational initiative to break down resistance among its frontline staff toward being vaccinated. Agronin is confident that, as those who resist see the impact of people being vaccinated, it will do more to assuage lingering fears than any outreach.
“It’s ironic that even as we have a vaccine, and we see the light at the end of the tunnel, we still are in the midst of this pandemic, as strong as we were last spring,” he said.