ABSTRACT
Background: Social isolation from COVID-19 has been shown to affect the mental health of all socioeconomic, ethnic and age groups. One of the most affected populations is long-term care (LTC) residents. This increased separation from their families and society has created an additive effect to their baseline physical and mental ailments. We investigated the change in depression and anxiety over time in residents of one LTC facility during this crisis. Aim: The aim of the intervention was to reduce the impact of social isolation by modifying recreational activities to include faceto-face visits, music therapy, and similar activities. Methods: Staff collected PHQ-9 and NPIQ (Neuropsychiatric inventory questionnaire) scores of all residents in the facility before implementing modified activities. Between 8/10 and 10/3/2020 we had a modified event calendar. Following the 8-week intervention, PHQ-9 and NPIQ scores were re-recorded. All LTC residents were eligible. Short-term residents, hospice patients, and those who did not participate in the intervention were excluded from analysis. Our primary outcome was change in depression and anxiety. Our secondary outcomes were change in weight, ulcers, and falls (MDS quality metrics). We hypothesized there would be a positive change in PHQ9 and NPIQ scores over time. We analyzed our data using paired sample t-tests. Analyses were conducted using SPSS v. 26. Results: 97 residents participated this intervention with an age range of 63-103 (mean = 86;SD 8). Participants' mean PHQ-9 scores improved significantly after participation in activities (9.1 vs 6.3) with a mean difference of 2.804 (CI 1.924-3.684, p<.001). Similarly, mean NPIQ scored showed a similar trend (18.74 vs 14.94) with a mean difference of 3.804 (CI 3.098-4.510, p <.001). There were no significant differences in falls, weight, or ulcers. Conclusions: This study highlights how COVID-19 has impacted LTC residents' mental health and suggests implementing modified recreational activities can improve the mental health of LTC residents. This is especially important as the pandemic, and associated restrictions, have lasted longer than anticipated. Therefore, LTC facilities should slowly and safely increase social interaction for residents whenever possible.
ABSTRACT
Background: It was not mandatory for Skilled Nursing Facilities (SNF) to screen patients for trauma before November 2019, when CMS initiated Trauma-Informed Care (TIC). With this requirement;however, CMS did not provide specific guidance for implementation. The purpose of TIC was to obtain traumatic experiences, identify approaches to manage reoccurrences of certain triggers, and to prevent re-traumatization thus providing a safer environment and more effective care. Here we communicate the accumulated experiences of the first-year implementation of TIC in one SNF. Methods: Budd Terrace at Wesley Woods, a non-profit, 250 bed long-term care and SNF, providing short-term rehabilitation and long-term placement. Without implementation guidance for TIC, our Interdisciplinary Team (IDT) added TIC questionnaires in the Baseline Care Plan, which is within 48 hours of admission. The admission nurse developed a process to guide the collection upon admission including the creation of a system encompassing a 6-part approach emphasizing the sensitive nature of trauma - Trust, Readiness, safe Atmosphere, Understanding, Minimize exposure, and Accommodation Results: We collected data from 473 new admissions from November 2019 to November 2020. Of these, 4.9% (n=23) reported experiencing trauma. Survivors ranged in age from 25 to 97 years old and reported a broad range of trauma experiences including: sexual assault (43%, all women);complicated grief (13%);COVID-19 (13%);combat-related PTSD (8.7%);intimate partner violence;racial discrimination;emotional abuse;other medical trauma;and accidents (all at 4.3%). The IDT was informed of the survivors' experiences. The social worker created a comprehensive person-centered care plan for the patient, addressing the trauma, goals, and interventions. Based on information gathered from this process we engaged in therapeutic approaches and take measures to prevent re-traumatization while in our care. Conclusions: During this implementation and ongoing pandemic, we recognized the profound importance of TIC in the SNF setting. Our process enabled us to connect better with our patients as their own self, with their own distinct experiences and needs that are often overlooked in medical charts. It has equipped us with a unique and valuable lens to view our patients, through which we can strive to provide a holistic, personalized, and a compassionate based care.