ABSTRACT
Due to the rapid spread of COVID-19 in long-term care (LTC) settings and the subsequent mandatory visitor restrictions that were put in place, the provision of behavioral health services in LTC settings was impacted. To examine the pandemic's effect on the provision of psychological services in this setting and its impact on clinicians and their patients, we surveyed 126 licensed mental health clinicians working in LTC settings during the pandemic. The sample consisted of psychologists, social workers, and psychiatry mid-level practitioners from 31 states who had provided mental health care services in LTC settings during the initial 7 months after the COVID-19 pandemic was declared a national emergency. This exploratory study revealed that the pandemic significantly impacted the availability and use of mental health services in LTC settings. Although there was a reported increase in the use of telehealth services compared to prepandemic frequency, it was noted that LTC residents went long periods of time without access to mental health services. Government-imposed visitor restrictions and pandemic-related restrictions were perceived as negatively impacting the emotional well-being, loneliness, and quality of life of LTC residents. Perceived factors contributing to the financial and emotional impact of COVID-19 on clinicians were explored, and it was noted that more than half of the sample reported experiencing burnout and nearly one third of surveyed clinicians believed they had experienced trauma by providing mental health services in LTC settings during the COVID-19 pandemic. Understanding this impact has implications for providing mental health services during the current and future pandemics.
ABSTRACT
Objectives The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted the mental health functioning of older adults residing in long-term care (LTC) settings. This study examines the impact of the lockdown on anxiety symptoms over time in LTC residents. Design Secondary data analysis was conducted on clinical data obtained with permission from a large behavioral health company that provides behavioral health services in long-term care (LTC) and assisted living (AL) facilities. Setting and Participants Data was obtained from 1149 adults (mean age 72.37, 70% female) in in LTC and AL facilities across the United States who were receiving psychological services one year prior, and one year after, the COVID-19 pandemic lockdown. Methods Changes in anxiety (measured using a clinician rating scale) over time before and after the pandemic were assessed using Latent Growth Curve modeling with psychiatric diagnosis, psychiatric medication and demographic factors included as covariates. Results Anxiety severity decreased over time before and after the onset of the COVID-19 pandemic. While pandemic level factors such as facility closure and telehealth availability did not affect anxiety over time, individual treatment factors such as OCD diagnosis, initial anxiety severity, bipolar disorder diagnosis, and prescriptions for anxiolytic and antipsychotic medications affected the trajectory of anxiety during the pandemic. Conclusions and Implications These results demonstrate that individual covariates such as diagnosis, symptom severity and medication use impacted the trajectory of anxiety symptoms before and during the COVID-19 pandemic more strongly than pandemic related circumstances (facility closure, telehealth availability). The impact of the COVID-19 pandemic may be better observed through treatment-relevant variables, rather than pure symptom severity. In preparation for future pandemics or other large-scale disasters potentially impacting service delivery, facilities should continue to prioritize continuity of care or a timely resumption of services attending to individual treatment factors.
ABSTRACT
Public Significance Statement The COVID-19 pandemic has disrupted the provision of mental health services in long-term care (LTC) settings, resulting in negative impacts not only for LTC residents who had previously been receiving mental health services but also the clinicians providing the services. This study examines the impact of the COVID-19 pandemic on mental health providers' ability to provide mental health services in LTC settings, patient functioning, and providers' personal well-being and professional functioning. The authors hope that information within this article will assist in elucidating critical insights that can serve as a guide for policymakers, administrators, employers, and mental health clinicians regarding the provision of mental health services to residents in LTC settings during future pandemics. Due to the rapid spread of COVID-19 in long-term care (LTC) settings and the subsequent mandatory visitor restrictions that were put in place, the provision of behavioral health services in LTC settings was impacted. To examine the pandemic's effect on the provision of psychological services in this setting and its impact on clinicians and their patients, we surveyed 126 licensed mental health clinicians working in LTC settings during the pandemic. The sample consisted of psychologists, social workers, and psychiatry mid-level practitioners from 31 states who had provided mental health care services in LTC settings during the initial 7 months after the COVID-19 pandemic was declared a national emergency. This exploratory study revealed that the pandemic significantly impacted the availability and use of mental health services in LTC settings. Although there was a reported increase in the use of telehealth services compared to prepandemic frequency, it was noted that LTC residents went long periods of time without access to mental health services. Government-imposed visitor restrictions and pandemic-related restrictions were perceived as negatively impacting the emotional well-being, loneliness, and quality of life of LTC residents. Perceived factors contributing to the financial and emotional impact of COVID-19 on clinicians were explored, and it was noted that more than half of the sample reported experiencing burnout and nearly one third of surveyed clinicians believed they had experienced trauma by providing mental health services in LTC settings during the COVID-19 pandemic. Understanding this impact has implications for providing mental health services during the current and future pandemics.