UAA student reports findings
As a graduating senior and assistant at an Alaska assisted living facility, I wanted to look at how COVID-19 impacted long term care residents. With careful attention to confidentiality agreements, and proper respect to resident’s privacy, I conducted a short, anonymous informal survey among the residents at the facility in Southcentral Alaska.
Background on long term care residents and their caretakers
In 2019, a Journal of the American Medical Association (JAMA) article reported that 46% of caretakers working in long term care homes missed at least one care task per shift and 65.4% felt they rushed at least one care task once per shift. The most frequently rushed task was talking with residents (49.2%) followed by oral care, toileting, bathing, and peri-care. With the added stress of the pandemic, a 2020 article in a Canadian FACETS journal reported, resident-staff interactions may not have been as beneficial to the social needs of long term care residents as implied by the increased closeness created by isolation within the homes. These studies also emphasized that residents of long term care homes faced issues of added loneliness and isolation on top of worry about their health and COVID-19, in general.
I wondered if the characteristic resiliency of the mostly “Greatest Generation” population of assisted living homes would apply to their current situation. Although older adults were the most likely to die from COVID-19 infection, they scored themselves significantly higher in good mental health compared to the other age groups in 2021 studies. Another study resulted in mean coping level (on a one through ten scale) of 7.9, with 87% of participants rating their coping positively. The primary coping methods were staying busy, seeking social support, and staying positive.
Alaska long term care resident COVID pandemic survey and results
A total of 30 residents were surveyed, 63% male, 67% veteran, 90% white (10% Alaska Native), and the average of three years living at the home. Seventy percent of residents felt that COVID-19 restrictions affected their day-to-day life, with 12 reporting that they felt lonely or missed family. An 80 year old male felt “...under a pressure that is not normal. One could call it depression...”. Similarly, a 68 year old female explained that her inability to go out made her “[feel] like [she] was in jail”.
Although the majority of residents agreed that their routines were changed due to COVID-19, seven mentioned that they understood the precautions were necessary. They used terms such as “they’re doing their jobs to keep us safe”, “I didn’t enjoy it but it was necessary”, and “I understand the rationale”. Sixty-percent of residents felt that the precautions such as masks and COVID-19 tests made them feel different. Ten residents spoke about the importance, safety and necessity of the masks and tests; 10 residents spoke about their dislike for the masks. Residents mostly explained difficulty understanding staff or being able to have a conversation with them.
Eighty-seven percent of residents felt that their overall experience living at the home had been positive. Conversely, 23% of residents felt that their feelings have changed due to “no more visitors’,” claustrophobia, and the “scary nature” of the precautions.
When asked if their access to visitors has changed since COVID-19, 80% of residents answered yes. Residents spoke of their family (children and grandchildren) and friends and how much they missed them. A 99 year old woman described her first experience being away from her family for a prolonged period as “difficult and lonely” and “[she] felt sorry she couldn’t see them”. Eighty-seven percent of residents received the COVID-19 vaccine. Residents felt that it “made them feel good” and were happy taking it “as long as it worked”.
The majority of residents (73%) did not notice a difference in their activity level or motivation to be active since COVID-19. Just one male resident explained how his physical health had been disproportionately impacted by the restrictions. He spoke of how “the second lockdown tore [him] up. It really affected [him] physically and mentally. [He] felt like [he] was being punished and others could walk around and do as they pleased”. These feelings were not unaccompanied, as a 77 year old female felt “[She] was not able to be socialized. [She] had to stay in [her] room and it made [her] less motivated”.
Seventy-three percent of residents did not perceive a difference in their appetite or interest in food. On the other hand, seven residents used terms such as “I eat too much,” “I have lost 50 pounds,” and “I am less hungry”. The majority (77%) answered no to a general question inquiring about a change in their well-being. Sixty-three percent of residents reported that they participated in the activities held at the home since COVID-19. The most common activities were singing and bingo.
Lastly, sixty-seven percent of residents perceived that they had not noticed a difference in their overall health since COVID-19. Seven residents felt that their health declined since COVID-19 and one felt their health improved.
Discussion and conclusions of survey findings
Based on the global response to the virus, it was hypothesized that older adults in long term care homes were affected by COVID-19 precautions. Results of this survey in this Southcentral Alaska long term care home indicate that the social consequences heavily impacted these residents.
Eighty percent of residents in the study experienced a noticeable change in their ability to access visitors. As described in previous studies, long term care residents most commonly spoke about missing their children, grandchildren and family. This trend was also seen in this study as residents spoke about longing for familial closeness difficult to achieve through window visits. Residents also complained of increased difficulty in communicating with staff.
The majority of residents in the study did not perceive that their activity level, motivation to be active, or appetite had changed since COVID-19. This trend indicates that some older adults may have resilience factors that are unique to their generation and/or age group that protect them from the negative psychological effects of COVID-19.
Most reported no difference in their wellbeing/outlook on life.
These findings help point to some areas of interest for future studies. A larger sample size, inclusion of multiple long term care homes, and identification of specific facilities is recommended.
The results of this study and review of other studies indicate a need for further research and advocacy on behalf of long term care resident health while infection control measures are implemented.
