For nearly three months now, skilled nursing residents have been on lockdown.
On March 13, Centers for Medicare and Medicaid Services (CMS) issued guidance banning all non-essential visits to the nation’s more than 15,000 nursing homes in efforts to stop the spread of COVID-19. This is a sorely needed protection for this most vulnerable of populations, but it brings a problem: increased social isolation for people whose normal interactions are already limited, and who face greater challenges as a result.
Fortunately, there are technological solutions to skilled nursing’s social isolation problem. Among them is RehabTracker, the resident engagement tool from Louisville, Kentucky-based RehabCare, which provides contract therapy services across multiple settings, including skilled nursing.
Here is a look at three of the top problems caused by social isolation among skilled residents, and the ways in which RehabCare addresses them.
Higher risk of anxiety and depression
Anxiety and depression are common among older adults, particularly in skilled facilities, and many of the best strategies for combating them have been lost due to COVID-19 restrictions: social interaction and a fixed schedule. Visits from family can reduce depression among cognitively impaired older adults, while a sense of normalcy around the day-to-day routine within a community or skilled facility can keep anxiety in check.
COVID-19 disrupts both of those.
“For many of our residents, they struggle with understanding why all of a sudden their world has changed,” says Glenda Mack, senior vice president of operations and chief operating officer at RehabCare. “We’re seeing this anxiety level starting to creep up.”
An increase in anxiety leads to unwanted, and unsafe, behaviors among skilled residents, Mack says. Therefore, the challenge is to find a way to balance the need to protect residents from the virus against the need to keep them healthy, happy and mentally fit.
“We have tried our best to create routines as a therapy company,” Mack says. “One of the biggest parts of that is ensuring that we … integrate any kind of social activity in their day in a safe and effective way.”
RehabCare is finding ways to increase communication, whether between residents and their family members, or among staff. RehabTracker’s engagement app helps residents stay connected with their loved ones, providing direct interaction on a daily basis.
Additionally, RehabCare is delivering personalized checklists which includes key signs of anxiety and depression that nurses or CNAs can use to ensure warning signs are quickly addressed and communication is increased among staff. This enables them to more quickly and comprehensively remain up to date on the status of a given resident.
Decline of physical mobility
For skilled residents, one day of decline in mobility requires three days to recover. When a lockdown keeps residents in their rooms and limits physical activity, there is an increased risk of functional decline that may be difficult for the resident to regain.
A dip in resident mobility can exacerbate health problems, both because of the lack of movement, and because they are seen less frequently by staff, who won’t have the opportunity to track declines. This can lead to an increase in urinary tract infections (UTI), incontinence and fall rates.
“We have to balance the risk of COVID with the overall wellbeing,” Mack says. “And at some point we have to have a very honest discussion of what does that look like as a society, and what kind of quality of life do we want our skilled residents to have?”
RehabCare works with its partners to increase communication and watch for the early signs of a progressed illness, such as changes in cognitive status or a development of a UTI.
“During a therapy session, our clinicians are looking for the psychosocial signs, (and) trying to determine underlying causes,” Mack says. “We’re asking our therapists to be on the lookout for some of the psychosocial issues.”
Therapists must serve as frontend evaluators of resident status. If psychosocial issues are identified, RehabCare has developed specific training for their staff, through their new Hope Conquers program, to address the issues quickly before they become major long-term health problems.
Compounding medical issues
Because comorbidities work in concert, the ability to stem depression and anxiety, and monitor physical decline can be two of the most important steps to preventing the compounding of medical issues. There is a direct line of balance and counterbalance running between social isolation and these compounding medical issues, as isolation reduces movement and engagement and builds a higher risk of hospitalization and rehospitalization, Mack says.
“As such, there will be a downstream impact,” she says, as a trip to the hospital poses another risk to increased COVID-19 exposure.
The fusing of technology tools and medical treatment can help keep residents healthy during the pandemic. RehabCare’s new patient screener app, for instance, highlights specific key points about a given patient, including patient diagnosis, medical conditions and prescribed medications, to expedite the intake process after a referral, helping to reduce resident evaluations prior to admissions from 45 to 60 minutes down to about two minutes.
It also helps ensure accuracy of the evaluation so the facility fully understands the unique needs of the patient.
“We feel like this will be a game-changer for the SNF world,” Mack says. “It will have key words that we will need to be sure we have further documentation, and will be hugely valuable to the SNF industry.”
Social isolation poses new challenges to resident health and wellbeing, including their quality of life and sustained dignity. Contact RehabCare to see how their innovative solutions and programs can help you reduce those risks and increase strong outcomes.