As Nebraska slowly rolls out coronavirus vaccinations across the state, a new project aims to address the mental health of the people who have spent months protecting the state’s most vulnerable: staffers at nursing homes and other long-term care facilities.
“We really recognize the incredible stress our long-term care facilities are undergoing — they’re dealing with a highly contagious virus that is deadly to the population they serve,” said Quinn Lewandowski, a research specialist at the University of Nebraska Public Policy Center.
The stress, he said, involves dealing with residents in quarantine, unable to accept visitors or go on outings; extra protective gear and other precautions to avoid transmitting the virus at work and at home; and sometimes the loss of lives in their care.
As of early January, data reported to the federal Centers for Medicare and Medicaid Services indicated more than 40% of COVID-19 deaths in Nebraska involved nursing home residents, and that didn’t include reports from other types of long-term care such as assisted living.
The Public Policy Center partnered with the Nebraska Department of Health and Human Services to win a $174,000 federal grant aimed at decreasing risks from long-term care job stress, which can include burnout, anxiety, depression, use of alcohol or drugs to cope and thoughts of suicide.
Other partners in the project include Leading Age Nebraska, an association of 70 non-profit providers of long-term care, and the University of Nebraska Medical Center, which already had a coordinator touching base with leaders of long-term care facilities.
The grant project is proposing to train, for free, an individual in each of up to 50 facilities in the life-saving practice of Question, Persuade and Refer. Those trained learn to recognize the signs of crisis and suicide and how to properly approach someone, have a supportive conversation and refer them to help. They then will train co-workers in QPR, eventually reaching 1,250 long-term care staff.
Enrollment is open to any long-term care facility in the state, and facilities can register online.
The grant program calls for other layers of support, including making online “resilience” training available to healthcare workers serving seniors. That training emphasizes development of personal resilience plans and tools for helping co-workers. Staffers learn to check on each other and recognize when someone is having a tough time, said Lewandowski, who also is a leader in the Nebraska State Suicide Prevention Coalition.
“It strengthens up the network within an organization and creates the capacity for individuals to support each other when disaster impacts a facility,” Lewandowski said.
In addition, the grant is enabling up to 10 communities to support healthcare workers with suicide prevention activities. The State Suicide Prevention Coalition has awarded $30,000 grants to groups wanting to help. They are planning a variety of efforts, including additional training and care packages.
The long-term care facility staffers have been through a lot since the March 2020 declaration of a global pandemic, said Jenifer Acierno, chief executive officer at Leading Age Nebraska.
“We knew so little about COVID-19, its impact and how to prevent it at first,” Acierno said.
Facilities struggled initially to get personal protective equipment — the masks, shields, gowns and gloves — that staff needed. Then already short-staffed facilities had more challenges as workers got sick or had family members get sick and had to quarantine.
“As residents became ill and had increased need for care, there were fewer people to give the care,” Acierno said. That situation continues, she said. “It’s hard to find nurses and aides on a normal day.”
She said people working in long-term care facilities, knowing how vulnerable their residents are, have shouldered a lot of anxiety and guilt: If they unknowingly bring it in or take it home, it could spread, and people could die.
The availability of vaccines and front-of-the-line status of healthcare workers and the state’s oldest residents doesn’t mean long-term care facilities can ease up on concerns about staffers’ mental health, Acierno and Lewandowski said.
It still could be months before enough people are vaccinated and a community’s positive-test rate declines enough for authorities to loosen precautions.
Threatening to prolong that, Acierno said, is that she has heard anecdotally that although as many as 95% of residents are registering to be vaccinated, some staffers are hesitant. She has heard of facilities where 40 to 70% of staffers are declining to be in the first round.
Lewandowski said the Public Policy Center’s work with the Nebraska Emergency Management Agency through other disasters has shown that it’s often after the hard-charging response phase that people can be susceptible to depression and other mental health issues.
“It’s about making sure we’re building up support for a community of people who have had to deal with pretty stressful times during this pandemic,” Lewandowski said.
“It’s not like a one-day event,” Acierno said. “The stress is pretty ingrained.”
by Deborah Shanahan | University of Nebraska Public Policy Center