'Anxiety, grief, fear': Pandemic's impact on care home residents and staff 

Staff reported high levels of stress, trauma, and burnout during the pandemic. Picture: iStock

Anxiety, grief, fear, isolation, and distress are just some of the words used to describe the impact the ongoing pandemic has had on some of our most vulnerable people and frontline healthcare workers.

A new study has revealed the extent of the wide-ranging effects Covid-19 and the lockdowns had on the mental and physical health of residents and staff in residential care homes.

The adverse effects extended to the families of those whose loved ones were in residential care during the pandemic.

A study led by Dr Mary Rose Sweeney from Dublin City University's School of Nursing, Psychotherapy and Community Health found that there was a reduction in the level/quality of care provision at residential care homes.

This led to significant physical, psychological, and social impacts for residents and their families while staff reported high levels of stress, trauma, and burnout.

One-third of residents confined to rooms during first wave 

According to staff, at least one-third of residents were confined to their own rooms without company during the initial wave of the pandemic. Picture: Getty 

Not being able to properly visit with family members in care was a huge source of emotional pain for people.

Family members were scared and anxious about the wellbeing of their loved ones and they felt helpless and frustrated that they could not do anything to help the situation.

The majority of families involved in the study said they did not perceive themselves to be visitors but rather as continuing their caregiver role in the residential setting.

When family members did visit, many said they could see an acute decline in their loved one's physical health including weight loss, reduced mobility, pressure sores, dehydration and an unkempt appearance. To see their loved ones this way caused added stress.

"In addition to mental health impacts, the deterioration of residents’ physical health was a strong finding, with family participants expressing shock and distress at this rapid decline," said Dr Sweeney.

Some of this deterioration may have been Covid-19 related but in many cases, it resulted from the reduction or absence of usual care."

According to staff, at least one-third of residents were confined to their own rooms without company during the initial wave of the pandemic.

Although 98% of residents were able to connect remotely with their families, the connection was deemed to be of poor quality and unreliable by many family participants.

Families believe infection rates in care homes could have been reduced 

Family members believed that those residents who did not have someone to advocate for them were at higher risk during the pandemic.

A large number of family carers and staff felt the rate of infection in care homes could have been reduced with more effective and diligent infection control measures.

Respondents felt areas of concern such as residents sharing bedrooms and poorly ventilated common areas were due to years of under-investment in state facilities.

The transfer of those infected with Covid-19 from the acute hospital sector as well as the movement of staff across different sites were considered to be additional factors in increased virus spread.

Staff were 'angry and distressed' but put residents before themselves 

Witnessing the impact of the virus on the vulnerable people in their care left staff members feeling distressed.

The pandemic took a personal toll on all frontline healthcare workers including those working in residential care facilities.

They suffered mental and physical exhaustion as they tried to support each other and the residents while managing their own fears about the virus.

Witnessing the impact of the virus on the vulnerable people in their care left staff members feeling distressed.

As well as this, there was anger and worry over the number of care staff who contracted the virus. Respondents felt unsupported and that their wellbeing and safety had not been valued or protected.

The majority of staff put the needs of residents above their own needs while dealing with staff shortages due to illness.

Media reports caused distress for staff and residents 

While the importance of the media in communicating important information throughout the pandemic cannot be denied, respondents said that reports which highlighted the issues in residential care left some staff and families distressed.

They felt there was 'media blaming' in the reporting on the rapid viral spread and the need for prompt intervention.

Headlines of failures and fatalities caused stress for residents and families and some staff said they were left feeling ashamed and embarrassed by where they worked.

Importance of family visits should be recognised 

Pictured in 2020: Helena Heneghan, 88, with Central Park Nursing home manager Caroline McGuire and care assistant Bridie Fahy enjoy a chat with Helena's son Paddy who was able to still visit his mother at the home by talking through an open window. Picture: Ray Ryan

The report included a number of recommendations, many of which focused on the importance of visitors for the residents' wellbeing.

It said any future visitation restrictions must be balanced with the rights and needs of the resident.

Each home should facilitate access to one designated family member who would visit residents on an ongoing basis even in the event of a pandemic, the report stated.

"Our study highlights the extent to which family members had hitherto provided direct care and the importance of this to their loved ones," said Dr Sweeney.

"The loss of the caregiving role was a major source of distress to family members particularly when they observed the mental and physical deterioration of their loved ones which arose from them being prevented from providing care."

In terms of staffing in residential homes, the report recommended an agreed staff-to-patient ratio to be decided at a national level and managers should proactively work to enhance staff retention.

Managers should also advocate for and oversee the introduction of adequate psychological support, debriefing, and practice supervision systems for staff as a matter of urgency.