As Senior Communities Try to Shut Out Virus, Residents Feel Locked In

As Senior Communities Try to Shut Out Virus, Residents Feel Locked In

With tight restrictions in place at their continuing care retirement community, Tom and Janice Showler are getting on each other’s nerves.

Most days, Tom, 76, likes to drive out of their community ― Asbury Springhill in Erie, Pennsylvania — to the store to pick up a few items.

“If you follow the right protocols, the likelihood is quite low that we would come down with coronavirus,” Tom said. “If I didn’t go out at all, I’d feel like the walls were closing in on me.”

Janice, 72, doesn’t think that’s a good idea. She has rheumatoid arthritis, an autoimmune condition that raises her risk of becoming seriously ill from the virus. Her father died of pneumonia, and “what terrifies me more than anything is not being able to breathe,” she said.

With her fear and Tom’s need for independence, “it’s become a bit of a power struggle,” Janice admitted.

Across the country, seniors’ lives are being upended as continuing care retirement communities take aggressive steps to protect residents from COVID-19, the illness caused by the novel coronavirus.

These communities offer a spectrum of services ― independent living, assisted living and nursing home care — serving older adults with disparate needs, from the very healthy to the very ill.

Since mid-March, aided by guidance from the Centers for Disease Control and Prevention, many places have instituted strict policies. Most often, group activities are being canceled. Nonessential visitors aren’t allowed. Dining rooms have closed, and meals are being delivered to people in their rooms. Staffers are screened (this includes a temperature check) when they enter and exit campuses.

And all residents, including seniors in independent living, are being asked to stay in their rooms most of the time. Leaving campus is strongly discouraged.

Minimizing the risk of contagion and ensuring the safety of residents is a top priority, said Henry Moehring, senior vice president of Asbury Communities, which operates eight of these communities in Maryland, Pennsylvania and Tennessee, including the center where the Showlers live.

Across the nation, there are about 1,900 such communities. Yet there’s no national data about the number of residents or staff members who’ve become infected with the coronavirus or died.

Nor is there reliable information about the extent to which testing for the virus is available in these communities. Anecdotal evidence suggests it is hard to get, as is personal protective equipment for staff.

This month, the CDC published the first study of COVID-19 in a Seattle community that combines independent and assisted living. One key finding: Three residents who tested positive for COVID-19 did not have symptoms. This calls into question the common practice of focusing on people with symptoms while trying to prevent the virus’s spread.

Another finding: The community’s early measures to contain the coronavirus appear to have succeeded. This may be because residents were able to practice social distancing and had relatively little contact with health care providers, researchers suggest.

Janet Schroeder, 86, lives at Three Crowns Park in Evanston, Illinois, an independent living and assisted living community where three residents were found to have COVID-19. Two have died. So far, state and local health officials have declined to test other residents. They say testing isn’t recommended for people who are asymptomatic.

Three Crowns has closed its garage, so residents can’t take their cars out. People are being asked to stay in their rooms. If they leave campus, they will be “asked not to return for the foreseeable future,” according to materials from Three Crowns cited in a local news report. The facility’s executive director did not respond to several requests for comment.

“Absolutely, I’m beginning to feel cooped up. Sometimes, I get very tired of my apartment. I want to get out and go someplace,” Schroeder said. “I miss seeing people.”

Initially, she said, she was “shocked and scared” to learn that COVID-19 was in the community, but now “I feel very confident that people here are taking good care of it and taking good care of us. As long as they hold the line and we all do what we’re supposed to do, I think it’s going to be OK.”

At Asbury Methodist Village in Gaithersburg, Maryland, which has about 1,400 residents, Mary Ellen Bliss, 78, has been helping to form “clusters” of residents who regularly check in with each other and “provide backup for anyone who has a problem.” She lives in an independent living section of the community called “the village,” where people have small houses.

Over the past several weeks, Bliss has noticed a marked change in attitude among friends and neighbors: “Even a week ago, some people were pretty indignant at the restrictions being put into place. They felt they were cautious and the rules shouldn’t apply to them: They should be allowed to come and go as they wished.”

But as reports of COVID-19 patients flooding hospitals and dying in nursing homes have multiplied, “pretty much everyone is all on board and what sounded excessive a few weeks ago now seems quite reasonable,” Bliss said.

As of last week, Asbury had reported two COVID-19 cases at its Gaithersburg campus: a resident, who was self-quarantining and asymptomatic, and a staff member who hadn’t worked on the campus since mid-March. None of its other communities were known to be affected.

Of course, some residents just won’t listen and insist on venturing out to stores or to see family. This has been an issue at Five Star Premier Residences of Yonkers in New York, where three residents tested positive for the coronavirus at the end of March.

“We are working to keep everyone safe inside the building. Residents heading outside our gates community at this point [are] asking for trouble. YOU must help me here as some of our residents do not realize how serious this is,” wrote John Hunt, executive director, in a March 29 advisory to residents.

A corporate official at Five Star Senior Living declined to comment.

“Every community will find there are certain people who have difficulty complying with requests,” said Kristin Hambleton, vice president of marketing for Presbyterian Senior Living, which operates 12 continuing care retirement communities in Pennsylvania, Delaware, Maryland and Ohio.

“We are addressing each of those people on an individual basis and discussing with them how their choices can impact the people they live with and the staff that works here.”

At the start of April, two staff members at Presbyterian Senior Living tested positive for COVID-19. “No residents were exposed while they were exhibiting symptoms,” Hambleton said.

Within the communities, threats other than COVID-19 abound. Without regular contact with other people, older adults can become lonely or depressed. A change in someone’s health status that might have been noticed if they didn’t show up for dinner can now go unobserved. Without stimulation, motivation and cognition can decline.

Communities have responded by having staff check in regularly with vulnerable residents, offering to arrange video visits with family members, organizing Zoom interest groups for residents and creating programming, such as exercise sessions, broadcast over closed-circuit, in-house television stations.

Sustaining residents’ and staffers’ spirits over the difficult weeks ahead is a priority for Stephen Colwell, executive director at NewBridge on the Charles in Dedham, Massachusetts, a community with 256 independent living apartments, 51 assisted living apartments, a 40-apartment memory care unit and a 220-bed nursing home on a 162-acre campus.

“We’ve made so many changes so quickly, we’ve treated this like a sprint,” he said. “But the fact is, this is going to be a marathon for all of us.”

“Their efforts really help to smooth out what is an incredibly difficult time here,” said Benita Ross, 71, who lives in a two-bedroom cottage on the community campus. Every day, though, she worries about her three sons, who are physicians, and friends in their 80s and 90s whose health is fragile.

“There’s intense anxiety that your family or friends may get sick and die,” she said. “It’s terrifying, and there’s not a damn thing you can do about it.”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Strategies for Long-Distance Caregivers

Strategies for Long-Distance Caregivers

Being a primary caregiver for a family member who lives in a different city or state can feel like a full-time job, complete with its own set of stressors and related emotions.

“I think caregivers can be disappointed at times,” said Vicki Williford, a chronic care nurse in Greensboro, North Carolina. “The home health nurse comes and goes, and [the caregiver] still has another 23 hours to go.”

That’s 23 more hours to make sure the care recipient has taken medication, avoided falls, eaten healthy meals, and made it to the bathroom in time — all of which have to be supervised remotely by long-distance caregivers.

The need for non-clinical family members to provide care to aging loved ones will likely continue to rise, due to a growing population of seniors and the shortage of health care providers in America. The burden of caregiving may be further complicated by distance; a 2015 study from the National Alliance for Caregiving found roughly 25% of caregivers live 20 minutes or more from the recipient’s home (PDF, 1.8 MB).

What unique challenges do long-distance caregivers face, and how can a relationship with a health care team help overcome these challenges?

The Challenges of Caring from Afar

Nearly 44 million Americans provide unpaid care for a family member. Of these Americans, between 5 million and 7 million are doing so from a distance of one hour or more, according to a report from the Journal of Gerontological Social Work.

All caregivers, regardless of geographic proximity, are met with tasks that challenge emotions and resilience, as they work to provide the best possible quality of life for a loved one in need of support. They may have difficulty accessing clinical training, balancing caregiving with a full-time job and personal life, and managing the length and scope of caregiving.

Those supporting a family member from a distance may experience added stress from coordinating logistics remotely, without the affirmations of face-to-face interactions from a health care team and their loved one.

Challenges unique to long-distance caregivers include:

  • Traveling to and from the care recipient’s home
  • Using technology to stay in touch
  • Limited in-person communication with the care recipient
  • Building provider relationships from afar
  • Coordinating legal and financial concerns remotely
  • Planning visits for other family members
  • Keeping all parties up-to-date
  • Wavering confidence about choices made for the care recipient

Digital Tools for Long-Distance Caregivers

Some caregivers may find help through digital tools that make it easier to check in on a care recipient, which can include:

Mobile Apps – For face-to-face communication

Smart Devices — to adjust home temperature or door locks

Wearable Devices — to transmit vitals or call 911 in case of an emergency

Home Cameras — to monitor activity and visitors; for keeping track of medication schedules and deliveries; providing alerts of home break-ins

Keep in mind, not all technology seems user-friendly at first, so it’s important to check in with all parties — including a health care provider — about the level of comfort using new tools.

Being Part of the Health Care Team

Many care recipients have a team of providers, such as nurses, managing multiple aspects of their treatment. Caregivers can certainly be a part of that team, even from a distance. That team can also offer support for the caregiver.

“All the research suggests that we do better with adversity by having people who are in our corner,” said Dr. Barry J. Jacobs, clinical psychologist, family therapist, and author of The Emotional Survival Guide for Caregivers.

“We don’t take over people’s lives,” he said of caregivers. “We work with them to provide support to enhance their lives to be more functional and help them live more the way they want to live.” Both the caregiver and provider need to understand the strains that each party is experiencing, which comes from clear and consistent communication. There are several ways family members can demonstrate to providers they want to be an active participant in a loved one’s care.

Building a Relationship with a Provider Remotely
  • Identify a member of the family who has the capacity and availability to be granted power of attorney for medical decision-making and communication with the primary provider.
  • Establish the need for regular check-ins and preferred modes of communication.
  • Attend appointments when possible. If it’s not possible to be there in-person, try dialing in, or follow up with a phone call to the provider and care recipient.
  • Conduct background checks of aides who are providing in-person care.
  • Keep notes of changes in health or questions about the care recipient’s needs.
  • Make a list of medications and other treatments in order to support medication adherence and monitor changes in therapies.
  • Understand that a treatment plan will evolve as the care recipient’s condition changes, and be open to that change.

Williford said it’s common for families to lack consensus on a treatment plan for a patient with an unexpected hospitalization, which can make a provider’s job much more difficult.

“Families come in from all these different states, out of town, and then they’re now faced with: ‘What do we do with Mom?’” she said. “They’re trying to decide, and yet the mom’s saying to me, ‘No one asked me what I wanted.’”

Having these conversations as a group can help the care recipient feel that they have agency over their treatment plan and keep everyone on the same page — regardless of what time zone they’re in.

A Taste of One’s Own Medicine

Supporting a loved one from afar involves complicated responsibilities and constant communication that can prove taxing. It’s common for long-distance caregivers — especially those with less support — to feel emotionally burned out or exhausted. Being far away from the care recipient can increase anxiety about a loved one’s wellbeing, and may be compounded by stress of periodic traveling or lack of sleep for providing care across different time zones.

Without proper self-care, caregivers may experience caregiver strain, or a feeling of burnout that leaves individuals unable to perform daily tasks or cope with feelings of anxiety.

“You know you’re experiencing burnout as a caregiver if you’re waking up in the morning with a sense of dread,” said Jacobs.

How to Manage Burnout as a Long-Distance Caregiver
  • Set a cadence for phone calls.
  • Make time to self-reflect each day.
  • Take an inventory of your emotions.
  • Accept help when it’s offered; ask for help when it’s not.
  • Utilize a care team on the ground to perform in-person tasks.
  • Take notes during visits so there’s less to memorize.

Drawing boundaries is one thing; adhering to them is another. Caregivers have to carve out time to care for themselves and get the help they need as well. Jacobs said he uses a marathon as a metaphor for caregiving.

People “need to see this as a long, arduous course for which they need to really take care of themselves along the way,” he said.

“They run past a water station at mile five and people are waving water bottles at them,” Jacobs said. “That kind of self-replenishment on a regular basis develops some sort of emotional wellness program.”

Even when distance is not a factor, caregivers are still at high risk of being overwhelmed. In fact, boundaries can be extremely difficult for spousal caregivers in particular, who feel a heightened sense of obligation for their loved one’s well-being. Spousal caregivers are at increased risk for burnout. Many of them — almost one in five — are outlived by their husband or wife, according to a 2018 study published in the journal Alzheimer’s & Dementia. Accepting an offer of assistance, even when it doesn’t seem crucial at the time, can help caretakers sustain the energy and will needed to provide the best quality care, while still finding time to rest and enjoy life with their loved ones.

Resources for Long-Distance Caregivers

Refer to the organizations below for further reading and resources on how to provide high-quality care for a loved one, from afar.

Citation for this content: [email protected], the online DNP program from the Simmons School of Nursing 

Adult-Gerontology Acute Care Nursing—What You Need to Know

Adult-Gerontology Acute Care Nursing—What You Need to Know

Working in gerontological nursing can be immensely rewarding, but in order to be successful, it’s critical to familiarize yourself with the characteristics unique to this age group. Here are some key areas to focus on if you are pursuing a career in adult-gerontology acute care nursing.

Bridge the Generation Gap

Generations previous to our own often have different sociocultural norms. Being mindful of this will facilitate their care. They may be uncomfortable being addressed by their first name, or they may be very private. Giving respect and space where needed will go a long way toward earning their trust and confidence, making it easier to care for them effectively.

Even elderly individuals without a cognitive impairment can experience a sudden change in mentation, often triggered by infection (UTIs are common culprits) or by a change in routine, geography or both. Safety is paramount, so be mindful of their room assignment as well as their potential for confusion to ensure that they are well monitored.

Making Sense

The elderly often lose acuity of one or more senses, so it’s important to accommodate these changes. Due to decreased activity levels, muscle mass, and food intake, they often complain of feeling cold. This is also attributable to chronic conditions such as anemia, kidney disease, underactive thyroid, or even the medications they take.

Offer them warm blankets, light jackets, or slipper socks to help their bodies retain warmth. Adjust the room temperature as appropriate. Elderly patients often will ask that their hot beverages or food be reheated. This alteration in heat perception is quite common in older patients, so reheat with caution to avoid injury.

Their hearing and vision are likely to be impaired to some degree, so speak deliberately and clearly. Let them see your face as you’re speaking. Repeat what you’ve said when asked. And encourage the use of eyeglasses and hearing aids where indicated.

The Physical

Functional impairments such as balance issues and weakness are common among the elderly. They should be closely monitored or assisted when ambulating. Be mindful of hazards that may cause falls: furniture placed too closely together, uneven walking surfaces, throw rugs, electrical cords, and IV tubing. Weakness may necessitate the use of assistive devices to ambulate. Monitor transfers to determine whether they may need greater assistance for the transfer order.

Due to their nutritional status, chronic conditions, and medication, many will have fragile skin—their skin may have a papery texture and is easily prone to tears and lacerations. Protect it by keeping it clean and well-moisturized. Choose an appropriate tape for dressings, IV tubing, etc.; this will help minimize damage to the skin and potential allergic reactions, or when appropriate use mesh sleeves.

Constipation is another common complaint, related to decreased fluid intake, reduced activity, and polypharmacy. Monitor their diet and fluid intake for fiber, nutrients, and adequate hydration; and encourage activity and fluids as tolerated per their doctor’s orders.

Want to know more about adult-gerontology acute care nursing? Visit here to determine which certification may be right for you.

Golden Careers: Gerontology in Action

Golden Careers: Gerontology in Action

Only one group of Americans has more than doubled in size over the past twenty years: the elderly. They’ve experienced more than most in their lifetimes, from world wars to the first man on the moon. Thanks to lengthening life spans, they have much more to experience; over 41.4 million Americans are 65 and older – that’s more than 13.3 percent of the total U.S. population.1

As this golden group ages, how can we serve and love the elders that hold such a special place in our communities and families?

GERONTOLOGY CAREERS

Case worker

The role of geriatric social workers includes:

  • Helping senior citizens cope with common problems experienced by the elderly
  • Ensuring the needs of their clients are met from day-to-day
  • Providing aid with financial issues, medical care, mental disorders and social problems

Geriatric care manager

Care managers help the elderly and their loved ones develop a long-term care plan and connect with necessary services.

Healthcare business manager

These managers make sure healthcare facilities provide the most effective patient care. This includes planning and coordinating services in hospitals and clinics.

Art therapist

Art therapy uses the visual and auditory arts to help restore function and general wellbeing. Benefits can include:

  • Increased cognitive skills
  • Intellectual stimulation
  • Improved motor skills
  • Alleviated pain
  • Socialization
  • Self-expression

78 percent of art therapists report working with older adults on a regular basis.2

Grief counselor

Grief counselors help seniors process bereavement and loss, as well as cope with thoughts of their own death.

Assisted living administrator

Administrators manage assisted living facilities or services, which provide care to adults who need help with daily tasks like bathing, eating and dressing.

Health educator

These educators provide the elderly with lessons that inform them about health concerns.

Physical therapist

Physical therapists help aging adults strengthen their muscles, increase mobility and improve endurance. They also help with recovery from an injury or illness.

HELPING AND HEALING

The elderly are likely to face hardships, but with our help, they don’t have to go through them alone.

Bereavement and loss

A natural part of the aging process is experiencing the loss of loved ones as well as coping with one’s own progressing age. Seniors often experience bereavement and loss differently than younger adults, which puts them at risk for depression, anxiety and PTSD. Grieving seniors can benefit from the support others as they work through difficult times.

75 percent of adults 50 and older reported finding humor and laughter in their daily lives.3

Family caregiving

Family caregivers play a crucial role in keeping the elderly comfortable at home by providing support like:

  • Economic resources
  • Loving relationships and companionship
  • Minimal health and wellness assistance
  • Support with day-to-day needs

More than 10 percent of the U.S. population have served as unpaid caregivers for older adults.4

Health promotion and self-care

Age can prevent seniors from properly taking care of their bodies, but we can help our loved ones stay beautiful and healthy. Helping the elderly groom themselves, receive regular medical attention and stay active can go a long way in promoting general wellbeing.

Disabilities

In more extreme cases, seniors may experience disabilities or other chronic health conditions. You can support older adults by ensuring they can access the healthcare professionals and resources they need. This might involve assistance with transportation and attending to business, legal and medical concerns.

75 percent of seniors have at least one chronic health condition, and most have two or more.5

End-of-life and palliative care

As our loved ones enter their final days, specialized care can help provide relief from the symptoms and stress. End-of-life and palliative care makes their last days as pain-free and comfortable as possible.

Quality of long-term care

Fortunately, there are a number of geriatric professionals trained to provide excellent care for aging adults in all of these areas. A growing population of the elderly means the demand for these practitioners is greater than ever – and there are more opportunities for you to bring wellness and care into the lives of the elderly than ever.

Interested in a career in a gerontology? Pursuing an online master’s degree can help. Learn more at: https://www.cune.edu/academics/graduate/master-healthcare-administration/gerontology/

SOURCES

  1. https://www.upi.com/133-percent-in-US-are-seniors/75971362689252/
  2. American Art Therapy Association
  3. https://www.aarp.org/caregiving/basics/info-2017/truth-about-grief.html
  4. https://www.merckmanuals.com/professional/geriatrics/social-issues-in-the-elderly/family-caregiving-for-the-elderly
  5. National Council on Aging

This sponsored story is brought to you by Concordia University Nebraska.

What to Know if You’re Interested in a Career in Adult-Gerontology Primary Care Nursing

What to Know if You’re Interested in a Career in Adult-Gerontology Primary Care Nursing

It’s no secret that our elderly are the fastest growing segment of the U.S. population, fueled largely by aging Boomers. So it’s simple to deduce that nursing careers in adult-gerontology can offer many opportunities for growth and nursing leadership. However, working effectively with this demographic requires specific skills for success.

Build the Basics

Nursing competencies should include a BSN and a minimum requirement of a firm base of experience in general medical-surgical nursing to care effectively for the disease processes that affect the elderly. Cardiac and respiratory conditions, diabetes, and cognitive impairments are among the most common pathologies troubling people over 55. Nurses must be adept with assessment skills to detect condition changes in their patients. Nurses advancing to management roles will be better prepared with their MSN, NP, and even a DNP.

Understand the Psychosocial

You’ll need capable skills for working with the most common psychosocial issues of those in their later years. Many elderly patients suffer from social isolation and depression, which can exacerbate physical issues they may be dealing with. Nurses will also need to demonstrate empathy and patience when working with those suffering from cognitive impairments such as dementia or Alzheimers. They must also demonstrate the ability to anticipate their patients’ needs when the patients aren’t able to articulate their needs themselves.

Assessment Skills are Critical

The health of elderly patients can be mercurial. Their immune systems are no longer as robust as they once were, and they’re often further influenced by other disease processes. Something seemingly routine and easily treated in younger patients, such as a urinary tract infection, can trigger a cascade of symptoms that can send many clinicians scrambling. A nurse well-versed in the care of the elderly will quickly identify the more subtle changes with accuracy.

Know Your Resources

A good geriatrics nurse also knows about the best resources to guide their patients to wellness. For example, making a patient or their family aware of adult day care centers in their neighborhood can lighten the load of caring for them during working hours. Asking the physician for a consult with a neurologist or psychologist for developing cognitive issues, or a urologist for intractable urinary infections facilitates the patient’s access to timely treatment. Requesting a referral to a social worker to address neglect or abuse issues in the patient’s home keeps the patient in a safe environment.

Interested in getting certified in adult-gerontology? Visit NursesGetCertified.com to learn more.

NP Gerontology Certifications: Which is Right for You?

NP Gerontology Certifications: Which is Right for You?

Earning certifications of any kind can definitely help your nursing career. If you work with adults in gerontology, you have a couple of choices. So, how do you choose the one that would work best for your particular situation?

Robin Dennison, DNP, APRN, CCNS, NEA-BC, Director of Nursing Programs at the University of Saint Augustine for Health Sciences, answered some basic questions about the differences between the two for Nurse Practitioners (NP).

Regarding gerontology certifications—specifically the ACNPC-AG and the AGPCNP-BC—what are the similarities between the two certifications? What are the major differences?

The ACNPC-AG (Acute Care Nurse Practitioner Certified in Adult-Gerontology) is offered by the American Association of Critical-Care Nurses (AACN) via the AACN Certification Corporation. The AGPCNP-BC (Adult-Gerontology Primary Care Nurse Practitioner certification) is offered by the American Nurses Credentialing Center (ANCC)

Both certifications require a passing score on an examination after verification of eligibility. Eligibility for both certifications require a current, active RN license in a state or territory of the United States or the equivalent in another country. Eligibility for both certifications require the applicant to be a graduate of an adult-gerontology acute care nurse practitioner program accredited by either CCNE or ACEN. The program must have three separate graduate-level courses in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology. They both require a minimum of 500 faculty-supervised practicum hours in the program. Eligibility for both requires submission of an official transcript.

While the fees are comparable, current memberships result in significant discounts. Membership in AACN or ANA results in a discount on the respective certification.

The test blueprints are similar, but the AACN certification has a greater percentage of the exam questions focused on clinical practice. The ANCC certification test blueprint has the majority of questions focused on clinical practice, but it has a greater percentage of questions focused on role-professional responsibilities and health care systems than the AACN examination.

How can nurses determine which one would be the better for them to pursue?

AACN, with its focus on critical care, would likely be the preference for a nurse who was previously a critical care nurse and held the CCRN credential. If the nurse did not have that previous affiliation with AACN, then they may select ANCC. It may even come down to the nurse’s memberships: AACN or ANA and the discounts that are given for the membership.

How could these certifications help them in their careers? Could having one of these help them get better paying jobs? Move up? Be experts in their field?

National certification in one of the advanced practice roles (i.e., nurse practitioner, clinical nurse specialist, nurse anesthetist, nurse midwife) is required for an eligibility for licensure as an advanced practice registered nurse in most states. The board of nursing in the state of residence will specify requirements for APRN licensure as well as standards of practice for the advanced practice role. Advanced practice licensure allows greater autonomy, authority, and generally higher salaries.

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