COVID blog #5: Mental health care professionals under pressure during corona

Everyone is now aware of the seriousness of COVID-19 and we usually adhere to the measures taken, such as working from home. However, this is not possible in nursing homes. The pressure in elderly care is increasing and there are growing sounds of fear and uncertainty among staff. On 1 April, approximately 900 out of 2,500 nursing homes in the Netherlands were reported infected and it is expected that this number will increase even further in the coming period.
In a previous blog, we described the impact of the closed doors of nursing homes on the residents. However, the arrival of the virus also has a major impact on care staff in nursing homes. In addition to the practical changes in the workplace – how to provide good care at a precautionary distance – COVID-19 also has consequences for the mental health of care staff. At the same time, despite the limitations, care workers are doing their utmost to offer residents the best care at this particular time. Support and recognition for them to persevere is now more necessary than ever: the right protective equipment, the possibility to test for corona, psychological support and appreciation from the organisation.
Feelings of uncertainty and fear among care workers
Care workers feel responsible for the residents and may therefore experience more feelings of insecurity and fear. Many staff members are worried that they themselves will be infected with the virus and that they will pass it on to the healthy residents. The scarcity of protective materials and the fact that not everyone is tested contributes to the fear.
Employees go through a complex mourning process
A Healthcare psychologist connected to the Psychogeriatric service says that care workers go through a complex mourning process. Normally, they can say goodbye to a resident who dies. But because of the measures, there are now less opportunities to do so. “The high mortality rates in a short period of time also raise a lot of concerns and have repercussions on the mental health of the employees,” says the GZ psychologist. A care worker who is struggling with this says: “You don’t mentally get the chance to close it off properly. They are people who are in your heart, you have taken care of them for a long time. And it goes so fast, it sometimes seems as if someone has suddenly left. That’s very hard”.
“You don’t mentally get a chance to close it properly. It’s people in your heart, you’ve taken care of them for a long time. And it goes so fast, it sometimes seems like someone’s suddenly gone. That’s very hard.”

Increasingly misunderstood behaviour of residents leads to high demands on employees.
More than a month after closing the nursing homes, the GZ-psychologist notices that more misunderstood behaviour occurs among residents. As a result, the professionalism of the employees is called upon to guide the behaviour. Precisely at a time when employees are already under pressure. People with dementia often feel the emotional charge and the level of stress that their social environment carries with it more strongly as the dementia increases. The restlessness experienced by the employees themselves often has an effect on the residents.
The consequences of scarcity of personal protective equipment
A nurse from a nursing home in Noord-Brabant says that management strives to protect their care workers as well as possible: “If there are not sufficient protective measures, our care workers cannot work”. Both inside and outside the ‘corona department’ we work as much as possible with the right protective measures. However, these measures differ per healthcare organisation. This has to do with the scarcity of personal protective equipment (PPE). In another healthcare organisation, for example, the rules are relaxed and employees may only use PPE if they come into contact with a resident (within 1.5 metres) who is suspicious or has tested positive.
The importance of mental support for healthcare staff
Care staff themselves also need support. There is a great need to talk about their feelings. Both with their loved ones as well as with immediate colleagues and possibly their manager. The Monitor on Dementia residential forms confirms this. The Monitor also shows that more than half of care workers received emotional support when a gripping situation arose. Three-quarters of them need a listening ear. “The support you get from the organization also gives a lot of rest”, says a care worker who is currently obliged to stay at home because her own father died recently from Corona. “I have talked to the social worker about my guilt now that I can’t physically support my colleagues. We also discussed what the fear surrounding the shortage of materials is doing to me. It even woke me up once! What if I would infect a resident or another colleague due to a shortage of protective equipment? I have a lot of trouble with that”.
“It even woke me up once! What if I would infect a resident, or another colleague, due to a lack of protective equipment? I have a lot of trouble with that.”
Several organizations offer this kind of support to their employees. Psychological support is also offered nationwide via telephone helplines, coaching and trauma treatment. The expectation is that care workers will not quickly ask for help with their own problems because they often put the welfare of others first. That is why it is important that care workers and managers continue to monitor how employees are doing and give recognition for what they are doing. Involvement from a manager, vlogs from the organisation, getting a little attention like a card, a flower or a chocolate can be valuable. “That’s good, it’s sweet and nice when people think about you,” says a care worker.
Humour also helps employees in these times
Care workers go through an emotional rollercoaster. “But humour is actually the most important thing, that keeps you straight,” says a nurse. “Sometimes we just turn the music on and do the polonaise.” In a nursing home in Utrecht they also experience this sense of belonging. A committed HR employee there says: “It’s so nice to see what kind of special vibes arise in teams where you wouldn’t have expected that at first. But also between the different districts and nursing homes. Although we realise that this can be different every day, we keep up the courage!”
Nursing homes are currently under the magnifying glass and the media are mainly talking about what is going wrong. But it is important to realise that so much more is going well. In spite of all the limitations, care workers are doing their utmost to offer residents the best care right now, with all the creativity that comes with it. That’s why this group deserves all the support they need: the right protective equipment, the possibility of testing for Corona and psychological support where necessary.
We would like to express our appreciation for the dedication of all employees in elder care. We hope that together you can continue to put your shoulders to the wheel and remain physically as well as mentally healthy. Taking good care of yourself is essential. Can you not do much more for the residents if you feel good about yourself?

Marleen Prins; Claudia van der Velden; Janne van Erp; Henriëtte van der Roest (

Published on 17 April 2020 at