COVID-blog #2: Closed nursing home doors. The struggle against loneliness.

 

Closing doors in nursing homes for visitors has a major impact on our elderly, care workers and informal carers. Loneliness and unrest arise. Fortunately, many alternatives are being offered. How do administrators, care workers and informal carers look at this and what can you do to maintain personal contact?

Informal carers are currently no longer able to physically visit their loved ones in the nursing home. It’s not possible to see how they are doing or give them a cuddle. On the one hand, there is understanding regarding this measure, on the other hand, measure also results in incomprehension and anger.

Loss of comfort, safety and structure

Social distancing helps prevent the further spread of the coronavirus, but can also lead to feelings of loneliness among the elderly. We know that loneliness in people with dementia has a negative effect on behaviour and quality of life. When their memory fails, people with dementia often find comfort and safety with those around them. Familiar faces of employees, but also family and friends are important. Family and friends are the link to the world outside the nursing home and to the past. Also, the visits of their loved ones often provide structure in their day. Especially when someone has dementia and already had to give up so much, these moments become more and more important.

Day care centres for people with dementia are also closed. In many cases, informal carers who are unable to bring their loved ones to the day care centre from time to time are kept in close telephone contact by the day care staff. Solutions are also sought to make people with dementia understand why they cannot go to the day care centre. For example, by sending a card explaining that the day care centre has to be closed for a while, but someone is welcome again later on. In some regions in the Netherlands, extra beds in nursing homes are made available for people with dementia in case of crisis at home due to the lack of day care.

Anxiousness but also understanding among informal carers

The consequences for informal carers are also significant. Many partners and family members are used to visit a resident regularly, or to spend the day together. “People are already separated due to dementia, and now they are no longer allowed to see each other,” says a director of a care farm=. Some caregivers are afraid that their loved ones will no longer recognise them when they are allowed to visit again. Uncertainty about the duration of these measures plays a role: “The uncertainty regarding how long this will take makes it difficult. I have even been thinking about temporarily caring for my father in my own home. Of course, he lives in the nursing home for a reason, he needs 24/7 care and support.”

“Even though my Dad at the moment is more lonely than usual, I would like to have him with us for a while longer.”

 

Besides anxiety and worries, there is also understanding for this measure. Despite the fact that informal carers find it ‘a very strange situation’ and ‘it takes some getting used to’, they understand that by keeping out visitors, there is less chance that the coronavirus will get into the nursing home. “Even though my Dad at the moment is more lonely than usual, I would like to have him with us for a while longer. And also, all the co-residents in the home,” says a daughter of a person living with dementia.

Measures give clarity

Administrators and healthcare professionals have the complex task of managing these new measures on the basis of the continuous flow of new information and guidelines. “I’m involved in different WhatsApp groups and new updates are coming in all day long”, says a geriatrics specialist. Clarity to caregivers and family members is very important. In that sense, the government’s policy has helped, because the rules are now clear and easy to explain. “Before the measure of closing the doors in nursing homes, we were presented with so many individual cases and we had to think and discuss again and again about what we should or shouldn’t do in this situation”, says the director.

Digital support and creative solutions

A care worker from a nursing home indicates that she and her colleagues are very aware of what these measures can do to someone’s quality of life.

“We therefore try to seize every opportunity to go the extra mile and meet the needs of our residents. We also have a lot of contact with their loved ones, to reassure them remotely”.

At one nursing home a Skype instruction is given to family members, at the other nursing home there are so-called “IPad nurses” who regulate the communication between the resident and their family. Companies help with this by providing tablets and laptops. Nursing homes also experiment with meetings behind glass or from the balcony. There are many smart care solutions that are particularly useful in these times to facilitate contact from a distance. For example, elderly people, care workers and informal carers can receive digital support, help in finding useful, fun applications and tips and information about aids that elderly people can use at home. In addition, the online intervention ‘Coping with Changed Behaviour’ [in Dutch: Omgaan met veranderd gedrag] is available for informal carers and care workers who have to deal with changed behaviour in people with dementia.

Authors: Marleen Prins, Claudia van der Velden, Janne van Erp, and Henriëtte van der Roest

Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands

 

Blog published in Dutch at March 26, 2020 at https://www.trimbos.nl/actueel/blogs/blog/gesloten-verpleeghuisdeuren-strijd-tegen-eenzaamheid