Chapter Contents

Wellness: Staff and Resident Health
Wellness: Psychological Health
Lessons Learned: Wellness of Staff and Residents
Lessons Learned: Psychological Wellness

Wellness: Staff and Resident Health

An organization that dedicates time, resources, and attention to the holistic well-being of persons served, staff, and other stakeholders may find that it is one of its wisest and most prudent investments. Promoting individual and collective wellness during a pandemic or other emergency is also a powerful way to build a sense of community. Organizations may find that sharing wellness resources among persons served and staff helps to form and strengthen bonds that enable everyone to find common ground. Circumstances may make it necessary to quickly shift wellness offerings into a different form or format, and the use of technology in this realm may prove to be essential in maintaining wellness offerings.

Organizations that build a healthy culture of support and services for all stakeholders’ mental health and psychological well-being will be better prepared for the ravaging effects of a pandemic. 

Staff Wellness

• Practical Tips to Support Your Employees’ Mental Wellbeing (LeadingAge)
• The Surprising Power of Simply Asking Coworkers How They are Doing (Harvard Business Review)
• What Makes Some People More Resilient than Others (New York Times)
• Staff Vacations and Travel Considerations During COVID-19 (LeadingAge)
• Dos and Don’ts of Employee Appreciation During Tough Times (Denise Boudreau-Scott, for LeadingAge Connecticut)
• Opportunities to Enhance Employee Mental Well-Being (simple strategies you can implement today)
• Fostering Emotional Wellbeing Among Team Members (LeadingAge QuickCast): A comprehensive systems approach can help make sure your employees are getting the support they need.

Resident/Client Wellness

• Care and Coping with Dementia and COVID-19 (QuickCast)
• Engagement in a Time of Quarantine (QuickCast)
• Creating Calm: Simple Activities for Stressful Times (QuickCast)
• How to engage residents to thrive, not just survive, amid COVID-19 (McKnight’s Business Solutions On)
• Care for Critically Ill Patients With COVID-19 (JAMA Insights)
• Loneliness and Isolation in Long-term Care and the COVID-19 Pandemic (JAMDA article; includes links to additional published research on the mental health impact of loneliness and isolation)
• Activities That Older Adults Can Do From Their Nursing Homes/Assisted Living Communities (AMDA–The Society for Post-Acute & Long-Term Care Medicine)
• Senior living scorecard focuses operators on health, wellness strategies (McKnight’s Senior Living): A pilot program from CDC, the U.S. General Services Administration and the Center for Active Design will be released in 2021. It is designed to create a senior housing scorecard for IL, AL, and memory care, and help owners optimize their properties to promote the health and wellness of residents and employees.
• Hot Topics During COVID-19: How Are Members Creating Alternative Mother’s Day Moments? (LeadingAge)
• Resident input key to programming for wellness culture (McKnight’s): Account of a presentation at the International Council on Active Aging Virtual Conference, Leadership Summit and Expo 2020: incorporating health and wellness into senior living programming, resident engagement, and “wellness chats” for residents.
• Wellness Through Design (Ankrom Moisan): The focus of this architectural firm is how to design for resiliency, which includes the COVID-related issues as well as a more general look at emergency response planning, and how the design of community infrastructure can play a role in improving outcomes across a variety of scenarios.
• Pandemic’s upending of senior living might not be such a bad thing: speaker (McKnight’s Senior Living): Senior living and care has been one of the industries most disrupted by the COVID-19 pandemic, creating “radical changes” in resident engagement. But that might not be such a bad thing, according to a presenter at the ICAA Virtual Conference, Leadership Summit and Expo 2020.
• Aging innovation pilots target healthcare gaps to impact social isolation, loneliness (McKnight’s Senior Living): A pilot, launching in June, will evaluate the effects of loneliness and social isolation on aging-in-place at-risk populations, with a particular focus on Black, minority and ethnic community members.
• Maintaining Physical and Mental Well-Being of Older Adults and Their Caregivers During Public Health Emergencies: A Needs Assessment and Environmental Scan Report from NORC/University of Chicago (January 2021). This project was designed to understand 1) needs and concerns of older adults and caregivers during the crisis and 2) what kind of supports are available; 300 public health programs and services were found, designed to deal with for social isolation, managing chronic conditions, and more. Listen to a LeadingAge interview with Alycia Bayne re the project.
• New Aegis Living community pilots wellness program, incorporates nature into design (McKnight’s Senior Living): Aegis Living’s newest assisted living and memory care community in Bellevue, WA, opens with a design that incorporates components of nature.

Stories from the Member Ideas and Inspiration series:

• Local Teens Go the Extra Mile to Help Residents and Staff
• Pandemic Can’t Prevent Celebratory Music Video
• Virtual Fitness Classes Gain Popularity
• Member Helps Keep Residents Entertained
• Sheltering in Place? Why Not Travel the World?
• Memory Care Households Adjust to a “New Normal”
• Provider Surveys Residents for Thoughts on the Pandemic
• Keeping Residents Engaged During the Pandemic
• Provider Attends to Spiritual Engagement of Residents
• Resident Engagement With a Celebrity Twist
• Multi-Site Member’s Best Resident Engagement and Activities Ideas
• Residents Need Not Miss Church Services or Communion During the Pandemic
• New App Helps Build Resident, Family Engagement
• Chaplains Get Creative to Tend to Residents’ Spiritual Needs
• Easter Celebrations Go On Despite Lockdown
• A How-To on Celebrating a Community Seder
• Celebrating Easter Via Technology (and Eggs)
• Helping Residents Celebrate Passover
• Easter Preparations Help Residents Celebrate the Holiday
• A Virtual Seder to Serve Residents Sheltering in Place
• Member Creates COVID-Safe Outdoor Game
• “Lifting Our Spirits” Campaign for Resident Engagement
• “Play Ball!” Provider Celebrates Opening Day, Baseball or No
• Resident Engagement at a (Social) Distance
• Helping Families Cope With Loss and Grief

Wellness: Psychological Health

The far-reaching effects of a pandemic can include serious psychological strain and mental health challenges for persons served, staff, families, and communities. Organizations that build a healthy culture of support and services for all stakeholders’ mental health and psychological well-being will be better prepared for the ravaging effects of a pandemic. Interventions to address a variety of psychological traumas, including prolonged anxiety, stress, isolation, depression, grief, and loss, should be developed and ready to implement in the event of a pandemic.

Engagement and social connectedness for older adults:

• Supporting Social Connectedness Through Technology (QuickCast)
• Engagement in a Time of Quarantine (LeadingAge QuickCast featuring Anne Basting)
• Supporting Social Connectedness through Technology (LeadingAge QuickCast
• Supporting Senior Mental Well-being in Congregate Living during COVID-19 (MN Dept. of Health)
• ACL Seeks Solutions to Match People Who Are Socially Isolated with Available Social Engagement Programs and Technology Solutions
• How PSL Continues Resident Enrichment During COVID-19 Distancing: “As the senior living industry as a whole continues to adjust to the new normal during this pandemic, I want to share what the Presbyterian Senior Living community teams are doing to connect residents to their own purpose and life meaning.”
• The Coronavirus Pandemic: Mental Health Fatigue, the Holidays and Resiliency (The Forum from Harvard T.H. Chan School of Public Health): As the coronavirus pandemic grinds on, how are people coping with ongoing needs to social distance, wear masks, stay at home and undertake other measures to keep themselves and others safe? How might these measures be impacted by upcoming holiday gatherings? And how can people cultivate their mental health resiliency now and headed into the new year.
• How to empower employees to fight social isolation among senior living residents (Global Health Research and Policy): The fight against social isolation among older adults is not new for senior living community leaders and employees. These residents, however, now are at even more risk of experiencing social isolation and loneliness, which can have negative health outcomes ranging from dementia to stroke to even coronary heart disease.
• Finding Innovation and Resilience During the COVID-19 Pandemic: Social Disconnection in the Era of COVID-19: A discussion of resources on “social disconnection” from the Georgia Health Policy Center at Georgia State University.
• Bridging the Loneliness Gap (report from iN2L): Loneliness has always been a major issue for seniors. Nowhere has this been more of a challenge than in senior living communities, a setting where many didn’t fully realize the extent of the issue until the ongoing pandemic highlighted the problem.
• Addressing the double pandemic of COVID-19 and loneliness (McKnight’s Senior Living): What we don’t talk enough about is an issue that has long since been present among seniors and has only been exacerbated by the virus: loneliness and social isolation.
• Impact of Social Isolation Due to COVID-19 on Health in Older People: Mental and Physical Effects and Recommendations (NIH)
• Webinar: Social Isolation and Loneliness Among Older Americans during COVID-19: Evidence, Policy, and Advocacy (National Council on Aging webinar)
• Loneliness and social isolation during the COVID-19 pandemic (Cambridge University Press): The present position paper aims to describe the nature of loneliness and social isolation among older persons, its effect on their health, and ways to cope with loneliness and social isolation during the COVID-19 pandemic.
• Associations of Social Isolation with Anxiety and Depression During the Early COVID-19 Pandemic: A Survey of Older Adults in London, UK (NIH): The COVID-19 pandemic is imposing a profound negative impact on the health and wellbeing of societies and individuals, worldwide. One concern is the effect of social isolation as a result of social distancing on the mental health of vulnerable populations, including older people.

Psychological well-being of staff:

• Ideas to Support Employee Mental Well-Being During the Pandemic (LeadingAge resource infographic)
• Opportunities to Enhance Employee Mental Wellbeing (LeadingAge resource page)
• Protecting the Mental Health of Workers (LTSS Center research summary)
• Introduction to: The Art of the Supportive Check In (LeadingAge): Dr. William Mansbach of Mansbach Health Tools, Allison Ciborowski of LeadingAge Maryland, and Dee Pekruhn of LeadingAge discuss how to have critical conversations with employees who are experiencing anger, stress, anxiety, or other psychological challenges in the workplace.
  • The Art of the Supportive Check In (1-page flyer): This is a companion handout to reinforce key takeaways from “The Art of the Check In Call” training videos.
• Clinician Grief Resources (grief resources for health care workers from Center to Advance Palliative Care)
• How to Stand Behind Frontline Workers (LTSS Center)
• Mental Health Support for COVID Health Care Workers (podcast from Johns Hopkins Bloomberg School of Public Health)
• Dimensions: Work & Well-Being Toolkit for Physicians, and a webinar that discusses self-care strategies for staff in LTC (Behavioral Health & Wellness Program, University of Colorado)
• Coronavirus and Mental Health: Taking Care of Ourselves During Infectious Disease Outbreaks (APA)
• Why Self-Care for Leaders Isn’t Selfish (Associations Now): To escape burnout, execs need to learn how to set aside the day’s crises and make time for themselves.
• Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019 (JAMA Network Open)
• Resources for Health Care Worker Well-Being and Resiliency (a curated list of articles, presentations, handouts, and toolkits from leading organizations that focus on well-being and resiliency for health care workers impacted by COVID-19)
• Boosting Your Resilience During Adversity (QuickCast)
• The Trauma Stewardship Institute focuses on raising awareness of and responding to the cumulative toll on those who are exposed to suffering, hardship, crisis, or trauma.
• Hot Topic How to Incentivize Staff to Work During a Pandemic? (LeadingAge)
• Guidance for planners of the psychological response to stress experienced by hospital staff associated with COVID: Early Interventions (COVID Trauma Response Working Group, NHS Trusts, UK)
• COVID-19 and Mental Health in the Workplace: Solutions for Employers and Employees (webinar from National Institute for Health Care Management [NIHCM])
• Assisted living workers say employers ‘fall short’ in mental health support during pandemic (Kaiser Family Foundation): The majority of frontline health care workers participating in a new survey have experienced adverse mental health effects from the pandemic, and 58% of assisted living and nursing home employees believe that their employers are “falling short” in supporting them.

Psychological health resources for all populations:

• Pandemic Mental Health Resources (CARF International resource page)
• How Congress Can Address Social Isolation in a Pandemic (LTSS Center research summary)
• Coping in Crisis Resources (Center to Advance Palliative Care)
• Serious Illness Communications, Grief, and Advanced Care Planning Resources (LeadingAge, updated)
• Mental Well-being Resources (LeadingAge): We are all living through a collective trauma. It’s important for us to acknowledge the mental and emotional impact of living through a crisis and remember that there is nothing disordered about feeling worried, scared, or anxious because of the pandemic.
• Mental Well-being: Regaining Confidence and Control (Dr. Susan Wehry, MD)
• Coronavirus in Context: Home Care in the Setting of Mental Health Disease (WebMD interview with Tom Koutsoumpas of Capital Caring Health and Dr. Ken Duckworth of the National Alliance on Mental Illness about using mental health supports in the home care setting during the COVID-19 pandemic)
• Creating Calm: Simple Activities for Stressful Times (Dr. Kristine Theurer, Ph.D.)
• Mental Health Training Toolkit (series; various speakers)
• Coping With Trauma, Celebrating Life: Reinventing Patient And Staff Support During The COVID-19 Pandemic (Health Affairs)
• Surviving the trauma of COVID-19 (Science magazine)
• Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic (CDC)
• COVID-19 Resource and Information Guide (National Alliance on Mental Illness)
• Mental Health and COVID-19 Information and Resources (Mental Health America, variety of resources)
• American Psychological Association perspective on nursing homes having become hotbeds for COVID-19 with a particular focus on loneliness, fear and stress for residents, their families and staff perspective.
• How tech connects older people with mental health services as COVID-19 isolates (Marketplace Tech podcast; discusses how the use of virtual visits and facilitating chats with loved ones helps the mental wellness of older adults)
• Tips to ensure your residents’ mental health needs are met during the COVID-19 pandemic (McKnight’s)
• New study to examine COVID-19’s impact on the mental health of older adults: Joint study by Baycrest and the Centre for Addiction and Mental Health (CAMH) re COVID-19’s impact on the mental health of older adults and identify ways to support them; some results expected by late 2020/early 2021.
• Mental Health Wellness Tips for Quarantine (from a practitioner, posted by The Foundation for Post-Acute & Long-Term Care Medicine)
• The Academic Consortium for Integrative Medicine & Health publishes a variety of resources on well-being. Also, see Professional Well-being in a Time of Crisis, is a grand rounds video.
• Strategies for Mitigating the Emotional Impact of COVID-19 (The Society for Post-Acute & Long-Term Care Medicine)
• AMDA COVID-19 Grand Rounds: Pearls from Your Colleagues (a grand rounds webinar series; recordings available for episodes from May to September)
• COVID-19 Resources (Intl. Society for Traumatic Stress Studies)
• Hot Topic: How to Help People Living with Dementia in IL Navigate Coronavirus? (LeadingAge)
• Coping with COVID-19 Stress: Differences in How Older, Younger Adults Handle Pandemic Stressors (Mather Lifeways)
• Emotional Well-Being and Coping During COVID-19 (UCSF Department of Psychiatry and Behavioral Sciences)
• After COVID-19 Diagnosis, Nearly 1 In 5 Are Diagnosed With Mental Disorder (NPR Coronavirus Updates): New research has found that nearly 1 person in 5 diagnosed with COVID-19 is diagnosed with a psychiatric disorder like anxiety, depression or insomnia within three months.
• General Wellness Guides for Managing Stress During the Pandemic (no cost) from the Substance Abuse and Mental Health Services Administration (SAMHSA):
  • Tips for Managing Stress During the COVID-19 Pandemic Wallet Card
  • Feeling Stressed or Anxious About the COVID-19 Pandemic?
  • Are You Working to Help People Affected by the COVID-19 Pandemic?
• Audio interview: Sept. 9, 2020: Natalie Dattilo on Recognizing Grief and Other Negative Emotions, and Creating Connections to Reduce Isolation
• Audio interview: Dec. 9, 2020: Michael Hebb on Conversation, Support, and Resources About Death and Grief
• Mental Health in the Time of COVID-19 (The Forum, Harvard T.H. Chan School of Public Health): This one-hour event will shine a light on the often-hidden mental trauma of the coronavirus pandemic and explore ways to move forward.
• Looking after our mental health (WHO): The new realities of working from home, temporary unemployment, home-schooling of children, and lack of physical contact with other family members, friends and colleagues take time to get used to. Adapting to lifestyle changes such as these, and managing the fear of contracting the virus and worry about people close to us who are particularly vulnerable, are challenging for all of us. They can be particularly difficult for people with mental health conditions. Fortunately, there are lots of things that we can do to look after our own mental health and to help others who may need some extra support and care.
• RESILIENCE: The New Currency of Senior Living (McKnight’s Senior Living e-book—downloadable PDF): Learn how the pandemic is a clarion call for cultivating resilience in residents, associates, and organizations.
• The Coronavirus Pandemic: Grieving and Mental Health (video from Harvard T.H. Chan School of Public Health): What does it mean to grieve—both as individuals and as a society—during this pandemic?

Resources from CARF:

• Encouragement to reach out to individuals with substance use disorders and mental health needs and others at risk due to the isolation.
• Trainings for staff and family members in Mental Health First Aid
• SAMHSA’s National Helpline to Assist in Locating Treatment for Mental Health and Substance Use Disorders: 1-800-662-HELP (4357)
• Many treatment providers have adapted to allow for social distancing and preventing COVID infections and/or offering services through telehealth. Find an accredited provider.
• Suicide prevention and use disorders:
  • CARF’s Quality Practice Notice provides a framework for health care providers to assess and intervene.
  • National Suicide Prevention Lifeline
  • Online trainings on engaging people with SUD and overdose prevention
  • Information on Opioid Overdose Prevention Medications
  • COVID-19: We Must Care for Older Adults’ Mental Health (American Foundation for Suicide Prevention)

Resources from the Center for the Study of Traumatic Stress, Uniformed Services University:

• COVID-19 Pandemic Response Resources: a large collection of fact sheets and other resources to support the wellness and mental health of communities impacted by COVID-19; free to use and adapt as needed
• Taking Care of Patients During the Coronavirus Outbreak: A Guide for Psychiatrists
• Psychological Effects of Quarantine During the Coronavirus Outbreak: What Healthcare Providers Need to Know
• Sustaining the Well-Being of Healthcare Personnel during Coronavirus and other Infectious Disease Outbreaks (Center for the Study of Traumatic Stress)

Support groups:

• Virtual Groups for Support and Connection During Coronavirus (Zencare)
• Virtual Support Groups Meeting During COVID-19 Outbreak (NAMI Georgia)
• Promoting Support Group Attendance (American Society of Addiction Medicine)

Lessons Learned: Wellness of Staff and Residents

In the midst of an emergency as impactful as a pandemic, we must often act first and reflect later. It’s common for leaders to ask themselves retrospective questions, such as:

• Did I act too quickly or too slowly?
• What could I have done differently?
• Did my approach of choice work as well as I anticipated it would?
• How can I improve my responses if a pandemic recurs?

And then, of course, there are a lengthy series of “What ifs” that we ponder.

LeadingAge has received numerous “lessons learned” tips from members during the COVID-19 pandemic, which we are sharing at the conclusion of each related Playbook Section. In addition, a compilation of shared Lessons Learned may be referenced in the Playbook Appendix.

• Resilience During COVID 19: Getting Comfortable with Being Uncomfortable (CLA)
• Team Health during COVID 19 (Center for Advanced Palliative Care)
• Dementia Care in the Time of the COVID 19 Pandemic (IOS Press Journal)
• Dementia in Daily Living: A Review of Post-COVID Practices (LeadingAge QuickCast)
• The Proper Application of Hope in the Midst of a Crisis (CLA)
• Dementia and COVID-19: Insights from the Field (QuickCast)
• Audio interviews:
  • May 12, 2020: Michelle Just of Beatitudes Campus on Communication, Opening Up, and Handling Mixed Messages
  • July 8, 2020: Josh Bowman of Bethel Manor on Scavenging PPE, Visitation Plans, and Positive Media Coverage
  • July 22, 2020: Don Blose of Spanish Cove Retirement Village on Preparing for Pandemics, Keeping Staff and Residents Busy and Loved

Lessons Learned: Psychological Wellness

• Covid-19 could cause a mental health crisis. It can also spark post-traumatic growth. (STAT)
• Resources from National Center for PTSD (U.S. Dept. of Veterans Affairs)
• COVID-19 Health Care Staff Trauma and Resilience Oriented Healing (The Joint Commission)
• Psychological Trauma Is the Next Crisis for Coronavirus Health Workers (Scientific American)
• Mental health care for medical staff in China during the COVID-19 outbreak (Lancet)
• The psychological needs of healthcare staff as a result of the Coronavirus pandemic (British Psychological Society)
• Detrimental effects of confinement and isolation on the cognitive and psychological health of people living with dementia during COVID-19: emerging evidence (International Long-term Care Policy Network)
• Coping With Trauma, Celebrating Life: Reinventing Patient And Staff Support During The COVID-19 Pandemic (Health Affairs)
• AMDA COVID-19 Grand Rounds: Pearls from Your Colleagues (a grand rounds webinar series; recordings available for episodes from May to September)
• LeadingAge QuickCasts:
  • COVID-19 and the Relief of Suffering
  • Managing Mental Health: Considerations in COVID-19
  • Care and Coping with Dementia and COVID-19
  • Dementia and COVID 19: Insights from the Field
  • Lessons from the Pandemic on Addressing Loneliness
• LeadingAge audio interviews:
  • May 13, 2020: Karen Hatfieldof Hospice of the Western Reserve on Hospice Services, Grief, and Help for Mental Health
  • May 18, 2020: Beth Kilgore-Robinson of Goodwin House and Karina Barragan of TELACU on the Mental Health of Residents and Staff
  • May 21, 2020, Marvell Adams of The Kendal Corporation on Staff Stress, Scheduling, and Self-Care
  • July 20, 2020: Lisa Balster of Hospice of Dayton on Grief, Hospice in a Pandemic, and Ways Hospice Can Help Staff and Other Providers
  • Sept. 9, 2020: Natalie Dattilo of Brigham & Women’s Hospital on Recognizing Grief and Other Negative Emotions, and Creating Connections to Reduce Isolation

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