Caregivers' Concerns About Assisted Living Residents' Mental Health During the COVID-19 Pandemic: A Cross-Sectional Survey Study

Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID-19 pandemic

BACKGROUND

While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic.

METHODS

This repeated cross-sectional study used population-based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017-12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk-adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late-loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic.

RESULTS

Quarterly samples included 2015-2710 AL residents and 12,881-13,807 NH residents. Antipsychotic use (21%-26%), pain (20%-24%), and depressive symptoms (17%-25%) were most common in AL. In NHs, they were physical dependency (33%-36%), depressive symptoms (26%-32%), and antipsychotic use (17%-22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%-1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%-0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%-0.8%], p = 0.0222).

CONCLUSIONS

QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.

The impact of COVID-19 on relationships between family/friend caregivers and care staff in continuing care facilities: a qualitative descriptive analysis

BACKGROUND

The COVID-19 pandemic and related public health measures added a new dynamic to the relationship between caregivers and care staff in congregate care settings. While both caregivers and staff play an important role in resident quality of life and care, it is common for conflict to exist between them. These issues were amplified by pandemic restrictions, impacting not only caregivers and care staff, but also residents. While research has explored the relationship between caregivers and care staff in long-term care and assisted living homes, much of the research has focused on the caregiver perspective. Our objective was to explore the impact of COVID-19-related public health measures on caregiver-staff relationships from the perspective of staff in long-term care and assisted living homes.

METHODS

We conducted 9 focus groups and 2 semi-structured interviews via videoconference.

RESULTS

We identified four themes related to caregiver-staff relationships: (1) pressure from caregivers, (2) caregiver-staff conflict, (3) support from caregivers, and (4) staff supporting caregivers.

CONCLUSIONS

The COVID-19 pandemic disrupted long-standing relationships between caregivers and care staff, negatively impacting care staff, caregivers, and residents. However, staff also reported encouraging examples of successful collaboration and support from caregivers. Learning from these promising practices will be critical to improving preparedness for future public health crises, as well as quality of resident care and life in general.