This section below summarizes scientific evidence and jurisdictional experiences on the wellbeing of LTCH residents during the COVID-19 pandemic. In terms of jurisdictional experience, information is presented on Canada (Ontario, New Brunswick), Australia, Europe, France, Latin America, Netherlands, and the United States (US) (Connecticut, Florida). All of the information identified on the wellbeing of LTCH residents pertains to the IPC practices of physical isolation or quarantining in LTC settings.

Scientific Evidence

Wellbeing of LTCH Residents

• Mental Health (New Brunswick, France, Europe, Latin America, Netherlands): LTCH residents have developed or are experiencing deteriorated mental health conditions (e.g., depression, delirium, loneliness, and mood/behavioural problems). Factors that may contribute to deteriorated mental health in LTCH residents include: social Isolation (i.e., restricted communal dining, social distancing during the death of a fellow resident); limited family contact; care dependency on caregivers whose time is now occupied with increased workload, shortages in equipment and supplies, and increased postmortem care; and lack of stimulation from social activities.

• Changes to Multiple Wellbeing Domains (Canada, US [Connecticut]): The physical and/or quarantine restrictions in LTCHs may result in multiple wellbeing domains being negatively affected simultaneously (i.e., physical, functional, cognitive, and mental health; weight loss; and urinary incontinence).

• Medication Use (Europe, Latin America): Dementia residents may experience an increase in prescription of antipsychotics and benzodiazepines for psychological conditions experienced during LTCH lockdowns.

• Cognition (Europe, Latin America): Dementia residents are likely to experience a cognitive decline during the lockdown.

• Social Isolation (Europe, Latin America, US [Connecticut]): Social isolation (i.e., reductions in direct care provision, policies that restrict visitors) contributes to a decline in LTCH resident wellbeing. Despite technological innovations like video calls and creative solutions (e.g., plexiglass partitions) being implemented, residents are likely to continue experiencing socially isolation.

• Loneliness (Netherlands, US [Florida]): Although prohibiting group activities decreases the risk of spreading the COVID-19 infection in LTC settings, it significantly increases the isolation and resulting loneliness in LTCH residents.

• Care Dependency (US, Connecticut): The COVID-19 outbreak may exacerbate the challenges associated with existing staff availability for resident direct care provision. Furthermore, LTCH visitor limitations prevent family members and other unpaid caregivers from providing important supplemental care to LTCH residents.

Recommendations to Addressing Deteriorated Wellbeing

• Technological Innovation (New Brunswick, US [Florida]): Evidence-based clinical information systems supporting the surveillance of mental health outcomes, and evaluation of strategies to improve socialization (e.g., inteRAI) are recommended to address the compromised wellbeing of LTCH residents.

• Visitors (Canada, EU, Latin America, Netherlands): Increasing visitor time and frequency can improve the wellbeing of LTCH residents. Best practices include:
  • Number of Visitors Permitted (Canada):
    • Outdoors: Outdoor visits can include more than one visitor at a time, provided that physical distancing can be maintained.
    • Indoors: One visitor per resident in the LTCH at a time is recommended.
  • Location of Visits (Canada): Outdoor visits should be prioritized, when possible and feasible, to minimize the risk of COVID-19 transmission and to maximize the number of visitors. When outdoor visits are not feasible for either the resident or the visitor (e.g., for cognitive, psychiatric, or physical reasons), the LTCH must provide an indoor alternative that provides ample open space for physical distancing and adequate ventilation.
  • IPC/Personal Protective Equipment (PPE) (Canada, Europe, Latin America): Visitors must remain masked at all times and maintain at least two metres of physical distance from the resident. Visitors should be encouraged to bring their own cloth masks for outdoor visits. LTCHs should maintain ample PPE supply to enable resident visits.
• Staff Training (France): Programs should be offered to train and educate caregivers on how to deal with the mental health disorders of LTCH residents.
• Therapy and Interventions (France, US [Connecticut]): Psychological therapies (e.g., cognitive and behavioural therapy, mindfulness-based stress reduction, meditation) and target interventions can be used to address the deteriorated mental health and negative impact of social isolation on LTCH residents.
• Vaccination (Europe, Latin America): Family caregivers and LTCH staff should be prioritized to receive the COVID-19 vaccine. Of particular importance is offering vaccines to LTCH staff when they can access it (i.e., during work shifts).
• Activities (Netherlands): LTCHs should implement policies that permit continuing daytime activities.

International Scan

Wellbeing of LTCH Residents

• Social Isolation (Australia, US [Florida]): Social isolation (i.e., being confined to LTCH rooms without congregate dining, activities, and in-person family visits) may lead to distress among LTCH residents, as it limits: physical activity; direct sunlight and fresh air; levels of social interaction; and access to medical, mental health, and other therapeutic services.
• Changes to Multiple Wellbeing Domains (Australia): The physical and/or quarantine restrictions in LTCHs can result in multiple wellbeing domains being affected simultaneously (i.e., physical and mental health). Limited physical contact, exercise, and fresh air may adversely affect residents’ mental and physical health.
• Care Dependency (US Florida): According to a Psychiatric Times commentary (Nov 11, 2020) on the impact of COVID-19 on mental health in LTC settings, the majority of LTCH residents may not be tech-savvy or tech-capable, making them fully or passively reliant on the time and availability of staff to facilitate video chats and interaction with family and friends.

Recommendations to Addressing Deteriorated Wellbeing

• Technological Innovation (US, Florida): Telecommunication devices intended to increase communication with family members (e.g., video chats, iPads), and health care practitioners (HCPs) (e.g., telehealth) may address LTCH residents’ experience of social isolation.
• Visitors (Australia, US; Florida): Communication and contact with family and community members can be facilitated through drive-thrus and are recommended to be used in conjunction with other public health measures (i.e., mask wearing and physical distancing).
• Therapy and Interventions (US; Florida): Programming (e.g., music therapy) can be used to address the deteriorated mental health and negative impact social isolation has on LTCH residents.

Canadian Scan

Wellbeing of LTCH Residents

• Social Isolation: Physical distancing in LTCHs may lead to increased incident cases of mental disorders that may go undetected and untreated. Physical distancing may also create an increased sense of isolation in LTCH residents, which is identified as a risk factor for depression and cognitive impairment.
• Mental Health: LTC residents describe their experiences during the course of the pandemic as devastating, emotional, terror awakened, muzzled, trapped, broken- spirited, and boredom.

Recommendations to Addressing Deteriorated Wellbeing

• Technological Innovation: In lieu of providing on-site support during the COVID-19 outbreak, psychogeriatric teams can provide digital support. For example, digital access to behavioural support specialists who are on call and can provide rapid consultation. Tablets can be used by LTCH staff and family members, to observe, support, and interact with residents who are in physical isolation due to infection. Current challenges associated with this technological innovation is the availability of devices and uneven Wi-Fi connection.
• Staff Training: LTC facilities should provide staff with training in assessing and managing common mental health disorders such as delirium and depression, management of neuropsychiatric symptoms, and responding to emergent mental health crises. These training programs require access to trainers, as well as resources to allow staff to attend these courses as part of their paid employment, while ensuring an adequate number of staff are available to support the ongoing needs of LTC residents.

Ontario Scan

Wellbeing of LTCH Residents

• Social Isolation: The risk of confinement syndrome has increased among LTCH residents during the COVID-19 pandemic. Confinement syndrome includes social networks and support systems being disrupted, including the support provided by essential caregivers and visitors in hospitals and congregate settings; access to health and/or social programming that have been reduced, including less in-person contact/ assessment and fewer activities/programs; less mobilization and activity occurring due to fear of contracting the disease, physical distancing across settings, and reductions in programming; and usual staff being less available to provide care due to staffing challenges and IPC demands, including additional time required for PPE.

Recommendations to Addressing Deteriorated Wellbeing

• No information identified.

The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues.