Hope for the Bruised and Battered

The media frequently refers to the development of vaccines to combat COVID-19 as our hope for a better year and a return to normal. This hope is being realized as more vaccines are available and residents and frontline workers are being vaccinated. 

This hope and promise for the future increasingly is supported by the literature.

And several articles create hope that, along with the benefits of immunization, environmental and procedural changes could mean that the frailest will receive care in settings where countless indignities are remedied and person-centered, risk-stratified care is provided.

Achievements Lead to Hope

One article, describing the resilience of older community-living adults, underscored their strategies to cope through troubling times. While it’s unlikely that frail, cognitively impaired residents will be able to master Instagram or a virtual conference, we have seen the value of this technology and we can expect to see more efforts to use it to support these individuals.   Some other promising conclusions in this article:

 

  • Expect to see increased use of telemedicine and programs to assess early for social isolation-related depression, as well as greater attention to advance care planning and less stigma regarding anxiety and depression. 
  • There is more outright acknowledgment of the need to counteract ageism and intergenerational division. Expect to see greater incorporation of the advice of social scientists who caution against allowing ageism to feed conflict between the generations in a healthcare model with scarce resources.

 

Hope for What Can Be Achieved

Another recent article notes how a passion for change may be achievable if we work from the top-down and the bottom up. The author reminds us that reforms to date have not been helpful. Value-based payments, the Patient-Driven Payment Model (PDPM), and compensation tied to quality outcomes didn’t help post-acute/long-term care communities weather the pandemic or increase survival rates. 

This suggests that, at a minimum, we should focus on tying quality to the outcomes that matter to the resident and the family. Recovery, rehabilitation, early discharge, and functional or cognitive improvements are not realistic goals to use as outcomes, or proof of good care for the frail and vulnerable nursing home resident. 

At the same time, a punitive, finger-pointing approach to change has proven ineffective; and punishment for what is unavoidable needs to be challenged.

The Solution? Start with the Truth

If we speak the truth to power we would admit that quality will happen when staffing is adequate, clinicians are trained in geriatric medicine, and licensed professionals and Certified Nursing Assistants (CNAs) are well paid and receive benefits that allow them to dedicate their time to one facility and stay home, with pay, when ill. 

If we contribute our expertise to this hopeful scenario, we would agree with other experts that private rooms and bathrooms, maintaining family contact, active infection control practices, and abundant supplies of personal protective equipment will bring hope to our new nursing home setting. We would add our own area of expertise that underscores the implementation of assessing for frailty to determine the inherent risk for achieving any outcomes, realistic or not. This allows us to focus our attention on the most vulnerable, giving us a fighting chance to prevent adverse outcomes and an opportunity to explain the inevitability of decline in the frailest.

Why Hope Can’t Be Deferred

Every day the aging population grows. Every day someone with chronic illnesses or sudden trauma needs more care than the day before. COVID-19 has destroyed many lives and livelihoods. Let’s not allow this virus to destroy our senior housing or our passion as providers, practitioners, and caregivers for what is possible.