Category: COVID-19

They say change is the only thing that is constant in life. Over the past two and a half years, long-term care has been immersed in this concept. In searching for a path out of the pandemic we find ourselves facing reroutes associated with COVID re-emergence or various other infection-prevention barriers. But we are now better equipped and prepared for these detours and, with the skilled eye of assessment, can equip our residents and staff with the tools and function to emerge stronger and fortified.

Many residents were inadvertently negatively impacted by the preventative measures put into place during the pandemic, others may be experiencing lingering deficits from having contracted COVID. Their current baselines are likely not the same as their pre-pandemic baselines.  Screening processes must take this into account to ensure attainment of the highest practicable level of independence, thereby promoting confidence in a return to normalcy for residents.

Even though most facility-based activities have resumed, and therapy gyms have reopened, some residents are hesitant to participate due to residual fears related to infection. Given the new, enhanced barrier precautions outlined by CMS, some residents may see these precautions and fear a surge is imminent. To offset this, open communication, assurance, and vigilance in infection prevention and control processes is key. Implementing health literacy interventions to convey information to residents in ways they can comprehend will allay concerns, provide reassurance, and instill confidence in their home environment.

As we navigate these paths, we should step into the moments that allow us to pause, celebrating our collective endurance, cultivating new bonds through shared activities, and discovering moments of inspiration. May we prevail in constructing a hope-filled future with the permanent paths to successful outcomes.

According to recent studies, older adults have experienced increased depression, loneliness, anxiety, and suicidal thoughts, as well as decreased physical health and overall quality of life as a result of COVID-19 and social isolation. As providers who relate so intimately with this population, we ask ourselves, what can we do now?

Participation in leisure, or the use of free time for enjoyment, has a large impact on the health and well-being of older adults. Research suggests that active engagement in healthy leisure can help to maintain preserved cognition, overall physical functioning, mental health, and quality of life. Now, more than ever, residents need opportunities to engage in meaningful activities that bring purpose and joy to their days. Through active collaboration and creativity from the interdisciplinary team, we can facilitate improved morale, satisfaction, and health for those in our care.  Review the following opportunities to explore ways to keep the resident’s mind, body, and spirit engaged:

• Identify hobbies that are meaningful to the resident or activities they are willing to explore. Talk to your therapy team about the Resident’s InterestChecklist for collaborative discussion.
• Request family and friends bring in items, games, or activities that are meaningful to the resident.
• Use creativity to incorporate resident’s interests into the care plan. Are there activity groups, events, or outings in which the resident could participate? Are there specific roles or responsibilities the resident could “own” (i.e. delivering mail, providing daily announcements, assisting with facility decorations, leading a weekly book club discussion)?
• Encourage participation in activities of interest during the resident’s downtime. Discuss safety precautions and resident capabilities with your therapy team.
• Provide opportunities for virtual leisure. Online card games, weekly FaceTime calls with loved ones, online learning platforms, and digital tours through museums and galleries around the world allow for engagement despite physical barriers.
• Communicate with your resident. Ensure that each resident feels known, heard, and cared for on both the physical and emotional level.

Although we can’t change what COVID -19 has brought to so many of our residents over the past two years, we are able to move forward with a fresh focus on their overall well-being. Through participation in healthy leisure, we can help our residents rediscover delight in their days.

October is a month of moving experiences- temporal, seasonal, and physical! It’s the beginning of the last quarter of the calendar year and the beginning of the Medicare fiscal year. It ushers in the holiday excitement with weather changes and spooky decor. Amid all of this, it is Physical Therapy Month, and an excellent opportunity to emphasize encouraging mobility for our residents at every possible opportunity. Almost daily, articles are released citing the benefits of mobility from improving appetite to improving skin integrity to preventing contractures.  With that in mind, there is a steadfast need to maintain and improve mobility with our residents.

Incorporating “moving experiences” into the daily facility routine is multifaceted and can bring holiday cheer while also embedding a culture of mobility and independence. There is no amount of too little movement- if residents are moving, benefits are happening. This may look like a high five in the hallway, door decorating contests, a shoulder shrug or leg kick “dance break” with music over the loudspeaker and referrals to therapy for concerns for safety with mobility.

It’s impossible not to think of the effect COVID-19 has had on industry as we round the second year under a healthcare emergency cloud, but we adapt. Skilled nursing residents and staff are resilient and keep looking forward. With an arsenal of wellness and mobility strategies provided to residents, we shape a holistic, healthy environment in which to thrive.  Remember, Reliant therapists are champions at mobility and are equipped to combat barriers to a quality “moving experience”. Thank you for partnering with Reliant!

As the Delta variant of COVID surges through the country, long-term care facilities are forced to revisit the effects of closure, social distancing, and isolation on residents.  This variant has caused healthcare professionals to reframe thinking from potentially leaving a pandemic behind, to best practice strategies to mitigate an ongoing response pattern. Facility staff should revisit the impact moving in and out of isolation has on residents. Consequently, a refresher on fall prevention strategies is appropriate.

Isolation has detrimental effects including reduced mobility, decreased cognition, increased depression, weight loss, and increased risk for falls. While the list of obstacles at times seems insurmountable, keen interdisciplinary teams can be a shining light to our residents by constantly adapting, advocating, evolving, and simply showing up. Though increased isolation may lead to residents spending more time alone, unsupervised in their rooms, putting them at an increased risk for falls, there are ways to reduce this risk through a proactive, interdisciplinary team approach.

Consider implementation of these simple tips to help mitigate the risk of falls:

1. Keep frequently used items within reach, especially the call button.
2. Educate new staff on residents’ preferences and nighttime routines: lights on/off, TV on/off, toileting schedule, bed positioning, etc.  
3. Make time to reassure residents who are feeling isolated and lonely.  Even 2-3 minutes of non-task-oriented company is beneficial. Set up virtual visits with family and friends. Decreased anxiety and agitation lead to calmer residents, and hopefully, fewer falls.
4. Place any mobility devices in the best position for self-transfer; remove if unable to self-transfer to avoid fall risks.
5. Take extra care to reduce clutter and ensure clear pathways in the residents’ rooms. Remove any throw rugs or items that may be blocking pathways.
6. Ensure exercise programs, including therapy, stretching, and balance activities are available to all residents as appropriate. Improved strength and balance can assist with fall prevention and help lessen injuries should a fall occur.
7. Identify residents’ interests and collaborate with the interdisciplinary team to facilitate creative ways for them to participate in preferred leisure activities.  
8. Refer to physical therapy for balance strategies, assistive device assessment and training, strengthening, transfer training, gait assessment and training, bed mobility training, education on fall prevention, and floor transfers.
9. Refer to occupational therapy for strength training, balance training, transfers and bed mobility training, facilitation of self-care independence, adaptive equipment training, education on safety awareness, room modifications, and/or cognitive training.
10. Refer to speech therapy for expressive and receptive communication skills training and strategies, memory, attention to task, sequencing, and safety awareness training techniques.

Educate staff to watch for signs and/or changes which may reflect an increased risk for falls and proactively adapt environments at every level. With a team approach of collaboration and communication, facilities are well equipped to not only reduce the risk of falls for this vulnerable population, but also to ensure that No Patient is Left Behind.  

As the public healthcare emergency (PHE) lightens and with vaccines abundant in the U.S., many businesses are feeling a note of normalcy. Nursing homes have been given the green light to reopen, but continue to be a target of investigation, regulatory ribbon, and reduced consumer trust. This paradoxical environment highlights the sweet and salty of long-term care (LTC). Prior to the pandemic, LTC’s focus was enhancing resident’s outcomes, improving quality of care and quality of life, and fostering a home environment worthy of the residents within.  As difficult as it may have been in the moment, we now know it was truly the sweet stuff.

During the height of the PHE, regulation and policy aligned to create a salty recipe for long-term care. Reporting requirements, acquiring PPE, reduced access to care, and navigating surveys overshadowed previous focuses. Through this pandemic, we’ve learned the necessity of the salty. Salt brings balance and accountability, but when added without first testing the effectiveness of current spices, it can quickly ruin a meal. When regulation, reporting, and accountability metrics are balanced in relation to care needs, quality outcomes, and resident satisfaction, a delightful sweet and salty mix, in high demand for any consumer, is created.

As we emerge into this new era, many are fatigued, short staffed, and considering alternatives to long-term care. Let’s partner together to remember the sweet, learn from the salty, and create an enhanced recipe. Embrace each step of reopening with a dash of optimism and a cup of determination. Give a patient a hug, ignite communal dining and activities with fanfare, have a welcome party in the therapy gym, hype the benefits of group therapy, and celebrate family and friend’s visitation! Talk openly about the expectations for infection control, safety measures, and possible temporary isolation needs. This balance will help achieve a transparent trust with our residents, their loved ones, and care partners.

Don’t let the sweet get lost in the salty, share resident and facility successes with Reliant’s Model 10^3.0 reports. Spotlight Reliant therapists who exhibit clinical excellence by climbing the Clinical Ladder and facility team who SMILE with purpose. Never hesitate to GROW your brand. Our partnership brings the best ingredients to demonstrate your facility’s value, skill, and compassion in the community. Bon Appetit!

According to Harvard Health Blog, recent studies indicate that 50-80% of patients recovered from COVID-19 continue to have at least one adverse symptom three months after the onset, even if the patient no longer tests positive for the virus.  This emerging condition has been described using a variety of terms including: “Post-Covid-19 Syndrome”, “Long COVID”, “Post-Acute Sequelae of SARS-COV2 infection (PASC)”, and “Long-Haulers”.  As healthcare providers to the most vulnerable population, it is our duty to monitor the evolving evidence in this area and adapt for timely identification and intervention of needs.  

Though what predisposes an individual to developing “Long COVID” is still unknown, a number of those with even mild symptoms have continued to experience lingering effects. Some of the troublesome symptoms that have been observed with “Long COVID” include many of the same musculoskeletal, cardiopulmonary, oral/respiratory, neurological, and psychological dysfunctions that are seen with active COVID-19. Furthermore, it has been noted that some individuals recovering from COVID-19 develop new conditions or complications of pre-existing conditions as a result of the illness.

Rehabilitation’s distinct role in COVID recovery and “Long COVID” is clear. Therapy can intervene to assist “Long Hauler” patients by maximizing their participation and performance in daily function with the use of the following:

• Referral to the IDT when changes in clinical presentation emerge
• Patient-specific musculoskeletal and neurological re-training
• Individualized cardiopulmonary programming
• Dysphagia analysis and treatment
• Compensatory strategies to assist with cognitive re-training
• Environmental modifications to facilitate increased participation and decreased risk of injury
• Trauma-informed approaches to care when addressing the psychological effects of prolonged isolation
• Patient and caregiver training on adaptive techniques and equipment
• Patient education to promote health literacy
  
  

Reliant is actively engaged with the therapists in the field by developing resources such as Reliant’s Post COVID Clinical Considerations in order to equip the care team to positively impact patients and residents. Evidence continues to emerge, but the tools and knowledge do exist to address the physical, cognitive, and psychosocial needs that COVID-19 has introduced. Whether newly diagnosed as COVID positive, challenged by long-term effects of “Long COVID”, or facing an entirely new condition as a result of COVID-19, a patient or resident will never feel alone as they can rest assured that we’re with them for the long haul.

References:

Anthony Komaroff, MD. “The Tragedy of Long COVID.” Harvard Health Blog, 1 Mar. 2021, www.health.harvard.edu/blog/the-tragedy-of-the-post-covid-long-haulers-2020101521173.

AOTA. “Research: Occupational Therapy and Physical Therapy Provide Significant Rehabilitative Value in Post-Acute Care.” American Occupational Therapy Association, 5 Apr. 2021, www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/Therapy-Outcomes-Post-Acute-Settings.aspx.

Cutter, Matthew. “COVID Long-Haulers: An End in Sight?” ASHAWire, 5 Mar. 2021, leader.pubs.asha.org/do/10.1044/leader.FTR1.26032021.42/full/.

Royal College of Occupational Therapists. “A Quick Guide for Occupational Therapists: Rehabilitation for People Recovering from COVID-19.” Rcot.co.uk, Apr. 2020, www.rcot.co.uk/files/guidance-quick-guide-occupational-therapists-rehabilitation-people-recovering-covid-19-2020.

WHO. “COVID-19 Clinical Management: Living Guidance.” World Health Organization, World Health Organization, 25 Jan. 2021, www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1.

With the increasing availability of COVID-19 vaccinations on the horizon and updated information being released almost daily, organizing the pertinent material into a concise usable format can be daunting. Below are the most up-to-date resources from the CDC, CMS, and FDA regarding the COVID-19 vaccine.

CDC Vaccine Resources

• Download CDC’s Preview Table
• Review CDC’s IIS Vaccine Code Sets
• CDC COVID-19 Vaccination Communication Toolkit for medical centers, clinics & clinicians

CMS Vaccine Resources

• Review CMS’ payment and CPT coding information on its Vaccines & Monoclonal Antibodies webpage
• CMS COVID-19 Provider Toolkit
• CMS COVID-19 FAQs

FDA Vaccine Resources

• FDA COVID-19 Vaccines webpage
• FDA resources (including fact sheets) for Pfizer-BioNTech COVID-19 Vaccine

• Screening of all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions or observations about signs or symptoms), and denial of entry of those with signs or symptoms
• Hand hygiene (use of alcohol-based hand rub is preferred)
• Face covering or mask (covering mouth and nose)
• Social distancing at least six feet between persons
• Instructional signage throughout the facility and proper visitor education on COVID-19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face covering or mask, specified entries, exits and routes to designated areas, hand hygiene)
• Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit
• Appropriate staff use of Personal Protective Equipment (PPE)
• Effective cohorting of residents (e.g., separate areas dedicated COVID-19 care)
• Resident and staff testing conducted as required at 42 CFR 483.80(h) (see QSO-20- 38-NH)