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By Ellen Bartoldus, nursing home administrator and social worker, Claudia S. Blumenstock, LNHA., and Aimee Falchuk, MPH, M. ED, CCEP, Board Member at Mental Health America

“I am so afraid I will be the one to bring the virus into my nursing home.”

“I am anxious every day and constantly worry that I will infect my family with COVID.”

“I get so depressed seeing so many residents die.“

“I feel bad seeing our residents so lonely and depressed because they can’t see their families.”

These are some of the statements we hear as we traveled the country, virtually, listening to the voices of hundreds of nursing home workers. We heard stories of exhaustion, fear, anxiety, and grief that have taken a toll on their mental health and resilience.

Nursing homes have been hit hard by the pandemic, in part due to the frailty of their population, the challenges of congregate living, and the multiple staff persons involved in providing care. The initial lack of clear regulatory guidance, conflicting scientific information, inadequate PPE, and the rapid spread of the disease have left staff feeling vulnerable and powerless.

Unlike their counterparts in hospitals, deservedly honored as heroes, nursing home workers have not been accorded the same accolades.  As resident deaths mounted, media painted nursing home workers as COVID spreaders, incompetent in managing the virus and allowing residents to die alone without family support. In some cases, workers have been blamed for spreading the virus because they work a second shift at another nursing home to make ends meet. (The national average hourly rate for a certified nursing assistant is $15 or $27,300 annually. The US Department of Health and Human Services defines the 2020 poverty level for a family of four as $26,200)

Although we are aware that there are nursing homes that provide substandard care and should be closed, this negative generalization has taken an incredible toll on the mental health of workers. Staff worry about wearing their uniforms in public and some are avoided by friends who know where they work. They are embarrassed and frightened by newspaper accounts of nursing home failures. Staff have told us that their fear of contracting and bringing the virus home has increased anxiety and, in some cases, serious depression. Staff have reported starting to smoke again and using alcohol and food to cope.

Although death in a healthcare environment is not uncommon, resident deaths in nursing homes are personal. Staff build long term, intimate relationships with “their” residents. Nursing assistants have told us that when a resident dies it’s like losing a family member. As with COVID, when multiple deaths take place in a short period of time the emotional toll of what we are calling a “pandemic of grief” has been overwhelming.  The combination of “public shaming,” physical exhaustion, and lack of ready access to mental health services places this population at risk for deepening emotional distress and burnout.

As we potentially face another wave of COVID, our response must include a fresh and deeper look at policies and practices impacting nursing home residents and those who care for them. How do we provide adequate reimbursement that will offer a living wage for caregivers without their having to work two stressful jobs? How do we build in easily accessible mental health services for staff and decrease the stigma in seeking help? COVID has placed increased attention on our nursing homes – let us not squander this opportunity for change.

And most of all, we need a public acknowledgement of the incredible work these workers are doing. They have stood by our elders, at great risk to themselves and their families. Now we need to stand by them.