By Jessica Kunkler, MA
Having a loved one in a nursing home often inspires intense emotions. For many, regular visits and calls to their loved ones helps alleviate some of those feelings and puts their minds at ease. However, after the official arrival of the coronavirus to the United States, these visits and calls all but stopped. Although these were necessary steps to protect residents, staff, and families, these changes compounded an already stressful situation by removing family members’ means of managing their emotions.
Lamont Johnson, who lives just a few miles away from his mother’s nursing home, was recently featured in a CNBC story. After the COVID-19 pandemic became widespread, he wasn’t able to visit her for months. “The stress of the situation was amplified by a lack of communication,” according to Johnson. “Oftentimes, no one would answer when he called the nursing home.”
When COVID-19 hit her facility, Kristie Bacher, RN, BS, RAC-CTA, RAC-CT, CPC, QCP, and her staff took action to ensure communication between the facility and residents’ families was in place. They instituted a weekly Zoom call open to all family members. In those calls, the medical director shared updates on COVID at the facility and explained the steps the facility was taking to battle the disease and reduce spread. On a more personal level, the facility had every staff member “buddy” with a resident and regularly report back to their family on how their loved one was doing. “It was all worth the effort,” says Bacher.
Communicating with families during this stressful time is not only required, it can also help your residents and their families immensely. Here’s how to better communicate with families during the COVID-19 pandemic, according to Denise Winzeler, RN, BSN, LNHA, AAPACN curriculum development specialist.
1. Practice empathy for family members.
Even under normal conditions, family members might be feeling a combination of fear, anxiety, loneliness, and sadness at leaving their loved one in a nursing home. When the doors of nursing homes closed to visitors after COVID-19, it’s likely that these sensitivities became heightened for many family members.
Consider family members who visited every day before COVID. For these people, their routines have been disrupted. Just as seeing their loved one regularly provided a level of comfort, the inability to see their loved one has likely increased their stress. For some, visiting daily might have helped them feel like they were ensuring that their family member would receive better care. Now, not visiting might make them feel out of control. For many whose loved ones suffer from memory loss, they might feel terrified that their loved one will not understand why they aren’t visiting—or worse, that the loved one won’t remember who they are when the time comes they can finally visit again.
Consider family members who live out of state. Family members who live out of state may also feel helpless. Even if they didn’t often visit before, increased travel restrictions and elevated travel risks now mean that they can’t visit at all. These families may be feeling guilty or like they’ve lost time with their loved ones. They might also fear what happens in the event that their family member dies. Their physical distance might also mean that they don’t know what’s going on in the area of the nursing home beyond what they hear on the news or from other family members. This lack of first-hand knowledge could make them feel desperate for details.
Put yourself in their shoes. The intense emotions described above can increase the chances for negativity in a family member’s communication with facility staff. Consider how you would feel if it were your loved one in the nursing home and you were in their situation.
2. Be transparent.
According to the CDC, nursing homes are responsible for educating “residents and families on topics including information about COVID-19, actions the facility is taking to protect them and/or their loved ones, any visitor restrictions that are in place, and actions residents and families should take to protect themselves in the facility, emphasizing the importance of hand hygiene and source control.” They should also “have a plan and mechanism to regularly communicate with residents, families, and healthcare personnel (HCP), including if cases of COVID-19 are identified among residents or HCP.” The Centers for Medicare and Medicaid Services (CMS) have also introduced a similar requirement with an associated F-tag, F885 (COVID-19 Reporting to Residents, their Representatives, and Families).
However, nursing homes should make it a point to communicate with families proactively, beyond these requirements. Being clear about the facility’s efforts can help to comfort families. For example, sharing infection control survey information, especially if a facility performs well, can help to demonstrate the steps the facility is taking and how hard staff are working to keep their loved ones safe. More than ever, families need transparency about what is happening inside of facilities since they can’t go there themselves.
Make ringing phones a priority. Prioritize clinical care, but find a way (if possible) to answer ringing phones. This might mean utilizing available staffing resources in creative ways.
Make information public. Update your facility’s website weekly to communicate what families should know. A website is a great way to communicate widely about visitation policies, safety precautions the facility is taking, available opportunities to communicate with residents, and what residents may have experienced (such as any activities) the previous week. Making sure that families know they can find these updates on the website will reduce the number of frequently asked questions posed to your staff.
3. Stay calm.
Once you’ve identified the resources to help family members reach a staff member, consider that the conversation that transpires has the power to ease family members’ anxieties or send them into a frenzy of worry.
Remind staff again and again not to take things personally. Families are not the only ones with complicated emotional reactions during the pandemic. Staff members have them, too. If a family member is upset or becomes agitated, it is crucial that staff members remember it’s not about them personally, so that they can better keep their composure.
4. Speak confidently.
Under pressure, it is also easy for some personalities to overshare irrelevant details that can confuse a situation. Be sure to remind staff to discuss the relevant details of a resident’s wellness in a kind and professional way.
Don’t share misinformation. If a staff member has picked up the phone and they are being bombarded with questions, make sure they know that they don’t have to answer everything on the spot, and they probably won’t have an answer to every question presented. This is especially true if they don’t know the answer definitively. Remind staff that it’s okay to tell the family member that they will circle back. But, remind them to make the follow-up call within a reasonable timeframe a priority.
5. Stay connected.
When you are rethinking your plan for communicating with families, remember, it is not a one-and-done circumstance. As the situation evolves, restrictions and protocols are subject to change. This is especially true given the unknowns regarding how and when the pandemic will end. Implementing now a new and improved communication infrastructure will help in the months and years to come.
Use technology to aid residents in communication. Some facilities are scheduling times to video call or conference loved ones. Others are making more of an effort to use email and social media. “Just because a resident’s family can’t be physically with them, that doesn’t mean they shouldn’t be able to see them,” says Winzeler.
Be creative. Whether arranging outdoor visits, scheduling phone calls, or writing letters and cards, think outside the box about how to make it possible for residents and their families to connect.
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