COVID-19 and Long-Term Care Healthcare Worker Mental Health in Rhode Island

Abstract

IntroductionHealthcare workers in long-term care settings and group homes for the disabled are at signi?cant risk of contracting COVID-19 and subsequently infecting the residents, fellow co-workers, and their family. In addition, lower paying long-term care healthcare workers maybe working multiple jobs which increases the risk of exposure. In April 2020, 27% of all deaths in the population was among residents in long-term care. The elderly population has the greatest risk for mortality from COVID-19 (Liu et al. 2020) and are disproportionality a?ected by social distance and self-isolation. Most long-term care settings have implemented lockdowns preventing families from visiting and limiting interactions among residents. Social isolation of the elderly is considered a serious public health concern. Social disconnection is a risk factor for increased depression and anxiety among the elderly. It is hypothesized that elderly persons are at high risk for poor mental health outcomes from the COVID-19 pandemic. The Alzheimer's Disease International suggest that those with dementia “may become more anxious, angry, stressed, agitated, and withdrawn during the outbreak”. These factors potentially may increase stress on healthcare workers in long-term care settings beyond the fears of exposure and transmitting COVID-19 to their families. There are few studies to date that examine the mental health impact of COVID-19 on healthcare workers in long-term care. The United Nations has highlighted the mental health risk to workers in long-term care. “First responders and front line workers, particularly workers in health and long-term care play a crucial role in ?ghting the outbreak and saving lives. However, they are under exceptional stress, being faced with extreme workloads, di?cult decisions, risks of becoming infected and spreading infection to families and communities, and witnessing deaths of patients.”MethodsHealthcare workers in long-term care facilities, and assisted living facilities in Rhode Island were given questionnaires to complete that examined mental health and risk factors associated with COVID-19. The questionnaire includes items on the healthcare worker's experience with COVID-19. Resilience is measured using The Brief Resilience Scale assessing the individual's ability to bounce back or recover from stress. Subjective incompetence is de?ned as the perceived incapacity to perform tasks and express feelings deemed appropriate in a stressful situation. Increasing distress and subjective incompetence may convert a normal reaction to stress into mental disorder requiring intervention. Demoralization is measured using the Demoralization Scale-II. Depression and anxiety is measured using two of the most commonly used screens in clinical care, the PHQ-9 for depression and the GAD-7 for generalized anxiety. Family functioning during and before the COVID-19 pandemic is measured using the three-item Brief Assessment of Family Functioning. Social support is measured during and before the COVID-19 pandemic using the emotional-informational support subscale of the Brief Social Support Scale derived from the Medical Outcomes Study Social Support Survey. Coronavirus Anxiety Scale is a mental health screener designed to aid in the identi?cation of probable cases of dysfunctional anxiety associated with the COVID-19 pandemic. The fear of Coronavirus-19 Scale was used to measure this construct. The ?ve-item Primary Care PTSD Screen was adapted to COVID-19 as a traumatic event. Items measuring healthcare worker workplace stress was developed based on a items from a number of existing scales. A 15-item health care workers attitudes toward the management of COVID-19 in the long-term care facility was developed by the research team that focuses on training of sta?, safety, and resident care.ResultsPreliminary data will be presented. Data collection is currently underway. There are 65 assisted living facilities and 85 nursing homes in Rhode Island. Approximately 10% of the facilities are currently participating with the aim to recruit nearly all facilities in the state.ConclusionsThe hypotheses to be tested is that healthcare workers in long-term care settings have mental health issues including demoralization, depression and anxiety due to the COVID-19 pandemic disaster. That those who are in facilities with COVID-19 residents have increased stress. Those facilities that have placed increased demands on healthcare workers will have employees that are having more difficulty in dealing with the COVID-19 pandemic. This study examines how healthcare workers in long-term care facilities have coped during the COVID-19 pandemic and the impact on their mental health; factors that protect or place the healthcare worker at risk for poorer mental health outcomes (depression, anxiety, demoralization, post-traumatic stress); and factors during COVID-19 that place the healthcare worker for poorer mental health outcomes during COVID-19 pandemic.FundingDepartment of Psychiatry of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Lifespan