Nursing Home Staff Research Articles

Exploring the Impact of COVID-19 Restrictions on Nursing Home Residents', Families', and Staff's Perceptions of Bioethical Principles: A Qualitative Study.

In this study, we employed a pre-interview survey and conducted interviews with nursing home staff members and residents/family members to understand their perceptions of whether the COVID-19 restrictions fulfilled obligations to nursing home residents under various principles, including autonomy, beneficence, nonmaleficence, justice, and privacy. We conducted 20 semi-structured interviews with staff members from 14 facilities, and 20 with residents and/or family members from 13 facilities. We used a qualitative descriptive study design and thematic analysis methodology to analyze the interviews. Findings from the pre-interview survey indicated that, compared to nursing home staff, residents and their families perceived lower adherence to bioethics principles during the pandemic. Qualitative analysis themes included specific restrictions, challenges, facility notifications, consequences, communication, and relationships between staff and residents/family members. Our study exposes the struggle to balance infection control with respecting bioethical principles in nursing homes, suggesting avenues for improving processes and policies during public health emergencies.

SARS-CoV-2 outbreak management in nursing homes in Ireland: reflections of COVID-19 response teams from earlier to later waves of the pandemic

BackgroundA review of key learnings from the response to the COVID-19 pandemic in nursing homes in Ireland can inform planning for future pandemics. This study describes barriers and facilitators contributing to COVID-19 outbreak management from the perspective of frontline teams.MethodsA qualitative study involving ten online focus group meetings was conducted. Data was collected between April and June 2023. The focus group discussions explored the views, perceptions and experiences of COVID-19 Response Team (CRT) members, clinical/public health experts who worked with them, and care professionals who worked in frontline managerial roles during the pandemic. All nine Community Healthcare Organisations and six Public Health Areas in Ireland were represented. Inductive reflexive thematic analysis was carried out using NVivo Pro 20.ResultsIn total, 54 staff members participated in focus group meetings. Five themes were developed from a thematic analysis that covered topics related to (1) infection prevention and control challenges and response to the pandemic, (2) social model of care and the built environment of nursing homes, (3) nursing home staffing, (4) leadership and staff practices, and (5) support and guidance received during the pandemic.ConclusionsThe response to the COVID-19 pandemic has resulted in a steep learning curve, internationally and in Ireland. Preparing better for future pandemics not only requires changes to infection control and outbreak response but also to the organisation and operation of nursing homes. There is a great need to strengthen the long-term care sector’s regulations and support around staffing levels, nursing home facilities, governance, use of technology, infection prevention and control, contingency planning, and maintaining collaborative relationships and strategic leadership. Key findings and recommendations from the Irish example can be used to improve the quality of care and service delivery at local, national, and policy levels and improve preparedness for future pandemics, in Ireland and internationally.

Nursing Home Staff with Children: Unique Needs Among Single and Partnered Parents.

Nursing home (NH) staff job dissatisfaction and turnover are associated with lower care quality. However, little is known about the impact of being single on workplace experiences. Guided by the Job Demands-Control-Support Model, we compared job satisfaction, turnover intention, and psychological distress for single and partnered parents working in NHs. Employee and manager data from the 2011-12 wave of the Work Family Health Network study were combined (N=1,144) to define parents with complete data (N=586). Bivariate tests and multivariate regressions clustering observations within NHs were used. Most single parents (n=190, 32%) were nursing assistants (NAs) (n=142, 74.74%) or licensed practical nurses (LPNs) (n=29, 15.26%). Compared to partnered parents, single parents were similar on turnover intention and job satisfaction, but they were more likely to report distress (OR=1.79, 95% CI 1.09, 2.94) observed only among NAs (OR=2.08, 95% CI 1.12, 3.85). Psychological distress was associated with greater turnover intent (β =0.02, p<.05) among NAs and LPNs, yet only among single parents (β =0.04, p<.01). Distress was more likely with higher family-to-work conflict (OR= 1.67, 95% CI 1.18, 2.36) and work-to-family conflict (OR=1.60, 95% CI 1.20, 2.14) among licensed nurses, yet the distress-work-family conflict associations were only significant for partnered parent nurses. Supporting NH staff depends upon knowing their parental, relationship, and occupational status. Additional research is needed to understand and develop strategies to mitigate psychological distress and increase resources particularly among NA single parents employed in NHs.

Alleviating Worker Shortages Through Targeted Subsidies: Evidence from Incentive Payments in Healthcare

Abstract Worker shortages are common in many industries. This paper examines the effect of government subsidies to address these shortages in the context of a reform that tied Medicaid payments to nursing home staffing levels. We find that the reform substantially increased staffing, especially for facilities serving many Medicaid patients. Facilities responded primarily by hiring workers in lower-wage roles rather than increasing hours of incumbent or high-wage staff. This contrasts with null effects we estimate for a non-incentivized rate increase, suggesting that the incentive structure of government payments—rather than just the level—is key to boosting employment in sectors facing worker shortages.

Navigating Communication in Nursing Homes During COVID-19: Perspectives From Families, Healthcare Professionals, and Managers in Southern Switzerland-A Qualitative Study.

This study aims to understand the effectiveness and challenges of communication strategies implemented to maintain contact between nursing home (NH) residents and their families during the COVID-19 pandemic, by considering the perspectives of families, healthcare professionals, and NH managers. Using a qualitative research design, the study analyzed in-depth semi-structured interviews with key stakeholders (N = 34), including family members, NH staff, and managers. The study found that communication strategies like video calls, telephone calls, and window visits were generally appreciated and facilitated contact between residents and their families. However, challenges emerged around technical and organizational issues. Both internal and external stakeholders concurred that an increase in technological and human resources was necessary to alleviate these challenges. The study underscores the importance of innovative and flexible communication strategies to sustain connections between NH residents and their families in crises such as the COVID-19 pandemic. Future readiness calls for increased investment in human and technical resources, and a commitment to understanding and addressing the diverse communication needs of NH residents.

Nursing Home Palliative Care Referral Process, Barriers, and Proposed Solutions: A Qualitative Study.

Despite evidence that specialized care for seriously ill nursing home (NH) residents is needed, barriers to accessing palliative care (PC) remain. A significant issue is the complexity of the referral process that inhibits timely and equitable access to care. This qualitative descriptive study explored the PC referral process in NHs. Using rapid qualitative analysis with semi-structured interview data from NH staff, primary care, and specialty PC providers (N = 17) in six states, this study outlines a multistep referral process along with barriers and proposed solutions. Key recommendations include comprehensive PC education program development, implementation of an evidence-based PC screening tool, and the holistic integration of PC services in NHs.

Mixed methods process evaluation of an advance care planning intervention among nursing home staff.

We developed the ACP+ intervention to support nursing home staff with implementation of advance care planning. While ACP+ was found to improve staff's self-efficacy, it did not change their knowledge about advance care planning. To describe the level of implementation, mechanisms of impact, and contextual factors. Process evaluation embedded in a cluster randomized controlled trial in nursing homes (NCT03521206). Throughout and immediately following the 8-month ACP+ implementation, we collected weekly diaries, post-training surveys, attendance records, facility data, and conducted interviews (n = 32). We applied descriptive statistics and thematic analysis. Management, staff, and ACP+ trainers in seven intervention homes. Although most participants reported they valued ACP+, 33% of eligible staff across nursing homes attended training (range: 6%-69%) and only a few reported they felt ready to engage in actual care planning conversations. Half of all nursing homes adapted parts of the intervention (e.g., more/fewer/shortened training; assigning a coordinating role for practical management). Enough time to consolidate skills, and management support were key for staff engagement in advance care planning, and limited time and staff shortages were significant barriers. Staff reported increased awareness of the importance of advance care planning and felt there was a more systematic way of organizing advance care planning. There was limited staff engagement. Management ownership, clear roles, and collaborative practices may enhance nursing home advance care planning. Accessible and ongoing training for all staff, and ample practical learning opportunities are needed.

Implementing a new multidisciplinary, remote, dementia staff training program for Veterans affairs nursing homes

BackgroundPreventing Loss of Independence through Exercise (PLIÉ) is a group program for people living with dementia that combines movements to support daily function with present moment body awareness and social engagement that has been found to have physical, emotional, social, and cognitive benefits. The goal of this study was to develop and refine a PLIÉ remote training program for interdisciplinary Veterans Affairs (VA) nursing home staff members also known as community living center (CLC) staff.MethodsThis pre-implementation study used iterative Plan-Do-Study-Act (PDSA) cycles. The 10-week PDSA cycles occurred from June to September 2021 at 2 VA nursing home sites. Remote training was delivered via Microsoft Teams and included 1-hour live-streamed weekly didactic sessions (nursing staff with PLIÉ instructor) focused on PLIÉ principles and 1-hour weekly live-streamed experiential sessions for staff to apply PLIÉ principles with residents. We administered weekly feedback surveys to iteratively refine the training process.Results14 staff members participated (5 recreation therapists, 3 social workers, 2 registered nurses, 2 chaplains, 1 psychologist, and 1 speech pathologist). The experiential sessions were rated as most helpful overall. Key PDSA refinements included: (1) creating 10-minute video recording summaries to support learning, particularly for those unable to attend live training sessions due to clinical schedules; and (2) incorporating self-reflection and goal setting to support staff incorporation of PLIÉ principles into routine care and personal life. These refinements resulted in increased use of PLIÉ principles with the residents from 67 to 89% of the staff participants. 100% of regular attendees (11/11) rated their overall satisfaction with remote training as “very good” or “excellent.”ConclusionsIt was feasible to train interdisciplinary CLC staff participants to deliver an integrative group movement program for residents with dementia remotely. PDSA cycles supported refinement of the training process and improved uptake. A larger study of PLIÉ remote CLC staff training is needed to assess outcomes on residents and quality of care.

Experiences of family caregivers and nursing home staff interactions during the adaptation process of elderly individuals moving to nursing home: a qualitative study

ObjectiveTo explore the interaction between family members and nursing home staff during the adjustment period of newly admitted elderly individuals in a nursing home.DesignA qualitative descriptive study based on semistructured...

Preventing Hospitalisation- Providing Specialist Geriatric Services To Nursing Home Patients

Abstract Background Nursing home (NH) residents often require acute hospital care in unexpected deterioration and may have repeated Emergency Department (ED) attendances. Grunier et al (2018) reported 48% of NH residents reattend ED within 1 year. Our aim is to determine if those who require acute hospital admission are more likely to reattend ED or require NH outreach services. Methods Nursing home residents who attended Mater ED in March 2023 were identified through Electronic Patient Record. Their age, gender, reattendance of ED within 28 days and 6 months, visit by NH outreach team within 28 days then 6 months and 6-month mortality were recorded. The residents were categorised as admitted or discharged from their sentinel visit in March 2023. Chi-square test was used, and statistical significance was set at p&amp;lt;0.05. Results Sixty-three nursing home residents attended within 1-month, median age 85 years (range 67-95), 43 were women. Forty-five (71%) required admission, 6 (9.5%) and 24 (38.1%) reattended ED within 28 days and 6 months respectively. There was no difference in 28-day or 6-month ED reattendance between those who were admitted or discharged in the sentinel visit to ED. Those discharged from ED were more likely to receive NH outreach visit within 28 days (84% vs 6.8%) and 6 months (84% vs 11%) than those who were admitted, p&amp;lt;0.0001. There was no difference in 6 months mortality between the groups. Conclusion Our study found that 71% of NH residents who attend ED require admissions showing that the transfer was warranted. More than one-third of NH residents reattend ED within 6 months. Those discharged from ED were more likely to be reviewed by NH outreach team as per service delivery. Working closely with the resident’s General Practitioner, NH and ED staff may help to manage these complex patients to coordinate their treatment and prevent ED reattendance.

Evaluation of Caru Programme: A National Programme Supporting Palliative, End of Life and Bereavement Care in Nursing Homes in Ireland

Abstract Background The aim of the interim evaluation report is to provide the Caru Programme team with information on the impact of the Programme to date and to highlight the outcomes and challenges, whilst reiterating the key aims and objectives of the Programme and the overall evaluation. Methods The evaluation utilities’ a combination of quantitative and qualitative methodologies. A pre-post design of baseline, mid-line and end-line primary data collection is used to measure the overall impact of the programme. Secondary data analysis of participant feedback, workshop evaluations and attendance was completed under the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Results The education sessions provided were highly valued, with the majority of participants indicating an increase in baseline knowledge after attending a session. There were very high levels of positive experience with 80-99% of participants strongly endorsing the activities and recommending the programme. Participants who attended the Project ECHO and the QI workshops, indicated an intention to change practice; however, at this stage of the evaluation, there is a lack of specific details on what practice or change would be introduced, or indeed, its timeline. This will be measured in the next phase of the evaluation. Conclusion Caru is an innovative continuous learning programme supporting nursing home staff in the delivery of palliative, end-of-life, and bereavement care to residents. The learning components are delivered using a range of approaches, Webinars, Project ECHO online learning, Regional Networks, Quality Improvement Workshops. The interim evaluation report outlines the outcomes from Phase I and the first year of the programme’s delivery. It provides insights into its impact, outcomes, and challenges as well as providing a basis for the next phase of the evaluation. This interim evaluation lays the groundwork for a comprehensive understanding of the Caru Programme model and impact and provides valuable insights into its effectiveness.

How did COVID-19 lockdown impact the health of older adults in nursing homes? A scoping review

BackgroundThe impact of the COVID-19 pandemic on older adults in nursing homes is significant, with high death rates, disrupted care, isolation measures, and inadequate treatment. Social isolation has increased risks of cognitive disorders, anxiety, and depression. While many studies have examined the pandemic’s effects on nursing home staff and residents’ families, less is known about the health consequences for the residents themselves. This review aims to synthesize literature on the COVID-19 lockdown’s impact on the functional, cognitive, and psycho-emotional states of older adults in nursing homes.MethodsA scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA extension for Scoping Reviews (PRISMA-ScR). Four databases were searched: CINAHL, PubMed, Web of Science, and PsycINFO. The eligibility criteria included studies on older adults in nursing homes during the COVID-19 pandemic, with data that could be disaggregated for this population and results on the lockdown’s impact on physical, cognitive, and psycho-emotional levels.ResultsSeventeen articles met the criteria for data extraction The synthesis was categorized into four main areas: functional, cognitive and psycho-emotional status, and isolation measures. Key findings included decreased functional abilities, lower cognitive test scores during the pandemic’s first waves, development of psychological symptoms, and increased negative feelings among residents.ConclusionsHighlighting the consequences of confinement for nursing home residents is essential for updating evidence, developing effective strategies, and establishing protocols to mitigate the impact and prevent health issues in future pandemics.

SARS-CoV-2 Seropositivity in Nursing Home Staff and Residents during the First SARS-CoV-2 Wave in Flanders, Belgium.

(1) Background: early in the COVID-19 pandemic, reverse transcription polymerase chain reaction (RT-PCR) testing was limited. Assessing seroprevalence helps understand prevalence and reinfection risk. However, such data are lacking for the first epidemic wave in Belgian nursing homes. Therefore, we assessed SARS-CoV-2 seroprevalence and cumulative RT-PCR positivity in Belgian nursing homes and evaluated reinfection risk. (2) Methods: we performed a cross-sectional study in nine nursing homes in April and May 2020. Odds ratios (ORs) were calculated to compare the odds of (re)infection between seropositive and seronegative participants. (3) Results: seroprevalence was 21% (95% CI: 18-23): 22% (95% CI: 18-25) in residents and 20% (95% CI: 17-24) in staff. By 20 May 2020, cumulative RT-PCR positivity was 16% (95% CI: 13-21) in residents and 8% (95% CI: 6-12) in staff. ORs for (re)infection in seropositive (compared to seronegative) residents and staff were 0.22 (95% CI: 0.06-0.72) and 3.15 (95% CI: 1.56-6.63), respectively. (4) Conclusion: during the first wave, RT-PCR test programmes underestimated the number of COVID-19 cases. The reinfection rate in residents was 3%, indicating protection, while it was 21% in staff, potentially due to less cautious health behaviour. Future outbreaks should use both RT-PCR and serological testing for complementary insights into transmission dynamics.

Perspectives of Nursing Home Staff in Advance Care Planning Conversations: Experiences from the APPROACHES Project

ObjectivesAdvance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences – a Role offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP. DesignQualitative interviews regarding ACP specialists’ experiences and perceived intervention impact. Setting and ParticipantsStaff of intervention-assigned nursing home facilities who completed a minimum of 10 ACP conversations with residents during APPROACHES program implementation. MethodsFourteen staff were interviewed. Interviews were transcribed and coded by the research team. ResultsThere were 21 codes identified that were then distilled into the following 5 themes: (1) experiences with the ACP specialist program, (2) engaging in ACP conversations, (3) considerations related to dementia, (4) benefits and challenges of ACP, and (5) involvement of multiple people in the ACP process. Participant responses suggested variability in experiences with the ACP specialist program and highlighted many aspects relevant to engaging in conversations with families and residents, particularly those living with dementia. Benefits of ACP, including relationship building and increased preparedness for changes in health status, were balanced with challenges related to sensitive conversation topics and logistical difficulties in scheduling ACP discussions. ACP specialists discussed the multiple roles that others played in the ACP process. Conclusions and ImplicationsFindings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.

Attitudes and preferences about retention: A survey study of nursing home employees

ObjectiveThere is an anticipated surge in demand for nursing home staff associated with the doubling of Americans aged 65 and older by 2060. Nursing homes face alarming turnover rates, exacerbated by the COVID-19 pandemic. This study explores the attitudes and preferences of nursing home staff toward non-monetary perks to better understand perks’ impact on employee retention. MethodsThis cross-sectional survey study, conducted in a 115-bed nursing home in Pittsburgh area, assessed employee preferences toward non-monetary workplace incentives. Descriptive statistics were used to analyze multiple choice questions and thematic analysis was used to assess open-ended questions. ResultsA total of 59 employees completed the survey. Participants indicated preferences for perks with monetary benefit, such as extra PTO for good work, gift cards, and classes. Thematic analysis revealed preferences for incentives such as equitable treatment. DiscussionThese preliminary findings offer insights on increasing nursing home employee retention using non-monetary incentives.

“I think we just saw happier residents”: nursing home provider reported readiness assessment of the individualized positive psychosocial interaction (IPPI) program

Objectives This study assessed the readiness of The Individualized Positive Psychosocial Interaction (IPPI) program in the nursing home (NH) setting from the perspective of NH providers implementing the IPPI. The evidence-based IPPI program is designed to help remediate distress and improve mood for residents living with dementia. NH staff are trained to engage residents in brief (i.e. 10-min) one-to-one, preference-based activities to alleviate emotional distress and enhance quality of life. Method NH providers (n = 15) who championed the IPPI implementation completed an exit interview based on the nine domains of the Readiness Assessment for Pragmatic Trials (RAPT). Interviews were audio-recorded, transcribed, and coded by RAPT domains, then scored by the research team to reflect an average for each domain. Results Providers rated the IPPI program’s readiness high on the domains of alignment, impact, risk, implementation protocol, evidence, cost, and acceptability. The domains of measurement and feasibility scored lower, likely due to broader contextual issues and require particular attention. Conclusion Results illustrate that the IPPI program successfully aligns with stakeholder priorities, is a safe intervention with minimal risk, and has beneficial outcomes. The IPPI’s low cost, design, and alignment with organizational goals also facilitated implementation while measuring outcomes and staffing considerations impacted organizational capacity for implementation.

Beyond numbers: a holistic exploration of nursing home staffing patterns and financial performance in the Patient-Driven Payment Model landscape

Beyond numbers: a holistic exploration of nursing home staffing patterns and financial performance in the Patient-Driven Payment Model landscape

Psychosocial stress and working conditions of nursing home staff in Covid-19 pandemic: A cross-sectional study

Psychosocial stress and working conditions of nursing home staff in Covid-19 pandemic: A cross-sectional study Abstract: Background: With the onset of the Covid-19 pandemic in March 2020 there were numerous changes in the daily professional lives of healthcare professionals. Aim: Since the focus has been mainly on hospital staff so far, it is also important to watch the care situation in old people's and nursing homes. This study aimed to investigate the impact of the Covid-19 pandemic on the daily professional life, the psychosocial situation and the interpersonal relationships of nursing staff in old people's and nursing homes in Brandenburg. Methods: Cross-sectional survey of nursing staff from old people's and nursing homes in Brandenburg in the period from August to December 2020. The questionnaires were analysed using descriptive statistics and qualitative thematic analysis. Results: On the one hand, the increased workload with more difficult working conditions due to Covid-19 hygiene measures or increased working hours led to physical and psychosocial stress. In private life, increased social isolation was evident and changes in interpersonal relationships were stressful. On the other hand, the participants reported recognition and increased professional political interest. Conclusions: The Covid 19 pandemic highlighted pre-existing pressures on caregivers. In the future, it is important to improve the known workloads for nursing staff in old people's and nursing homes and to work out measures to counteract an increase of stress in situations like the pandemic.

Follow-Up of SARS-CoV-2 Antibody Levels in Belgian Nursing Home Residents and Staff Two, Four and Six Months after Primary Course BNT162b2 Vaccination.

When COVID-19 vaccines were implemented, nursing home residents (NHRs) and staff (NHS) in Belgium were prioritized for vaccination. To characterize the vaccine response over time in this population and to identify poorly responding groups, we assessed antibody concentrations two (T1), four (T2) and six months (T3) after primary course BNT162b2 vaccination in six groups of infection-naive/infection-primed NHRs/NHS, with/without comorbidity (NHRs only). Participant groups (N = 125 per group) were defined within a national serosurveillance study in nursing homes, based on questionnaire data. Dried blood spots were analyzed using ELISA for the quantification of SARS-CoV-2 S1RBD IgG antibodies. Among all groups, antibody concentrations significantly decreased between T1 and T2/T3, all with a ≥70% decrease at T3, except for infection-primed staff (-32%). Antibody concentrations among infection-naive NHRs were 11.96 times lower than those among infection-primed NHR, while the latter were comparable (x1.05) to infection-primed NHS. The largest proportion [13% (95% CI: 11-24%)] of vaccine non-responders was observed in the group of infection-naive NHRs with comorbidities. A longer interval between infection and vaccination (≥3 months) elicited higher antibody responses. Our data retrospectively show the necessity of timely COVID-19 booster vaccination. Infection-naive NHRs require special attention regarding immune monitoring in future epidemics or pandemics.

Loneliness in Seriously Ill Nursing Home Residents During the COVID-19 Pandemic.

Background: Loneliness and social isolation coexist, making it difficult to study each separately. The COVID-19 lockdown provided an unprecedented and ethically viable opportunity to study loneliness in seriously ill nursing home residents under uniformly imposed social isolation conditions. Objective: To understand the phenomenon of loneliness of the seriously ill nursing home patients under a uniform social isolation condition imposed by the COVID-19 pandemic lockdown. Design: Cross-sectional, semi-structured interviews were tape-recorded, transcribed verbatim, and analyzed qualitatively using an inductive thematic analysis. The University of California, Los Angeles (UCLA) Three-Item Loneliness Scale was used to measure loneliness and any relationships between self-reported loneliness and isolation were elucidated. Setting/Participants: Thirty seriously ill nursing home residents living in complete social isolation imposed by the COVID-19 pandemic lockdown. Results: Thematic analysis identified four key themes: (1) Diverse perceptions about the impact of the COVID-19 lockdown, (2) regret over the missed opportunities for spending time with friends and family, (3) using electronic communication to maintain connections with loved ones, and (4) the impact of nursing home staff. In total, 50% of the participants reported feeling socially isolated, 60% patients reported loneliness, and 70% reported being adversely impacted by the lockdown. Patients who felt socially isolated also reported experiencing loneliness (Kendall's Tau = 0.61, 95% confidence interval [CI] = 0.30, 0.89, p < 0.01, large effect size). Persons from communities of color had higher median loneliness scores compared to Non-Hispanic Whites. Participants in the last year of life also reported higher levels of loneliness. Conclusion: A study of loneliness under uniform social isolation conditions in seriously ill nursing home patients showed a high prevalence of loneliness and a strong correlation between self-reported loneliness and social isolation, especially in persons from minority communities and those in the last year of life. In-person support provided by nursing home staff and virtual support from family was helpful to patients.