I wanted to take some time in today's podcast to share my unique view as a psychologist. So I have this really unique opportunity to be let into many worlds intimately and deeply. So I specialize with older adults, so I often hear the perspective of older adults. I also specialize in the families of older adults and so I'm often let into their world as well. I also provide a lot of training and education to long-term care communities. And so what's happening lately is I am getting messages from older adults, from families, from long-term care communities, sharing with me some of their struggle and also looking for resources and guidance. And so today I wanted to share my position of seeing into three worlds and really these three worlds, the older adult, the family and the long-term care community and where they intersect the older adult, the family and the long-term care community. Today, I wanted to talk about this intersection and to do this, I want to talk about what each of these groups are experiencing during the Coronavirus Pandemic, what the challenges are, and then what each of these groups can do to make it a little bit, yeah, better.

I'm Dr. Regina Koepp. I'm a board certified clinical psychologist and I specialize with older adults and families. I created the psychology of aging podcast to answer some of the most common questions I get about aging. Questions about mental health and wellness changes in the brain like with dementia, relationships and sex caregiving, and even end of life. Like I say in my therapy groups, no topic is off topic. We just have to have a healthy way of talking about it, so if you're an older adult or caring for one, you're in the right place.

Let's get started.

Here's a freebie just for you

Welcome to my fourth episode of the psychology of aging podcast. As I get started today, I wanted to share an important freebie that I made just for you called the COVID-19 Wellness Guide for Older Adults. In this guide, I share lots of strategies for helping older adults to stay mentally and physically well during the Coronavirus pandemic. So grab your free copy by going to www.drreginakoepp.com/covidwellness. So let me just also put on the table that all of the tips that I recommend in this guide are tailored just for older adults.

Okay. Now let's get started.

So we've all heard stories of older adults on lockdown in their long-term care communities and maybe you've even seen the images of family members visiting their loved ones. Um, so the older adult is inside of a room, maybe, and a younger person is on the other side of the glass, looking in. You might've seen the picture of a granddaughter who is sharing her engagement ring, kind of standing in a flower bed outside of her grandfather's room, sharing her engagement ring or a son sitting outside, talking on the phone with his dad. Um, kind of relaxing, talking on the phone. His dad is inside his apartment. Uh, presumably at a long-term care community or a couple, a video of a couple presenting their newborn to the grandfather. All of these tender moments, not to mention like all of the musicians going and playing bagpipes outside of long-term care communities or saxophones or guitars. There's, um, a lot of that image. I wanted to take some time in today's podcast to share my unique view as a psychologist. So I have this really unique opportunity to be led into many worlds intimately and deeply.

I specialize with older adults. So I often hear the perspective of older adults. I also specialize in the families of older adults and so I'm often led into their world as well. I also provide a lot of training and education to long-term care communities. And so what's happening lately is I am getting messages from older adults, from families, from long-term care communities, sharing with me some of their struggle and also looking for resources and guidance. And so today I wanted to share my position of seeing into three worlds. And really these three worlds, the older adult, the family and the long-term care community and where they intersect. So each of those images that I was talking about earlier of the son sitting outside his dad's window or the granddaughter sharing her engagement, ranked her grandfather who's inside or the young couple with the baby showing the baby for the first time to the grandfather.

These are all examples of these three worlds intersecting, the older adult, the family and the long-term care community. And so today I wanted to talk about this intersection and, and to do this, I want to talk about what each of these groups are experiencing during the Coronavirus Pandemic, what the challenges are, and then what each of these groups can do to make it a little bit better. Um, I'll be offering tips for each group at the end of this episode. So listen all the way through because these tips will really help each entity, um, weather this storm of the Corona virus. So listen all the way through.

As I get started, I want to acknowledge that older adults are diverse. And even though there may be many older adults living in long-term care communities, no older adult in a long-term care community is like another, some older adults, um, maybe fully independent. Some may have a cognitive condition like dementia, some might have a physical condition, some might have mental health conditions, some might have all of the conditions. And so I just need to acknowledge here and now that no one older adult is alike. I'm gonna speak generally, but please know that I value the differences between older adults and also the differences between their families and the differences between long-term care communities. There are different types of long-term care communities as well. So this is not a one size fits all model. I'm just going to be talking about some of the common experiences. Of course they're going to be nuances in between. So just know that I get it. I acknowledge that.

The Challenges of Moving and Adjusting to a Senior Care Community

If your loved one recently moved into a long-term care community, their system totally changed. Right? Or think back to when your loved one moved into a long-term care community. A lot of times families will, especially if there is a dementia disorder, may have to do what feels like "trick" the older adult into moving or "deceive" them into moving. Um, sometimes older adults will kick and scream or hold hope that they're going to be moving back to their previous residence or their home, for example. And so the struggle to even adjust to long-term care living in general, especially if it's not the older adults decision necessarily can be really, really tough. And even when it's not tough, like even when the older adult is actively choosing to move, suddenly the person's home, the older adults home includes lots of new people and really it includes strangers and a brand new community. And so it can take a while to adjust. And this adjustment and transition can be really, really challenging even for the healthiest person and even for the healthiest family.

So think back to what it took to find a norm for your loved one and their long-term care community. It took a lot of hard work. It took communication, consistency, familiarity, the same staff members, meeting friends, learning the system, learning a new routine, learning when lunch was served, learning what activities were available, learning, uh, which residents to become friends with. Over time, you figure out your roles. So the older adult finds their role and the family finds their role and the long-term care community finds their role. So you, it might look like, okay, well I visit my spouse or partner on Monday, Wednesday, Friday from nine to one. We have lunch together. And then I go to the grocery store and get my errands done and be home before sundown, right? Or I visit my mom every Thursday and we have lunch and play cards together.

You find your routine. You know which staff your loved one connects with and which staff they don't. You know, which residents your loved one befriends and which they steer clear from. And over time they find their norm, they figure things out and it becomes familiar and maybe a home away from home. Okay, so now let's throw in the Coronavirus.

The Coronavirus has literally disrupted every fabric of our society and this includes long-term care communities. It's literally disrupted our norm, our equilibrium on a macro level, like on a society wide level and on a micro level as well in our own homes, including homes like long-term care communities. If I just think about my home for a minute, my three and four year old are home every day, all day. We don't even, we don't have a break. So today I, I want to take the time to share with you the perspective of each of the groups that I mentioned earlier, the older adult, the family and the long-term care community.

Older Adults Living in Senior Care Communities During the Coronavirus

So I'm going to start with older adults. So earlier this week I did therapy on the telephone with an older adult who lives in a continuous care retirement community. So this is a kind of community where you can start living in independent living as your physical or cognitive needs change. You can move to assisted living, you might move to memory care and some even have like a skilled nursing facility connected if you need that. So I was talking with him on the phone and he shared with me that he's not able to eat in the dining hall, not able to leave his room except to walk outside on specific and designated hours and places and has to quarantine himself if he goes to locations other than the designated areas in his community. And I mean like quarantine himself for days that he wouldn't be able to leave his apartment.

He lives in the independent arm of the continuous care retirement community. So he shared that the staff actually drop off meals three times a day and he likened this experience to being incarcerated for a crime that he didn't commit. He's said that he's doing his best to exercise multiple times a day, which is actually essential to his personal health and coping. So he has Parkinson's and it's really important for him related to his Parkinson's disease and related to his coping that he exercises. He's learning to use FaceTime and Zoom and is speaking with his children and grandchildren regularly as a result. So before coronavirus, he was a somewhat anxious person. And though now what's interesting is he's acknowledging the things I eat and encouraging himself to limit his media intake, which is actually a recommendation that I've been giving to all my patients and their families.

Limit your media intake. If you download that wellness guide, it actually talks about that and share some sources maybe that you'd want to limit your intake to. All right, let me get back on track for a second. Okay, so here's another example. So I have a very close friend whose mom lives in a memory care unit of an assisted living facility. She's living a lockdown life currently. She's relegated to her room. She's not allowed to congregate in any common areas and can only also go outside to designated locations. And just this morning I asked my friend how her mom was doing and my friend said she's good. Her biggest concern is getting the right hair dye to cover her grades. I want to let that sink in for a minute. Her biggest concern is getting the right hair dye to cover her grace. What's your first thought with that? My first thought was that was a great sign. And let me tell you why. If my friend's mom is still focused on her appearance, to me that says she's valuing herself and maintaining a sense of self esteem. She actually wants to engage in an activity that's making her feel good and beautiful and like herself. And here's another good reason. If that's not enough. Here's another good reason. Sometimes when people become depressed, which I can imagine living in long-term care on lock down would be recipe for depression, right? And sometimes when people become depressed, they can experience what's called apathy, which is not having an interest in things or another term, A-volition, which is not being motivated to act or actually do things. And the idea that my friend's mom wants to continue to look and feel good about herself is a great sign. My reaction was find her that hair dye. Call up Sally's beauty and find her that hair dye.

Not all the stories are positive. Some people who live in long-term care communities, you know, even before COVID are higher risk groups for illnesses and mental health conditions and cognitive issues. And now with COVID, these older adults have increased levels of fear for their own health and safety. They might be experiencing destabilization in their environment, like they might lose their sense of security and their um, residential community because of staff shortages and fear that people there, the staff there might expose them to cope it. A lot of older adults fear becoming a burden on their family or on society and the community and with covert around they might, this might reinforce that fear. And then on top of that, not having access to the outside world can be really, really hard as well.

And then that lack of access might inadvertently validate the fear that they just sent me away to die, which is a fear that I hear sometimes when I'm talking with older adults who don't agree with the recommendation to move into a long-term care community in the first place. Sometimes I hear they're, they just want to send me away to die. They just want to get rid of me. And so my fear, my worry and my fear is that for the older adults who are already experiencing this, um, sense of rejection from society or abandonment from society, that this experience with being locked down and shut in and separated might reinforce this fear that they have that they are, are just being sent away. I know this is a tough thing to talk about, but I think it's also an important thing to talk about. I um, because I hear about it and I want to share that thought and that fear with you. So I'm going to summarize some of the common feelings and experiences I hear from older adults who are currently on lockdown from the Coronavirus pandemic. Okay. These experiences and feelings are powerlessness incarcerated for a crime I didn't commit. So trapped fear of being a burden, being abandoned and being forgotten.

Pretty heavy stuff.

Family Members of Older Adults Living in Senior Care Communities During the Coronavirus

Okay, now I'm going to move on to family members. So family members of loved ones in long-term care are really struggling right now as well. They feel pushed out, helpless, desperate for information and answers and terrified. So family members, you know, part of finding the routine or the norm or the homeostasis with moving into a long-term care is that family members find their routine as well. Like I mentioned earlier, Monday, Wednesday, Friday, Thursday afternoon for lunching cards. So was the coronavirus struck, you know, families might have been visiting their loved one on a regular basis and have a predictable schedule and then all of a sudden are shut out. So if their loved one becomes sick, they're left out. Wondering, is this because of all this stress and isolation that my loved one is experiencing? Is this because my loved one isn't getting the care that they need? Is this because they can't see me or the other loved ones is often, I mean, there's so many questions.

And then to add onto that, there are many older adults living in long-term care who have dementia and experiencing the changes related to COVID, like all the staff changes, all the changes related to social distancing and lockdown and can't and inability to go into community areas or eat together. And the challenge with a dementia disorder is that some of these older adults might not understand why they can't leave their room or why things are different, why their favorite staff person isn't there to support them, and then there are family members who wonder, well, well, maybe I should just bring my loved one home. Maybe that would be better, but then think through it and realize, Oh wait, I can't bring them home for supervision reasons or safety reasons or care reasons, whatever the reasons were that had them moving to the long-term care in the first place and then experience the cycle of guilt all over again.

It's almost as if they're making the decision again to move them into long-term care. Then they have to deal with all of those emotions again and feeling guilt and shame and like, I'm not a dutiful child or a dutiful spouse. Oh, it's overwhelming as if that is not enough. Then if your loved one gets sick with or without coven, then you're not going to be able to see them. And you're just going to hear reports that they're not doing well or reports that the doctor was called, but you're not going to be able to go in and see for yourself because of all the restrictions on visitors and long-term care communities. And so if you can't go in, then you're going to have all sorts of questions that you're going to have trouble finding answers to. You're not going to be able to lay eyes on your loved one. And of course, when somebody is sick, what do we do? We want to rally around them and they need that too. And so this act of separation of families is so painful and it leaves family members with so many questions and so few answers. And as a result, there are incredibly intense feelings. There's a loads of uncertainty and this is really, really distressing to families. Naturally, you might have experienced the escalation in your own feelings when I was going through that litany of experiences that families are going through.

The common feelings here are helplessness and desperation, fear and uncertainty. It's really, really intense.

Senior Care Communities During the Coronavirus

Okay, let's move on to long-term care communities. So most long-term care communities are licensed in their state and most are required to follow the CDC guidelines, which I'm going to link to in my show notes, but you'll see that on the CDC guidelines page at the very bottom, the CDC actually provides long-term care communities with a letter to share with families and residents and you'll see on this guidelines page for long-term care communities that the CDC is recommending these restrictions, not necessarily the long-term care communities.

In fact, the long-term care communities are struggling also as a result with all with all of the restrictions and changes. Let me just share a little bit into the insight [inaudible] of long-term care communities. They're really, really complicated places, so they have the responsibility of creating a home and a community for their residents. Let that sink in for a minute. They have the responsibility of creating a home, a home, and the responsibility of creating a community all in one place. But that's not all. They also have the responsibility of maintaining a safe work environment for their staff. They have the responsibility of creating an environment that can enhance the quality of life of their residents and provide their residents with protection from harm. So that's why they can't allow one resident to come and go during the coronavirus pandemic because that will affect the entire community. It's really, really complicated.

And the staff are really in the middle. They're building bridges between the residents and their families, the residents and the outside world. They're in a bind. They have to tell the residents that they can't leave and they have to tell the family members that they can't come in and they're doing all of this while limiting their own life and coping. And let me tell you what I mean by limiting their own life. So if staff members are working in a long-term care community, many times they're told that if they are indeed working, they have to limit their exposure to others. Staff members are screened when they come in, like for fevers and they go through a questionnaire likely and are also screened when they're leaving. At the same time while they're at work, they have to hold space for the residents, emotions, the family members, emotions and their colleagues emotions.

And at the same time they have to provide hope and stimulation and activities and support. It's really challenging as you can imagine, and I am just, you know this, these are for each of these groups. This is the tip of the iceberg. So many staff in long-term care communities are saying that they're working harder and longer than ever before. And all of this in the context of staff shortages. So if we think about staff who work in long-term care communities, staff might have children, children aren't going to school, staff might not be able to work because they have to, they have no childcare. And then the other staff who are able to work have to pick up the load. So they're holding space and building bridges and trying to maintain hope and wellness all while they're going through their own struggle as well. And then staff are also worried, you know, they care about their residents, they don't want to harm their residents. It's why they're in this line of work and they're worried that they might be carrying the virus and be asymptomatic. So they're constantly on edge or kind of walking on eggshells like, Oh no, I don't want to expose them unknowingly.

So the common feelings and experiences of long-term care communities are overworked and tired, afraid, thankless. It does seem like a thankless task.

And so one of the challenges also that long-term care communities are facing is how much information to share with residents and their families, right? I mean it's so complicated. If you're working with folks with dementia, how much information do you share it? And not everybody with dementia is alike of course. And so can you share, you can share some information with one person. Maybe they are, they are able to reason. And another person with dementia, they might not be able to share that same amount of information.

Recommendations for Older Adults, Families, and Senior Care Communities

The most important recommendation of all...

So now I want to talk about recommendations and I'm going to talk about recommendations for each group. But actually my primary recommendation is for everyone to work together as a team. In fact, it will be the fastest way to find a new equilibrium during the Coronavirus Pandemic is if everyone can work together and to try to see the good in each other and highlight the good when you're communicating.

Recommendations for Older Adults Living in Senior Care Communities

So for older adults, here are the recommendations I have for older adults. In addition to working together as a team, look for moments of joy. So family and staff want to see you happy and content and well, so be joyful when you can engage in the activities that the staff are putting on. Take care of your health in any way that you can. So this is going to look different for different residents. So eat and drink regularly. Maybe get out of bed every day, get fresh air, work on a project. Maybe that project is just sharing the stories of your life or writing them down or dictating them. Recall times in your life that you overcame hardship and really think about how you persevered when times were tough. And of course talk with your friends and family on the phone or on zoom or FaceTime or WhatsApp or Skype. Keep the communication going.

Recommendations for Families of Older Adults Living in Senior Care Communities

All right. Here are some tips for families, of course, call your loved one or FaceTime or zoom or Skype and focus on quality phone calls, not just quantity. So when you're talking with your loved one, especially like your level and with dementia, consider some tips from my interview with Gary glaze from the Alzheimer's poetry project. So actually Gary Glazner and I did a zoom call with this interview and we did some fun call and response poetry activities over zoom. And it gives examples of how you can do this with your loved one. So I'll link to this in my show notes as well. So in addition to the zoom calls and Skype and WhatsApp, consider writing letters or sending care packages with photos. So you'll want to call the long-term care community and see if care packages are allowed. Writing letters and reading letters are really valuable way of staying connected and what what they can offer really is an artifact of love.

And so you can, um, imagine when you, you have a letter, right? And you store it and then you you're feeling lonely or wistful, or nostalgic and you read through the letters that you have. It kind of brings back memories. It fosters closeness, it fosters love and connection. These are artifacts of love and artifacts of a bond that you share. These are really important while people are separated and what's really cool is that this will perhaps appeal to the nostalgia and your own older loved one. You know, growing up I had, I had pen pals and we wrote letters. I didn't have the internet until I was in college and so I love a good handwritten letter, don't you? Another tip is to maintain positive communication with the long-term care community. If you see that the long-term care community is doing something well, tell them, tell them what you admire, tell them what you value in what they're doing, tell them that you appreciate them and be authentic of course, but tell them they really need to hear it right now.

And then another way that you could be helpful right now is just to make sure that the long-term care community has your most up to date contact information and that one family member is the primary point of contact with the long-term care community. So the long-term care community's already overwhelmed right now if they have five family members calling them about the same resident, it's going to take time that they don't have. So if you as a family can designate one person to communicate with the long-term care community, that would be great. And then have this one person communicate with the rest of the family members. Maybe you do that on a Facebook group or maybe you do that on a text group, but find a system for communicating with the rest of the family once you have that liaison designated.

Recommendations for Senior Care Communities

Okay. And so here are tips for the long-term care community Be very clear about creating opportunities for sensory stimulation like light and sound in fresh air and touch social stimulation and physical stimulation like physical activity. Be clear about these opportunities and communicate them with the residents and with the families. So don't leave the families or residents guessing. So maybe it's have outdoor time every day. Maybe you help residents call their family and friends. Talk about the healthy meal options.

Another idea to create a sense of community even while residents are in their apartments or in their rooms, is to create a board where everyone can contribute. So the residents aren't necessarily touching the board. Maybe that's left to a staff member, but create an opportunity where everybody can contribute to the board. So, um, this will give a sense of belonging in that they're working toward a shared goal. This is important, especially on lock-down.

So if there are some residents who enjoy walking and they get out, maybe you have a "steps" board. And so it's not a competition. Maybe resident Jones, um, walks 3000 steps and maybe resident Smith walks five steps. You add them all together on a board and um, and then you kind of share them with the residents. So it's not a competition, it's a collaboration and they try to reach a goal or a shared goal. Or maybe there's a reading board. Maybe some residents like to read and so they read a certain number of books and then you tally up those books on a board. Again, it's not a competition, it's a collaboration. Um, so just to create an opportunity for a shared goal, even if they can't see each other, participating in this goal of a staff member carries a board around, they can see that they're contributing to something bigger than themselves and something that's a part of the community.

Give it a try, see if they like it. Another tip is to communicate regularly with the families. So you could do this by sending out a weekly newsletter with activities from the week and pictures. You could include important information like how you're maintaining safety by doing a staff check when they come in and when they leave of their, you know, temperature. Maybe you could include your protocol for medical changes. So how will you be communicating with families when there are medical changes in your residents? You could talk about how you're keeping the residents engaged, what kinds of activities you're offering can share if services like physical therapy and occupational therapy are still being offered, how family members can communicate with their loved one if meals or care packages can be dropped off or delivered. You could highlight good news among residents and staff and share how your residents are staying safe and part of the community.

And this is really important, this communication because when family members don't have answers to their questions, they begin to fill in the blanks with their own thoughts, which during this time are going to be driven by fear and concern and uncertainty. So the more you can share with them proactively what you're doing, the better. Okay. Another tip is to talk with your residents in, reassure them. Let them know that this is difficult and that they're safe and in warm and loving hands. And then don't forget to praise your staff. Your staff are probably getting close to burned out. So the more you can let them know that you value what they're doing, that what they're doing is incredibly important, that you really admire the work that they're doing the better. So don't forget to praise your staff.

Wrapping Up

This is a pretty long episode, but I wanted to share this perspective of my view into these three intersecting worlds and to really emphasize that the more we can work together, the more we can work together as a team, the healthier everybody is going to be.

Speaking of health to help you manage your own stress and maintain your physical and mental wellness during code. Don't forget to download the coven 19 wellness guide for older adults where I share a lots of strategies for staying mentally and physically. Well. You can grab your free copy by going to www.drreginakoepp.com/covidwellness

And if you liked this episode, be sure to subscribe so you'll be the first to know when new episodes are released and then leave our review. Subscriptions of reviews actually help people to find this show. All right, I'm wrapping up. It's important to share that the ideas expressed in this episode are mine alone, and that information shared does not take the place of licensed medical or mental health care. See you next week. Same time, same place, lots of love to you and your family. Bye for now.