What the pandemic taught us about caregiving

The COVID-19 pandemic had adverse effects on every aspect of our society, but even more for caregivers of older adults, as they struggled to manage care. Many residents in long-term care went without visits from loved ones, creating isolation, heightened anxiety and depression due to fear of contracting the virus. Meantime, caregivers reported more duties, burnout, and clients and colleagues who experienced adverse health and psychosocial challenges.  We talked to four specialists in the caregiving field: Faiza Najar of the Detroit Area Agency on Aging; Thiera Clifford of the Mind Management Institute; Ann Marie Cook of Lifespan in Rochester, N.Y.; and Angelique Moore of Hartford Nursing and Rehabilitation in Detroit. They shared their thoughts about what’s changed in their field since the pandemic – and what they’ve learned. Edited excerpts follow.

Q: What has changed since the pandemic in how you are providing care ? 

Thiera Clifford: Our facility has become more flexible and accommodating in how we treat our patients. We’re switching to a more holistic treatment approach – such as mindfulness and yoga, and learning about the basics of wellness and implementing them into our everyday routines. 

Ann Marie Cook: During the pandemic, we were one of only a handful of agencies that did not close. The staff had to go to older adults’ homes, do assessments, connect people to telemedicine and deliver food and prescription drugs. Many of our family caregiver services went to Zoom meetings during the pandemic. Since the end of the pandemic, we have done a mix of Zoom and in-person. It was particularly difficult for our long-term care ombudsman team who work in nursing homes. We could not go into the homes. Family caregivers were depressed, angry, and scared. It was challenging to find a way to help. We are back in homes advocating for older adults.

Angelique Moore: I’ve had a hyper-focus on my patients’ psychosocial needs and overall well-being since we resumed in-person care. They’ve experienced so much isolation. For the patients who don’t receive many visitors, we’re paying more attention to them and ensuring they’re OK.

Q: What are your biggest challenges in caregiving now?

Faiza Najar: We’ve heard concerns and complaints from residents about not receiving their care and services timely. This can be due to some nursing homes not always being prepared or trained to serve those with mental health issues. 

Moore: The alarming rates of caregivers becoming burned out due to a shortage of caregivers in the field. I’ve experienced burnout many times myself. Taking care of patients as well as family members during this time can become overwhelming and take a toll on your mental health.

Q. Has anything positive in caregiving come out of the pandemic?

Najar: I noticed long-term care got a lot of attention, which helped educate the public about nursing homes. I also saw families and residents come together and advocate for unrestricted visitation and a return to group activities. Overall, there was more hands-on collaboration with the long-term care ombudsman by state agencies. 

Clifford: I would describe this pandemic as a “tough-love silver lining.” We finally got to see the impact of burnout, and sadly, it had to come by way of the pandemic. We got to see the result of people not having enough rest, being able to work from home, getting more rest and experiencing convenience instead of the everyday grind. The silver lining of this pandemic was the reality we’ve been hiding behind. 

Cook: It is easier to connect with caregivers over Zoom. This provides the opportunity to save both staff and caregivers time. For many family caregivers, they cannot leave their loved ones alone.

Moore: More people are aware that there’s a need due to more people living longer. I would hope it has motivated more people to come into healthcare careers to help. I’ve also noticed that there are more caregiver and burnout workshops because the organizations that are trying to support them actively realize there is a burden. 

Q. What do you wish were different as a result of the pandemic that isn’t?

Clifford: I’ve experienced several personal losses due to COVID. However, I believe being able to sit down and experience a genuine human experience is something I wish we would’ve kept a bit more of. We had it for that moment and then it went away.

Cook: Workforce shortages. We saw a lot of workforce issues and they are not getting better fast enough.

Moore: I would increase the number of professional training at facilities so that the patient ratio isn’t so high. I know that’s something the long-term facilities especially have to look at that closely, but sometimes the length of time that the patients may have to wait because there aren’t enough trained personnel can cause complications such as skin breakdown and lack of appetite because of the food constantly being cold. A lot of professionals in long-term care decided to not return during and after the pandemic because of burnout, which increased the shortage of staff to help older patients.

Q. What do you wish people understood about caregiving?

Najar: As an ombudsman, I am an advocate for the residents. I wish people understood that we are there to listen and work with them, to be their voice and make sure their needs are being met. We make sure to uplift their voices by holding who takes care of them accountable.  

Clifford: I wish people understood that what comes with caregiving is not just showing up and doing the job, there’s a mental load that comes with this work. You have to form your entire life on taking care of your clients; you have to be more cautious and careful about your well-being both physically, emotionally and mentally. There’s a cause and effect. That what you do can and will impact others, and we should be mindful of this. I remember taking care of my great-grandmother and my grandmother while taking time for myself, my husband and my children. Wearing so many hats can also burn you out. I need time to recharge as well. 

Cook: Caregiving is very difficult and lonely. Caregivers need information. They need support and they need understanding. Many caregivers lose their social support during their caregiving experience. It can be quite devastating.

Moore: Caregiving of older adults is sometimes viewed as taxing. I’ve gotten this from how people interact with one another and/or expectations of a person’s physical and mental ability as it declines. You can’t get frustrated with a population that needs assistance. They can be labeled as “hard to get along with” or “angry” and some of that comes from the way they’re being treated.  I’ve witnessed people treat older adults in such a disrespectful manner. I just want people to think about how it may make them personally feel to go from being completely or mostly independent to solely or primarily depending on someone else. Providing more understanding and compassion can be helpful. 

Q. What coping mechanisms have you been recommending to older adults to manage stress?

Najar: We’ve heard concerns and complaints from residents about not receiving their care and services in a timely manner. This can be due to some nursing homes not always being prepared or trained to serve those with mental health issues.  Our agency collaborated with the Michigan Department of Health and Human Services to deliver 4,500 animatronic dogs and pets to our residents. These dogs and cats barked and meowed as real dogs and cats did. This made the residents happy; they’d host celebrations and take photos with their pets.  

Clifford: Helping patients go back and remember the times during their 20-somethings and relearning how to be a part of social groups. I’d always recommend the St. Patrick Senior Center in Detroit, where they had virtual cooking classes during the pandemic. Staff from St. Patrick would drop off meals to the participants so that they could cook them on Zoom together. I thought that was the coolest thing ever. Learning how to get connected was a big piece and being able to navigate that. 

Cook: Yoga and tai chi classes were implemented online for our clients. We also encouraged people to connect with family and friends. We encouraged people to reach out to their doctors if they were struggling. We developed a friendly caller program to check in every week.

Moore: Keeping a positive attitude, meditation, listening to music, phone and video calls with family, and connecting to their higher power beliefs.

Q. What did you learn during the pandemic that is now part of your routine practice?

Najar: I learned the importance of being available as an ombudsman, how important a visit can have a huge impact on residents. Our agency updated our policies to ensure the appropriate measures are taken in case we need to work remotely in the future. Being more prepared for future pandemics and crisis situations. 

Clifford: Listen to the first symptom you have. Even if it seems like a little cough or sneeze, always check in. I think too often between myself and other care providers, we didn’t listen in the beginning to our bodies and we didn’t end up in the best position because of that. Being very cautious even if you don’t think it’s COVID, taking care of yourself is important. 

Cook: We can do some things online. Everything doesn’t have to be in person. Also, some services are offered both online and in person, hybrid.

Moore: Smile at everyone, don’t procrastinate, and that life is very precious.

Q. How have older clients responded to the return of in-person caregiving?

Najar: Our residents were so happy to be back. To return to a caring and compassionate face, rather than seeing only a mask and gloves. They were happy to be receiving visits again after not receiving any at all. In my area, there are a great number of residents that have public guardians. Therefore they don’t have a lot, if any, family visits, so our visits mean so much to them. Not someone to just check in with me over the phone, but to check in with me in person. It makes all the difference. I missed my residents, with all the time we spend and work together, hearing their concerns and stories, they become like family. 

Clifford: We have 50% of patients that are happy to get out of the house and come in and the other 50% are like “No, the outside is full of germs, and I’d rather stay home and we’ll do this right here.” I believe my patients have started to like the idea of doing more telemental health work, where they’re able to do their sessions online.  

Moore: They’ve responded well to the in-person caregiving services, looking forward to having things go back to normal, as much as possible after the pandemic. 

Q. How can caregiving of older adults be more resilient to future pandemics or crises?

Najar: In my opinion as an advocate and hearing directly from the residents’ concerns, I’d say increasing visitation and assuring residents that they aren’t alone. We need to be more focused on the quality of life and care. The importance of socialization and meaningful activities. The residents missed a human touch.

Clifford: Continuing to teach older patients how to use technology, therefore, if and when crises and pandemics arise, they are equipped and prepared. Such as teaching them how to start a Facetime call, how to log into the portal, how to log into Zoom, and how to get into medical records from a phone. It will keep us from that disconnection, teaching them so they don’t have to relearn while they’re pivoting. 

Cook: Through this pandemic, I think we know more than ever the electronic ways to connect with people and that it helps. I have found that many older adults have been through a lot in their lives. This was scary. This was isolating but they bounced back. 

Moore: Learning from our past, making more exceptions for the elderly population that needs consistency in care. Allowing families to visit or take their family home regardless of the health care system’s negative position. As individuals, we all have the right to make tough decisions regarding who we want to be around, what treatments we want, and who can treat us. 

Q. What advice would you give to new caregivers starting in a post-pandemic environment?

Najar: Be compassionate and caring to the care recipients. It makes a huge difference. When you go to visit them, smile and show them that “I’m there to listen to you”. Trying to engage them with stimulating and engaging activities. 

Clifford: Understanding that things will shift quickly, especially while working in the medical field, and being OK with that. When you’re fresh in the field, you want to do a lot and want to help as much as you can, but sometimes you can fall into a rut of feeling as if you aren’t doing enough or you don’t understand a lot and get down on yourself. It’s OK. A lot of caregivers burn out so quickly because they jump in head first. Take your time to learn and give yourself grace for what you don’t know or haven’t learned yet. 

Cook: Take care of yourself. The phrase, “Put on your own oxygen mask before helping others” is so true. Some staff had to leave the field during the pandemic because they had loved ones at home who needed them. 

Moore: Seniors are living longer and need assistance. Entrepreneurship tailored for the elderly will be helpful and needed for the future. There will be tons of opportunities for entrepreneurship and collaboration, such as transportation services, meal service and modifying homes to make sure home environments are safe while not taking advantage of the elderly and not overcharging, but providing a service to make their lives easier. The elderly need socialization to thrive, especially if they don’t have a social system. It’s important for older adults to have contact with another human being who only wants to make sure we’re doing good.