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How nurses can help to rehabilitate care home residents after COVID-19

Nurses can use their skills to unlock the potential for rehabilitation of older people in care homes

Nurses can use their skills to unlock the potential for rehabilitation of older people in care homes

  • The physical, cognitive and emotional effects of COVID-19 can be devastating for care home residents
  • By supporting rehabilitation, nurses can counter the risk of deconditioning
  • Keeping residents active, using music and connectedness with loved ones are among ways to create a sense of life as normal

Care home residents recovering from COVID-19 may find the physical, cognitive and emotional effects devastating, but staff can play a major role in rehabilitation.

So says a report by researchers at the University of Leeds and the National Care Forum , which covers

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Nurses can use their skills to unlock the potential for rehabilitation of older people in care homes

  • The physical, cognitive and emotional effects of COVID-19 can be devastating for care home residents
  • By supporting rehabilitation, nurses can counter the risk of deconditioning
  • Keeping residents active, using music and connectedness with loved ones are among ways to create a sense of life as normal
Picture: Neil O’Connor

Care home residents recovering from COVID-19 may find the physical, cognitive and emotional effects devastating, but staff can play a major role in rehabilitation.

So says a report by researchers at the University of Leeds and the National Care Forum, which covers topics including promoting recovery and rehabilitation.

Karen Spilsbury

‘It’s important to remember that people in care homes often have multiple complex conditions and are living with frailty’, says University of Leeds chair in nursing research Karen Spilsbury, lead author of the report LESS COVID-19: Key Lessons Learnt, So Far, by Frontline Care Home and NHS Staff.

Social care nurses can unlock the potential for rehabilitation

‘If someone is already frail and has a period of acute illness, often they don’t bounce back to the level they were at before,’ says Professor Spilsbury.

‘For those who aren’t as mobile or in bed, there’s a real risk of deconditioning. But social care nurses can unlock the potential for rehabilitation.’

The report is based on interviews carried out in June and July with 35 front-line staff across a range of geographical locations in England. This was followed by consultations in September with 11 senior operational and quality managers in care homes.

Insights into symptoms, progression and management of COVID-19 in older people

National Care Forum policy director Liz Jones explains: ‘The report came from an anxiety from our members to be able to share what they were learning – lots of new things that we needed to capture.’

The report was published in October, and the goal is to collate insights from the front line about the symptoms, progression and management of the COVID-19 virus in the older population in England, particularly sharing these with homes that have not yet experienced an outbreak.

Other themes covered by the report include clinical presentation, an unpredictable illness trajectory, managing symptoms and providing supportive care, end of life care, infection prevention and control, and promoting partnership through cross-sector working and support.

Three key areas where efforts need to be concentrated

As well as considering recovery and rehabilitation for those who have had COVID-19, the report also addresses the detrimental effect on quality of life for those who have stayed virus-free but have experienced prolonged periods of reduced activity alongside social isolation.

For Ms Jones, there are three key areas where efforts need to be concentrated.

The first is nutrition and hydration. ‘It’s important that people are eating and drinking well, particularly because of the nature of this virus and how it seems to affect taste, smell and longer-term appetite,’ she says.

Ideas on encouraging residents to be active

While decreased cognitive and emotional well-being is a factor for many care home residents who are recovering from COVID-19, exercise can help to minimise its effect, says the report.

The study found that creative approaches to engage people in physical activities are vital, bearing in mind the specific challenges for those with cognitive impairment and dementia.

Some of the tips included in the report

Second, she identifies helping people to become active again or increase their activity levels within the scope of what is personally achievable for them, getting outside if possible.

The report stresses the importance of reintroducing exercise to minimise deconditioning, with concerns that spending months at reduced levels of activity affects physical health and fitness, including strength, stamina, suppleness and skills.

Third, reducing the effect of some of the restrictions residents have had to live under is also crucial, especially for those with dementia, she says.

‘Trying to keep people happy, occupied and stimulated, with a one-to-one focus where possible, is beneficial for them,’ says Ms Jones.

Key lessons for recovery and rehabilitation

‘Until effective vaccines for the virus are available, older care home residents will remain vulnerable and at greater risk of poorer outcomes if they contract COVID-19,’ says the report.

Among the lessons learned so far

  • COVID-19 has a significant effect on the physical, cognitive and emotional health and well-being of many older people
  • Rehabilitation should be provided for all care home residents to address reduced activity and social isolation during extended periods of lockdown
  • Recovery for older people post-virus is unpredictable, varies by individual and often takes time, especially as many are already living with co-morbidities
  • Planning therapy and rehabilitation services for older people is an important aspect of the recovery phase
  • There is limited and variable access to therapy and rehabilitation services for older people, particularly for care home residents, creating challenges for care home and NHS staff in supporting older people’s recovery

Care homes working with residents funded by the local authority are increasingly asking for a level of funding that will enable one-to-one care, says Ms Jones.

‘The benefits are manifest. It’s even more important in a COVID world than before. Lots of the activities that used to happen in care homes, providing stimulation, distraction and interest, no longer can, so it’s been very difficult, with staff under increasing pressure.’

‘It’s time the government invested in this sector… we need better rewards and recognition’

More financial investment in staff is also needed, she says.

Liz Jones

‘We’ve seen how amazing our care staff have been and how they have stepped up,’ says Ms Jones.

‘It’s shown us how essential this workforce is and how extraordinary they’ve been in such difficult circumstances.

‘But there are inequities in how people are paid in different parts of healthcare.

‘It’s time for the government to invest in this sector, so we can pay people better – we need better rewards and recognition.’

Highly skilled social care nurses with a great deal of responsibility

Nurses who work in this area are highly skilled and have a great deal of responsibility, she adds.

‘The knowledge, management and key skills that make an excellent nurse – you need to have all these in spades to work in social care.

‘You’re also empowering staff who work with you to carry out more aspects of care than they might have thought about. We need to celebrate all of those skills and expertise.’

Further challenges include concerns over limited access to therapy and rehabilitation services for residents, even before the pandemic struck.

‘Care home staff stress the importance of providing care that instils individual hope and positivity for residents, preventing them from giving up’

The need for continuing support must be addressed urgently by commissioners, says the report, not least because recovery for individuals can be varied and unpredictable.

Picture: iStock

Older people need access to intermediate rehabilitation teams in recovery care planning

Involving intermediate rehabilitation teams in recovery care planning is essential and a resource that all older people should be able to access, the report says.

Engaging other healthcare professionals – such as physiotherapists, occupational therapists and activity coordinators – during someone’s recovery phase supports them as an individual, the study suggests.

It also encourages other staff to adopt a rehabilitative and positive approach in their day-to-day care.

‘But our members report a mixed picture,’ says Ms Jones. ‘In some areas, access is okay to wider specialist support, while in others it’s poor.’

Using digital technologies enables progress, cutting waiting times to speak to a specialist.

The need to thrive rather than simply survive is another key issue, with care home staff stressing the importance of providing care that instils individual hope and positivity for residents, preventing them from ‘giving up’.

Facts and figures

  • Currently around 420,000 people live in UK care homes
  • According to the NHS, people at an increased risk from coronavirus include those aged over 70, who have a lung condition such as asthma, heart disease, diabetes, chronic kidney or liver disease, have a condition affecting the brain or nervous system such as Parkinson’s disease or are very obese
  • According to an Office for National Statistics report published in July, of 66,112 deaths of care home residents, COVID-19 was involved in 19,394 of them

Professor Spilsbury says: ‘We heard a lot about hope from front-line staff and it resonates throughout the report.

‘There are a lot of small things that staff can and are doing every day, to try and integrate rehabilitation and recovery. Incrementally, they make a difference.’

Ms Jones agrees: ‘Even though from the outside it looks a bit harder, there are things we can still do to keep life vibrant and thriving in care settings. It’s finding ways to help people connect with what’s important for them.’

Maintaining residents’ relationships with family members and friends outside the care home is essential

For example, this includes listening to particular pieces of music, using free virtual resources.

‘It needs to be done with care, because music can cause all sorts of emotions,’ says Ms Jones. ‘But if you can spend some time finding out what someone likes to listen to or helps them reminisce well, it’s a relatively easy thing to achieve.’

The report says maintaining residents’ relationships with family members and friends outside the care home is also essential to address isolation and low morale, with staff finding creative ways to help, including making use of virtual technologies.

COVID-19 pandemic has shone a light on existing challenges many staff already face

‘It’s an important element,’ says Ms Jones. ‘That contact and connectedness with loved ones is another way of helping create a sense of life as normal, as far as it can be.’

For Professor Spilsbury, the pandemic is shining a light on the existing challenges many staff were already facing.

‘It’s highlighted some of the fragility in the system,’ she says. ‘One of the positive things that could come out of this is that these can be addressed, with solutions offered.

‘Care homes don’t need rescuing. They do a good job. But they need support at the right time.’

Share your thoughts

There is an opportunity to comment on the report’s resonance, relevance or any gaps by taking part in the LESS COVID online survey

The intention is to use the feedback to update the report by January 2021 and produce a new version.

Based on the findings, the National Care Forum working with the University of Leeds also plans to create resources specifically for the care sector.

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