Excellence in Action- Overcoming the Effects of Isolation: Proactive Care for the WIN!

With COVID-19 spreading in the U.S. and around the world, older adults and those with chronic medical conditions have emerged as the most vulnerable populations. As a result, Skilled Nursing and Long-Term Care facilities have put into place many precautions to protect these vulnerable patients from contracting the virus. 

These precautions, though, present with their own set of risks and downfalls, one of which has had a negative impact on the psychosocial well-being of the residents in these facilities: Social Isolation.  Residents in long-term care settings thrive on activity and movement.  Their days revolve around mealtimes, therapy, family visits, and facility activities.  With the federal restrictions placed on socialization and communal dining in our nursing facilities, many of our long-term care patients have experienced declines in functional ability and increases in behavioral outbursts as a result.

A long-term resident of our Merritt Island, FL, facility is a former Army Ranger who thrives on routine and structure in his day.  He had a debilitating stroke several years ago, which resulted in required 24-hour care in a nursing facility, due in part to severe expressive aphasia which limits his ability to communicate with his family and caregivers, and cognitive deficits which impact his ability to live at home safely.

Our Merritt Island Rehab team has had this patient on caseload several times in the years he’s been at the facility, and over time, they’ve built quite a strong rapport with him.  They know he is proud of his service in the Army, that he likes his room “just so”, that his appearance is very important to him, and that he is very regimented in his grooming schedule.  He shaves every day, keeping his appearance neat and clean, and has regular haircuts to keep his hair “high and tight” the traditional military look.  He also has a strict daily routine he follows, as to what time he goes to the dining room each day, where he sits, and so on. 

Our Team has utilized TMC’s “More than a Memory” Program to assess the patient’s cognitive abilities to ACL Level 4.0, Early Stage Dementia, which is Green on TMC’s “Color My World Cognitive” Program. They have provided Functional Maintenance Plans and Nursing Education as to how to meet the resident’s needs, encouraging his independence and using his best abilities.

Since the COVID-19 pandemic and resulting social isolation, the patient has had a significant decline in function.  He hasn’t been able to wheel himself to the dining room at his customary time for meals, or to sit in his regular spot at the table to have his daily Danish and coffee. His daily schedule has been completely disrupted, leaving him very frustrated, and at times, agitated.  He’s had multiple falls, and most notably, has completely abandoned his very regimented grooming routine.  His beard had grown extremely long, and he refused to wash his face or to allow staff to assist him with grooming. He refused to come out of his room at all, even for therapy. 

Ultimately, the resident became combative with staff, preventing personal care, showers, face washing, and beard trim/cleaning.  His daughter even stopped visiting during scheduled visit times, for fear that she was making the situation worse.

Shonda, COTA, had previously established rapport with this resident.  When she noticed his change in function and behavior, she approached her OT, Lori, who evaluated the patient and set up his plan of care.  During treatment, Shonda used therapeutic sense of self to relate with the resident.  She “listened” to his nonverbal speech, allowing him time to point and gesture to things he did and did not want or like. She talked with him about his life as an Army Ranger, using the rapport she’d established with him before this illness to encourage him to allow her to help him.  She started with small amounts of care; starting with simple handwashing, which led to face washing, and then, as further rapport and trust were gained, she eventually was able to convince him to let her help him trim his beard. 

Once his beard was shaven, it was as if the resident was a new man!  He couldn’t wait to leave his room to show the rest of the facility how good he looked.  He went down to the therapy gym, waving to everyone in the hallway, wanting to show off his new look.  He went to the dining room for coffee and Danish.  Shonda called his daughter, who was ecstatic to hear that he was doing so much better.

As therapists in long-term care facilities, we have the unique opportunity to get to know and spend time with these residents.  Many times, we may be the first to notice even slight changes in personality and declines in function that, if addressed early on, can prevent accidents, injuries, and unwarranted use of psychotropic medications. We are so proud of Shonda for being proactive with this resident, and for implementing the skills she gained through her Dementia Capable Care Training to meet the resident’s needs in a stage-appropriate manner. 

At Merritt Island, FL, we are ALL IN for our Dementia Program and ALL IN for our Long-Term Residents!