Taking Action to Support Nursing Home Resident Well-Being: Perspectives of US Nursing Home Staff During COVID-19

Background and Objectives Coronavirus disease 2019 (COVID-19) negatively influenced resident well-being in nursing homes (NHs). We examine perceptions and experiences of U.S. NH staff during the COVID-19 pandemic regarding resident well-being. Research Design and Methods We sampled 68 NHs (out of 13,423) in strata defined by quality ratings, urban/rural location, and whether they served a resident population of <70% White. We enrolled 10 NHs and interviewed 11 nursing staff (8 certified nursing assistants/aides, 3 registered or licensed practical/vocational nurses), 12 managerial staff (4 administrators, 8 directors of nursing), and 5 infection preventionists. Thematic analysis identified themes related to challenges of quarantine/isolation, attempted solutions, and lessons learned concerning resident well-being. Results Nursing home managerial, infection prevention, and nursing staff described how COVID-19 policies contributed to increased resident loneliness and declines in physical and cognitive well-being. Solutions/strategies employed across the United States and in low- and high-quality NHs included proactive mental health support, resident-centered family visitation, increased communication and care planning with families and efforts to maintain resident normalcy. Discussion and Implications Strategies to mitigate and alleviate concerns with resident well-being were both structural and made via staff choices. NH leadership needs to proactively plan how to adapt processes and structures that prioritize resident well-being along with resident care in times of crisis. Research is needed to outline the planning, implementation, and recommendations required to operationalize these strategies into practice. Determining the most effective ways to implement these structural changes within NH practices and workflows is critical to ensure that staff have sufficient time to spend with residents.