Mental health and psychosocial support for older adults during COVID-19 in China

Perspectives of non-medical service providers
Submitted by: Tao Li, MD and Huali Wang, MD; Peking University Institute of Mental Health (Sixth Hospital); Beijing, China

Key Highlights:

• Risk prediction, implementing operational procedures, and knowledge and communication comprised three pillars for nursing home operation during the epidemic.
• Four measures might help balance the strict quarantine regulations and quality of care: strengthen prevention strategies, support necessary medical care, provide balanced nutrition for maintaining immunity, and promote mutual support between family members and the facility.
• Creating a playful environment can provide residents of nursing homes with meaningful activities and improve dementia care during the pandemic.
• Online psychological counseling and social work integration improves access to the mental healthcare for older adults.

During the COVID-19 pandemic, we have observed that older adults are at an increased risk of mental health problems due to both anxiety related to the possibility of becoming infected and social isolation with distancing measures, reduced community activities, and limitations on family visits.  The Chinese Society of Geriatric Psychiatry (CSGP), an affiliate of the International Psychogeriatric Association (IPA), responded to the crisis promptly with an interdisciplinary solution. The CSGP published a book on psychosocial support for older adults (see Figure 1) and expert consensus on mental health and psychosocial support (MHPSS) for persons living with dementia (including the key message bulletin) which are open access.

Within the CSGP multidisciplinary mental healthcare framework, mental health professionals, social workers, nursing home administrators, and volunteers delivered the MHPSS which is especially relevant for community-dwelling residents and nursing-home resident; the process of how this was coordinated was recently published in International Psychogeriatrics (DOI:10.1017/S1041610220000551). Herein we would like to share the experiences and perspectives of the non-medical service providers who worked at nursing homes and those who provided mental health and social support for community-dwelling older adults during the COVID-19 epidemic.

Three Pillars for Operations of Nursing Homes

Ms. Shuyi Jiang, Vice President of Gonghe Senior Living, who is a Development Transformations (DvT) Therapist, proposed three domains for managing nursing homes during the COVID-19 epidemic consisted of three domains:

Risk Prediction: During the acute phase of the COVID-19, there was a shortage of personal protective equipment, which posed a great challenge. Risk predication was used by the administrative team to make timely decisions about the utilization and assignment of protective supplies.

Operational Procedures:  Operational strategies including personnel management were important aspects of intervention. ⁽¹⁾ Personnel management: The COVID-19 outbreak occurred during the Chinese New Year. However, most employees canceled their travel plans and resumed working under lock-down precautions. Each employee's travel history was tracked using an epidemiological investigative approach, and staff were trained to monitor the physical and mental health status of the residents, maintain effective communication, and create an alliance to prevent infection.⁽²⁾ Managing operational costs: With operational costs dramatically increasing during the pandemic, staff were encouraged to be creative and contribute cost-saving ideas. For example, the cafeteria provided a take-out service for employees, which increased food safety with reduced risk of cross-infection, while also financially benefitting the catering service.

Knowledge and communication: During the epidemic, the Ministry of Civil Affairs and the Municipal Civil Affairs Bureau had issued regulations on the management of aged care facilities. It was essential to collect the facts of COVID-19 from official channels and convey the messages timely to the care staff and residents of the facility.

Four measures to win the battle without compromising the quality of care

Dr. Yonghui Nie, Medical Officer of Senior Living L’Amore, is a neurologist specializing in cognitive disorders. She designed a manual for preventing and controlling COVID-19 in all facilities nationwide owned by Senior Living L’Amore. Four key measures were highlighted during the battle without compromising the quality of care for older residents in these facilities.

Strengthen prevention and control strategies of the epidemic: The facility implemented a series of interventions to achieve "five early" goals, i.e., early detection, early report, quarantine, early diagnosis, and early treatment. The building was divided into "five areas," including a clean area, buffer area, pollution area, observational quarantine area, and total isolation area. If a resident returned from emergency medical treatment, he or she had to be placed in the quarantine area for absolute isolation before they were admitted to the facility living areas. Meanwhile, external reception rooms were set-up to balance the need for lock-down regulations and need for family visits.

Support necessary medical care: The care teams were educated to monitor the health status of the residents closely, actively attend to the residents' mental health status, timely understand the changes of the residents' care needs, and commit to efficient communications. First aid and CPR refresher training was provided to care workers and resources were available from medical experts in the case a resident would require emergency medications.

Provide balanced nutrition for maintaining immunity: The catering department used a variety of food sources to maintain a diverse menu while optimizing resident nutrition.

Mutual support between family members and the facility: To create a pleasant atmosphere, the care teams organized indoor activities for a Spring Festival and for residents to express their pandemic-related concerns.

A specific App was designed to allow family members to follow the health status of residents remotely. Families were encouraged to use video chats to support residents, alleviate anxiety, and promote social connectedness, and in return some families made generous donation of personal protective equipment.

Creating a playful environment for older residents and persons with dementia

Ms. Li Gu, an Aged Care Management Professional at Beijing Qianhe Home Care Service Co., Ltd. shared practical tips for supporting the mental health of older adults and those with dementia during the pandemic.

Personalized service: Meeting personal needs was important for customized care. For example, drinking water was infused with varieties of fruits, and residents could choose their favorite while encouraging proper hydration. Flour doughs were made in different cartoon and animal shapes to stimulate residents’ appetite. Also, frequent hand hygiene was encouraged by floating yellow foam ducklings in the facility sinks.

Engaging environmental arrangement: The staff invited the residents to help decorate the environment, which improved the resident sense of engagement with the facility.

Maintaining psychomotor training and physical exercise: The care staff coached residents in doing physical activities and psychomotor training, which also helped manage anxiety and insomnia.

Support communication with family members: Video communication was used for residents to stay in touch with family, and for those without family available care staff would frequently interact with them to promote a sense of wellbeing.

External support for physical and mental health support: The facility increased contact with community health centers for additional resources like online consultation and counseling.

Utilizing advanced technology to promote online psychological counseling and psychosocial support

Ms. Ping Yang, the CEO of Hualingyiyang Aged Care and Mental Health Service Center, is a registered psychological counselor. During the COVID-19 epidemic, she provided online counseling for older adults living in Wuhan and Beijing.

She shared her personal experiences: “From my point of view, I feel that I would no longer feel frustrated when challenged with the crisis.” She proposed that advanced online technology can make mental health and psychosocial support services more easily accessible, not only in Beijing and Wuhan but throughout the country.

Social workers help with community affairs

Ms. Luling Li and Mengmeng Xia are social workers at Beijing MooYoo Social Work Development Center. During the COVID-19 epidemic, they and their team initiated several projects that supported older residents and their caregivers living at home. For example, they delivered online courses aiming to improve access to online resources. The examples of the online courses included how to use a mobile phone, how to improve communication using the WeChat App, and how to relax the body and mind. WeChat teams supported those living alone or with limited access to family members by helping with activities of daily living, such as buying food. Luling and Mengmeng shared that "the community support was quite different from earlier experiences." "During the COVID-19, we, social workers, needed to be more closely involved in more community affairs. For example, we also had to secure protective supplies for older adults living in the community."

For further reading:

1. Chinese Society of Geriatric Psychiatry et al. (2020). Expert recommendations on mental health and psychosocial support for persons with cognitive disorders and their caregivers during the COVID-19 outbreak. Chinese Journal of Psychiatry, 53(2), 89–94. doi: 10.3760/cma.j.cn.113661-20200225-00056.
2. Ministry of Civil Affairs of China (2020). Urgent call for prevention and control of the novel coronavirus pneumonia in nursing homes. January 28, 2020. Available at: http://www.mca.gov.cn/article/xw/mzyw/202001/20200100023683.shtml%0A (accessed March 7, 2020).
3. National Health Commission of China and Ministry of Civil Affairs of China (2020). Guidelines for strengthening psychological support and social work in response to COVID-19 outbreak. March 5, 2020. Available at: http://www.nhc.gov.cn/jkj/s3577/202003/a9b0bcb3bb7445298c480c5003c51d6d.shtml (accessed March 8, 2020).
4. Wang H, Li T, Gauthier S, et al. Coronavirus epidemic and geriatric mental healthcare in China: how a coordinated response by professional organizations helped older adults during an unprecedented crisis. International Psychogeriatrics 2020. DOI: 10.1017/S1041610220000551
5. Wang H, Li T, Barbarino P, et al. Dementia care during COVID-19. The Lancet, 2020;395(10231):1190–1191. doi: 10.1016/S0140-6736(20)30755-8
6. Wang H, Yu E, and Tang Y. (Eds.) Psychological Support and Counseling for Older Adults During the Outbreak of COVID-19, 1st edition. Beijing: Chinese Medical Multimedia Press, 2020.

Dr. Tao Li is a senior geriatric psychiatrist and the vice director of the inpatient psychogeriatric ward at Peking University Sixth Hospital.

Professor Huali Wang is the Editor-in-Chief of the book “Psychosocial support for older adults during the COVID-19” and directs the national network on building coordinated psychosocial support for older adults living in communities. In addition, Dr. Wang published a correspondence “Dementia care during the COVID-19” on the Lancet.