[MUSIC]Hello. This is Alice Bonner. I'm adjunct faculty at the Johns Hopkins University School of Nursing. Today we're going to talk about promoting mental health and well-being. We have some learning objectives here: We hope after this presentation that you'll have learned at least two potential causes of stress that are related to the COVID-19 pandemic, that you'll be able to describe how the pandemic may lead to anxiety or worry for residents or tenants, family members or care partners. You'll be able to explain the role of at least two interventions to promote enhanced communication during COVID-19, and finally that you'll be able to review how the Age-Friendly Health Systems or 4Ms Framework may promote mental health and well-being of older adults and support staff during COVID-19. Some of you who are learning about this today may be familiar with this graphic. It's been shared widely and distributed quite a lot, so you may have seen it. It refers to the 4M framework of Age-Friendly Health Systems. Each friendly health systems often are coordinating with Age-Friendly Communities. Assisted living residences and senior housing campuses very often may straddle both of those worlds. This is a framework for how we deliver care and support not just health care, but social support also to older people, care partners and how we work with staff. The 4Ms are what matters, medication, mentation, and mobility. On this slide you can see a short description of each one of those Ms. This slide is showing us also that the 4Ms are a set. Delivering and supporting older people in whatever environment they're in wherever they live, we anticipate that providing these 4Ms as a set and thinking about each one and how they interact will really lead to more care and support for older people and for staff, a way to organize their care. The goal is for reliable practice or reliable delivery of services. With COVID-19, you might be saying, "Well, why is this in a lecture that's about COVID-19?". We really believe that with the addition of infection prevention and strategies to work with a lot of older people in a particular setting, organizing the care around the 4Ms helps with workflow and it helps to understand what's going on with older people. For example, if a medication is added for COVID-19 as part of a care and then the person perhaps gets confused or they get some delirium, or they have a fall. These things are all interacting with one another. What matters is important because having advanced care planning in place helps older people and sometimes care partners to determine whether a hospital transfer is something that the person wants or whether they would prefer to continue to receive the care that they can in assisted living or in senior housing. All of those things are important. It really builds on a lot of the care processes and the support processes that you already have in place either in senior housing or assisted living. Communication and leadership are critical elements of all of the age-friendly house system work both in communities and in hospitals and other settings. We want to always consider how infection prevention and management can be integrated into the 4Ms, as I was just referencing a few moments ago, and how they can be used to support staff, mental health, and well-being. Because if we are feeling as though we are short-staffed, that it's challenging to get through the work and the workflows. It's challenging to each of the residents and the tenants that we want to be working with. Having a framework like the 4Ms can really help with mental health and well-being. Some of the very basic principles here. Corona-virus and COVID-19 are really new ideas, particularly COVID-19 and so there's a lot of uncertainty. It's an unfamiliar virus that causes high rates of death in particular in long-term care facilities such as nursing homes, but also in assisted living and senior housing. Wherever people have a number of chronic conditions and vulnerabilities in their health to begin with. Trauma induced care and support for both residents or tenants and staff is needed. There's high rates of worry and depression, anxiety. You hear about these things, I'm sure, insomnia and stress. How do we approach this? The causes of stress during COVID-19, at least some of them are listed on this slide. All of these interact with each other. I just want to call out Sarah Sjostrom, who's a colleague and an Associate Chief Nurse here in Massachusetts. She and others have identified that these are very often issues that come up related to COVID-19. You might think about, well, why does this happened during a pandemic? For each of the issues we identified, there are some reasons that you might already think about, but for example, loss of safety and insecurity. Where do we get that? Well, we get it from PPE shortages. We get it from the fear of transmission or the fear of getting sick ourselves. In terms of the uncertainty, there's a lot of change, changes to policies and procedures, we rely on the Centers for Disease Control or we rely on CMS, the Centers for Medicare and Medicaid Services. Sometimes when those guidelines change frequently, It's hard to keep up. Again, lots of good information I think on this slide. What can we do in terms of putting forward some solutions and interventions because we want to be positive where we can't be positive, we want to provide solutions and move forward with positive momentum. We can create a dialogue between leadership and point-of-care staffers, service staff in housing organizations. To promote a sense of safety, let's communicate policies and procedures frequently, early and often. Let's acknowledge if there's been change, let's talk about it. Let's communicate about resources and support plans, etc. In terms of promoting a sense of hope, sending a simple short, thank you note, the old-fashioned way handwriting it but that means a lot to people, sharing recovery stories and continuing to focus on the future. We know that this is going to get past us at some point, so we want to think about a different time going forward. Examples of how to support team members, again, simple things, a quiet room for staff and yet reinforcing the importance of social distancing both inside the center, on the campus and when we're home and in the community, a lot of people follow certain regulations when they're at work, but they don't necessarily do what we would like everyone to do in terms of wearing masks and keeping social distancing in the community, so really important. We want people to be able to access food and essentials probably doesn't surprise anyone who works in these settings that a lot of direct care workers are low wage workers, many on Medicaid and so food incentives are important. Providing information on childcare or family care, staff engagement programs and really focusing on direct care workers. All of us are at risk of social isolation and of loneliness. Social isolation refers more to feeling restricted and feeling that you can't go out and spend time in large groups of people as you used to do, for example and loneliness is different. Loneliness is feeling very alone and feeling limited in terms of social contacts. Those are very important things to be thinking about for all of us. We can recommend daily huddles, which are short stand-up meetings and resources for mitigating burnout and anxiety and depression. We've provided some of those in a slide. Finally, we've provided a slide with resources for addressing grief and distress within the context of the pandemic. Here are a couple of references that are posters that you can post in a break room or any area of your organization. We need to remember that domestic violence is an aspect of people's lives and we want them to have the resources they need. Here's information on the National Suicide Prevention Lifeline. Very important to share this information with our team members. Thank you very much for listening today.[MUSIC]
