Mental Health and Long-Term Care

Dr. Alex Mihailidis

When we measure the impact of the pandemic on the long-term care (LTC) sector, we typically focus on numbers:  the lives lost, the people sickened by COVID-19. But that is not the whole story.  Harder to tabulate but also devastating is the damage to the mental health of residents, loved ones, and caregivers.

This is an aspect of LTC that has never been considered enough, an issue around which policies and standards have long been lacking.

I hope that is now changing. As the technical subcommittee that I chair on behalf of CSA Group works towards developing a new Standard for long-term care homes, we are considering more than the buildings themselves. We also want to support the mental health of the people who live and work within them.

In a parallel project, CSA Group led timely research, Supporting Mental Health and Well-Being in Community Residential Care Settings. The report, published in late 2021, informed and supplemented our Standard development work, building on the extensive knowledge of our technical subcommittee.

The general public is likely unaware of the magnitude of the mental health challenges in community residential care settings, including LTChomes. The report lays out the startling numbers:

Mental health problems are common in LTC, with the majority (76%) of residents diagnosed with a mental disorder (40%) or Alzheimer’s Disease and related dementia (36%). As well, delirium affects 40% of residents in LTC facilities, up to 20% of residents live with an anxiety disorder, and between 6.5% and 58.4% of residents experience clinically significant symptoms of anxiety. Two to three per cent of residents in LTC live with schizophrenia.

And that was the situation before the pandemic. Add in all the issues related to social isolation and stress since March of 2020, and it paints a sobering picture. The report’s conclusion is a stark call to action that we must all heed:

The conditions and issues exposed are not conducive to supporting the mental health and well-being of the diverse, vulnerable resident populations with complex needs who live in residential care. Chronically under-resourced by an unstable and poorly supported workforce, often in outdated institutions, many facilities have been struggling even before COVID-19 to provide humane care.

I agree. Care has always tended to focus on physical health, on what you might call “fixing things”. Mental health was always secondary at best, never considered an integral part of a resident’s care plan. The report shines further light on this issue.  

Our surroundings naturally have an impact on our state of mind. Anyone who has visited a LTC home might be familiar with their institutional colour schemes and design. But these are not hospitals, they are peoples’ homes—something our subcommittee has and will continue to keep top of mind.

The choice of what colour we paint the walls may seem mundane, but it is one of many details that can make a difference in making a place feel comfortable and like home. Rather than make standardized recommendations on colours, it would be beneficial to consider the preferences of each individual resident. Before entering LTC, residents may have opted for lighter, muted hues or brighter, vibrant shades in their homes, so whenever possible, these should be mirrored in their new residence. Personalized touches such as family pictures or meaningful artwork can make a real difference in achieving an environment that is more homelike.

Other design choices can have a salutary impact on mental health. Hallways and common spaces should be structured so that they facilitate social interactions and are welcoming to visitors, all while ensuring appropriate standards of safety. Outdoor spaces should be available so people can get out into the fresh air, visit with families and converse with other residents.

Environments that allow the sharing of meals in a setting that does not feel institutional can support cultural practices that are meaningful for many people.

This can be a difficult balance to strike. We want residents’ rooms to look and feel like home while still maintaining standards for infection control. Finishings and fabrics should be antimicrobial as well as comfortable.

Thanks to the dedication and expertise of our subcommittee, informed by the many stakeholders who have provided input, I feel that the Standard developed will provide valuable guidance in reaching that balance. That said, our work is not done. We are still listening, still adapting, and preparing for a 60-day public review period in February. I encourage you to review the Standard and send us your comments. We will read them all.

Stay tuned for the public review announcement!

This blog post was originally published in the CSA Communities space for long-term care homes. Learn more and join the conversation here.