Going beyond the basics: the role of care homes in addressing the mental health challenges of patients
Care homes are a significant component of the healthcare system in the UK and globally. While care homes and care providers deal with the complex and sensitive requirements of particularly the elderly population, the mental health concerns of patients are often overlooked. Accordingly, existing systems of care provision necessitate certain improvements to overcome the normalisation of mental health issues as a universal outcome of old age.
The global demographics have been shifting over the last 50 years, where a notable drop in fertility has been accompanied by a dramatic increase in life expectancy. This has led to a growth in ageing populations, where the number of people over the age of 60 years is expected to increase from 46 million in 2015 to 147 million in 2050. Accordingly, with the advancement of populations composed of elderly persons, care homes and care providers have become an integral component of their healthcare and way of life. This is due to older people being more vulnerable to developing chronic illnesses such as heart disease, respiratory disorders, diabetes, osteoarthritis, dementia, and loss of hearing, vision and movement, rendering care dependency essential for them.
Mental health issues, while are common concerns in care homes, they are often circumvented as an inevitable side-effect of old age. Many residents do have pre-existing psychological conditions; however, studies show the prevalence of mental illnesses that develop either as a result of the stress and anxiety of living in a care home apart from one’s familiar environments or due to the toll of physical ailments.
It is estimated that 490,000 elderly persons live in care homes. While more than 70% of care home patients are diagnosed with conditions of dementia and long-term memory loss, this is often a figure that is considered normal and in line with the general ageing process and cognitive impairment. However, symptoms of mental health illnesses such as depression and anxiety often go unnoticed as their indications mirror the normal ageing process. Here, sudden shifts in mood, feelings of constant lethargy, being less active and uncommon sleeping habits are likewise seen in both states. It is projected that 40% of older people in General Practitioner clinics face mental health issues, which rises to 50% of older people in general hospitals and 60% of those in care homes. While depression is recognised as one of the more common long-standing mental health conditions that affect more than 40% of care home residents as a result of chronic bereavement, this is closely followed by bipolar disorder or schizophrenia as well.
Studies further suggest that emotions of loneliness and social isolation create a negative impact on the overall quality of life of elderly persons residing in care homes. Loneliness suggests subjective emotions an individual may undergo due to their desired level of social contact being less than their actual levels. In comparison, social isolation is an objective measure that examines the amount of social contact a person may have. Unlike loneliness, social isolation could stem from the individual’s choice to limit the connections he/she may possess. With reference to the impact on the quality of life, both the aforementioned emotional states are prevalent among elderly residents in care homes. The restrictions or low levels of visitations by family or friends, feelings of non-belonging and poor health all culminate in the engendering of loneliness or social isolation that can lead to a vicious spiral in the psychological state of residents. Accordingly, research shows that patients in care homes possess a mortality rate that is four times higher than elderly persons receiving residential care via community care programmes. This is due to the higher levels of cognitive impairments and behavioural disturbances that suggest the necessity of a focused mental health management system to address its growing challenges.
Mental health: an unfamiliar and unexpected face
Following the pandemic, the need to address mental health concerns of care patients further became a noteworthy issue. With the declaration of a global pandemic by the WHO in March 2020, the organisation produced detailed guidelines for symptom recognition and prevention methods while acutely describing its levels of severity and how it affects different age categories. In addition, a striking inclusion in WHO guidelines were their recommendations for mental health and psychosocial concerns that may engender or exacerbate as a result of the COVID-19 outbreak as well as prolonged periods of lockdowns or quarantine. In these guidelines, a demarcated list of instructions for elderly persons residing in care homes was provided. Accordingly, WHO recommended the provision of emotional support through family networks and healthcare professionals, to practice patience and ensure that the necessary information is communicated repeatedly and clearly for easier retention, as well as to maintain regular schedules of exercising, chores and other hobbies and interests to aid elderly persons restricted to care homes undergoing mental health strain. Thus, this illustrates a mounting necessity for a targeted approach to psychological care so as to address the mental health concerns of patients in care homes.
What can be done?
- Training care home staff to recognise and address mental health issues
Investing in training and career development can support providers to attract and retain staff. Especially by creating programmes and care regimens that bring together care providers with mental health specialists, a planned and targeted approach to care provision could be achieved. This will allow care workers to understand the complexities of mental health while accurately diagnosing illnesses before they become critical. This also encourages a regular channel of communication between mental health professionals and care residents, across which the former can provide regular assessments and support while offering the necessary therapy, helping manage medication and tracking the patient’s progress.
2. Retention of care workers by improving working conditions
The care industry experiences a high turnover in staff due to its often vaguely defined career pathway. Furthermore, many care workers are overworked and undervalued, which impacts not only the individual worker but also the quality of care provided to the patient. Hence, if national institutions such as the Royal College of Nursing promote a national career trajectory, it would improve the recognition of their service, which may lead to a rise in pay and benefits that equivalently compensate for their labour. This will offer longevity in the profession of a care worker, which may be essential to building healthy and dependable relationships with patients.
3. Creating opportunities for socialisation
To reduce the risk of loneliness, care homes should create opportunities for residents to socialise with others, as social isolation can be detrimental to mental health. Organising activities and events such as game nights, coffee mornings or a movie day where patients can interact with others in a structured and supportive environment could help those who may feel a sense of non-belonging or feel withdrawn, communicate and express their emotions, that will inevitably benefit their trajectory towards recovery.
4. Creating a safe and comfortable environment
Care homes should be designed and maintained in a way that promotes feelings of safety, comfort, and well-being. For instance, the greater availability of natural light, access to outdoors and natural surroundings, comfortable seating, a homely arrangement of space and the management of noise to appropriate levels help to reduce a care patient’s feelings of anxiety and stress. Creating spaces that look and feel familiar to them, rather than institutional settings that may come across as constrained and regulated, could help patients relax and feel calm in their recovery process.
5. Greater involvement of family
Families play an important role in supporting the mental health of patients in care homes. They should be kept informed of their loved one’s mental health and be involved in the treatment plan. Particularly elderly persons who may feel disconnected and dejected with mental strain and physical ailments could be motivated by the love and support received by their respective families. By scheduling regular family visits and meetings, care homes can support the patient’s recovery. Such situations could be made beneficial to provide an update on the patient’s condition and to discuss any concerns whilst helping the family to be actively involved in the decision-making and care plans of the resident.
The success of care provision lies within the understanding of the individual needs of the patient. Hence, generalised and ambiguous measures, while may function to help some patients who exhibit similar symptoms or conditions of mental health, may not complement the specific cases and experiences of care residents. Thus, it is crucial for care homes to tailor their services to individual patients and adapt the solutions according to the particular needs of each person under their care. This may be no easy feat as both within the UK, and internationally, economic tensions remain high, with increasing leanings towards discontinuing donation and funding programmes and slashing healthcare budgets. However, a sustainable approach to structuring a targeted mental healthcare system is essential to improve the quality of life of care residents.