NIC Notes

Insights in Seniors Housing & Care

By: Ryan Brooks  |  August 26, 2020

Staff Mental Fatigue and Burnout: The Hidden Toll of COVID-19

COVID-19  |  Senior Housing  |  Skilled Nursing  |  Workforce

A recent study from North Carolina State University and Georgia Tech found that healthcare workers in the United States are struggling with significant mental-health challenges during the COVID-19 pandemic, including depression, anxiety, and insomnia. While all healthcare workers are at risk, one key feature of caregivers in a seniors housing and care setting is that many of these caregivers have spent months, if not years, developing relationships with the residents they serve and their families. This means the emotional toll experienced by these staff may be that much more overwhelming.

Adding to the stress load is that filling staffing gaps amidst the pandemic has become even more difficult, stretching existing staff thinner. While attracting and retaining personnel has long been an issue for many seniors housing and care operators, the current crisis has exacerbated this challenge. The most recent wave of NIC’s Market Fundamentals survey indicated that 85% of organizations were offering overtime hours to mitigate labor shortages and 42% were tapping agency or temporary staff.

A Pandemic of Grief

In the initial months following the COVID-19 outbreak, much of the media focus was on hospital emergency room and ICU staff – those who would most traditionally be considered as the frontline healthcare workers. There has also been coverage of long-term care and senior care resident well-being and the impact of social isolation and loneliness on resident mental and physical health. What seems to get less attention is the impact of the pandemic on seniors housing and care staff. These staff have been facing high levels of stress resulting from many months of continued crisis as they seek to protect and care for residents while observing the latest infection control protocols. They have also been coping with forced isolation and, in some instances, death of residents for whom they have become the only ‘family.’ Finally, they carry the burden of concern for their own families’ health and safety.

Increasingly, however, these frontline workers are sharing their own deeply personal experiences of mental anguish, symptoms of post-traumatic stress disorder, and burnout. Many have highlighted these experiences to draw attention to the plight they and their colleagues are experiencing to reinforce that these workers absolutely should be considered frontline healthcare workers, and to underscore their need for supportive mental health services.

Tools for Identifying At-Risk Workers

The University of North Carolina School of Medicine, UNC Health, and Google have launched a mobile app that is designed to provide healthcare workers with mental health resources. The Heroes Health app is designed to identify mental health stress among healthcare workers and apprise leaders about the times of day or particular units that might need additional support, without identifying specific employees.

Healthcare workers complete weekly questionnaires on symptoms related to various mental health conditions. These questionnaires then feed summary reports of the user’s symptoms and trends over time. The summary reports include an assessment of their sleep quality, anxiety, and potential PTSD symptoms.  

Additionally, apps like Headspace and The Breethe meditation app are supporting healthcare workers by offering free access to their platforms in an effort to help mitigate the stress and anxiety felt by those who are caring for sick patients and residents. Such access includes breathing exercises to reduce stress and meditation for anxiety.

Proactive Coping Strategies

Given the high-stress nature of frontline healthcare roles, forward thinking operators are striving to combat the mental fatigue that working during a pandemic poses to their staff. It is crucial to find ways to support staff mental health and provide them with tools for managing the very real personal toll this crisis is taking on them. As an example, frontline caregivers may find themselves restarting old habits like smoking amid the stress. Without effective mitigation strategies, there is going to be a great deal of burnout, and the risk of these staff leaving the field going forward.


Overcommunication is one of the strategy pillars Aegis Living has employed throughout the pandemic to keep staff current on the latest information. In the early days of the pandemic, these were daily communications that served to provide the most up-to-date information. These frequent touch points with staff provide leadership the opportunity to connect with their staff, to validate their experiences, and to be a source of support and encouragement for them. As Aegis Living President Kris Engskov has stated, these interactions were in part “to be a cheerleader” for staff. These points were further emphasized during the most recent NIC Leadership Huddle: Coping with the Pandemic held on August 17 when Lori Alford, Co-Founder and COO of Avanti Senior Living and Lynne Katzmann, Founder and CEO of Juniper Communities discussed “COVID-fatigue” and its impact on staff.

Managing Staff Emotions

As residents have become ill or passed away, staff and caregivers are understandably grieving. However, the work of caregiving and supporting residents and their families does not go away during the grieving process. Staff need support from one another, and to be able to talk and listen to each other, sharing feelings of anxiety, grief, panic, or guilt. While staff are all sharing in collective grief, leadership should reinforce with staff that this is in no way indicative of their failing.

The unfortunate reality of the pandemic is that residents may get sick despite all that staff do to protect and care for them. Given all these stress factors facing staff, managers should be on the lookout for warning signs, such as distractions while on the job, incomplete work, irritability with families or clients, and emerging lateness or absence from work which did not exist previously. Operators should also be encouraging staff to seek professional help as needed, especially as tele-mental health services have become increasingly available. Remind staff that there is no stigma in doing so. Empathy and understanding are key when addressing these issues and encouraging staff to seek help.

As Executive Coach Dan Brown of Arden Coaching pointed out during NIC’s recent Leadership Huddle, operators and administrators should be attuned to the signs of high stress amongst frontline workers. Brown listens for maladaptive thoughts, or feelings, and whether they are persistent. “One of the feelings that you really want to listen to, when you’re working with people on the front line, is a feeling of guilt, that ‘I can’t do enough.’”

Advising Staff

One of the most important aspects to keep in mind when considering the mental health and well-being of senior housing and care staff, is that staff cannot consistently offer great care to residents unless they are taking care of themselves. This may mean remembering to schedule their own relaxation time, whether that is a warm bath, an in-home movie, a favorite food, or a glass of wine.

Staff are going to be worried about bringing the virus into their own homes, so operators need to be providing regular testing for staff as well as reminding them to follow safety protocols at work, and to shower and change their clothes before engaging with family members at home.

One thing is clear – there will be no resolution to the pandemic anytime soon. The mental toll that it is having on frontline caregivers is real and could be extremely detrimental if this brave and needed workforce succumb to depression, PTSD, and other mental health challenges. As the battle with COVID-19 shifts from a sprint to a marathon, one of the key tasks of executive leadership teams and management at all levels is to be attuned to and address the mental health of their staff. Caring for the mental health of staff—especially during a pandemic that has caused high levels of mental stress and fatigue, and profound depths of grief—is essential to avoid burnout and enable staff to continue providing great, compassionate care for residents.  


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About Ryan Brooks

Senior Principal Ryan Brooks works with the research team in providing research, analysis, and contributions in the areas of healthcare collaboration and partnerships, telemedicine implementation, EHR optimization, and value-based care transition. Prior to joining NIC, he served as Clinical Administrator for multiple service lines within the Johns Hopkins Health System, where he focused on patient throughput strategies, regulatory compliance, and lean deployment throughout the organization. Brooks received his Bachelor’s in Health Services Administration from James Madison University and his Master’s in Business Administration from the University of Maryland.

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