TABLE 3.

Nursing home administrators noted negative outcomes of the pandemic on resident wellbeing.

Concept	Representative quote, nursing home characteristics
Outbreaks, negative outcomes for population	“We did have residents here that saw their friends die and at a fast and alarming rate. Where they are still around and those friends have gone, and loss is real.” S4N2.4, September 2021, Midwest, <100 beds, Star rating 5, Not for profit
Visitation, activity, dining restrictions and impact on wellbeing	“We've obviously had to put a lot of safeguards into place. So we have no visitations at this point. We only have designated staff that are able to work in our health care unit. They are still restricted as far as not being able to do communal dining, communal activities, group activities. So there's been a major shift for our residents, certainly, as far as the psychosocial point of view.” S7N1.1, September 2020, South, <100 beds, Star rating 4, Not for profit
Reduced access to rehabilitation, behavioral health	“There's not the access that there should be. I only have a couple people that are able to meet with somebody because they were already hooked into a system prior to this. So, I still have no means to get my other individuals who I feel could benefit access at this stage… There's not enough mental health resources to begin with. Secondly, because they'd be new clients, they would be expected to be like a walk in and to sit there, and I cannot let them do that. They cannot just sit there for five or six hours waiting for somebody not to have shown up for their appointment…And for as many advances as we did with telehealth…the mental health center has not been able to incorporate those mechanisms into doing an intake via telehealth or Zoom.” S1N4.4, April 2021, Northeast, <100 beds, Star rating 2, For profit
Cognitive decline	“I see a change in their mental capacity, or I think some have just failed in general, just not having the same, the routine they had and the social interaction to the level they had it before. And Activities is just trying very hard to do things in the hallway where they can sit outside their door and participate in an event or whatever…I think there's signs of depression. Yeah, mobility, yes. However, we do have an in‐house therapy team that is really focused on the long‐term residents. They actually have a pretty big caseload of folks that they are trying to pick up and work with every day, to make sure they are still moving and grooving and maintaining their functional ability. I mean, I'd say, yes, there's a decline if you look at the population overall. But between therapy services and the limited activities we can do, there is some depression. Luckily we have not had a lot of weight loss, we are not seeing that, but I think a little down in the mood department.” S1N3.3, January 2021, Northeast, 100–125 beds, Star rating 5, For profit
Depression, needing to shift mental health services to virtual	“I would have to say COVID‐19 has had an immediate impact on our residents' mental health, their engagement with other residents and staff. It has, I do not want to say isolated them, but it has increased our need for mental services, which we contract out. We have a provider for that service. And complicating that even more is we have had to do that very, very important function virtually and, under the circumstances, given the very nature of the intimacy between the therapist and his or her patient, it's been complicated at best to walk around with a tablet and set the resident up, especially if the resident has never used a tablet, that technology before.” S2N3.1, October 2020, Northeast, 151+ beds, Star rating 1, For profit
Weight loss	“And then, you know, when you have a COVID outbreak of any kind, even if we have one person, they have to go to their rooms, so they feel isolated. We had to stop the communal dining, so they all had to eat in their rooms… our weight loss went up tremendously at that point.” S3N4.1, January 2021, South, <100 beds, Star rating 3, For profit
Staff taking on family‐like role for residents	“Something we have done more recently is we have a guardian angel program where we have staff that are … The message we are trying to give is, be the family for the resident, to the extent that the resident does not have family or does not have family that can come in and visit. We're an extra set of eyes and ears, that type of thing, for the family. Try to take the resident outside, get some fresh air, visit with them, get to know them. Kind of get to know their baseline, and if there's any changes, involve nursing with that so we can detect early if there was any signs of infection or anything. But really more from a psychosocial and a wellbeing standpoint, check in on that resident. And as we do that, they look more forward to those visits, and becomes something that gives them hope and something to look forward to.” S6N2rep.1, March 2021, South, 100–125 beds, Star rating 5, For profit