Telehealth appeared to mitigate anxiety during the pandemic for assisted living and nursing home residents with higher pre-COVID anxiety, and ensuring telehealth access during potential future pandemic lockdowns in long-term care facilities should be considered a medical necessity, particularly for residents who have anxiety, according to the results of a new study.
Researchers from Palo Alto University in California, Deer Oaks Behavioral Health in San Antonio and Stanford University in California studied the effect of pandemic disruptions to mental health services on depression and anxiety symptoms in more than 5,600 assisted living community and skilled nursing facility residents.
In their findings, published recently in the journal Clinical Gerontology, the researchers said that residents with anxiety symptoms were more affected than those with depressive symptoms, adding that residents with cognitive impairment and a trauma history were most affected.
During COVID-19 lockdowns in long-term care facilities, many mental health providers were denied access due to unclear guidance on whether they were considered essential healthcare workers, the investigators noted. When the regulatory barriers to telehealth came down during the pandemic, community mental healthcare often was delivered or supplemented with telehealth.
Although there was a reported increase in the use of telehealth services compared with pre-pandemic frequency in assisted living communities and nursing homes, the researchers said that residents often went for long periods without access to mental health services.
Worries about accessing healthcare services during the pandemic could have exacerbated anxiety levels in some residents whose levels of anxiety already were elevated. Residents with access to telehealth services during community closures, however, did not experience the same increase in anxiety.
Although depression symptoms did not increase, the condition did appear to hinder someone’s ability to seek and use available mental health services.
“In LTC settings, the abrupt disruption to daily routines, restricting activities and social connectedness due to social distancing, and unpredictability of the virus, could be viewed as anxiety-provoking for most adults, but may particularly negatively impact those with trauma histories who benefit from feeling safe and secure in their everyday lives,” the investigators noted, adding that the pandemic could have triggered additional trauma or stressors that worsened symptoms. “Our finding reiterates the importance of continued trauma screening and assessment in the LTC environment, particularly during times of pandemics and wide-scale disruption,” they said.
Preserving telehealth access
A bipartisan group of US senators recently reintroduced a bill that would remove restrictions on virtual mental healthcare — telemental health — for Medicare beneficiaries. The Telemental Health Care Access Act would remove the requirements of having at least one in-person visit before receiving Medicare coverage for digital mental health services. Another bipartisan bill, the CONNECT for Health Act of 2023, would make pandemic-era telehealth coverage rules permanent.
Easier access to telemental services also could allow senior living operators to make more referrals for residents. Most assisted living communities do not currently offer mental health services directly, despite the high prevalence of dementia and depression among residents, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics.
