Mental toll on long-term care staff a looming peril
Workers fear impact of prolonged service on front lines of pandemic
Amy Ayers has barely had time to catch her breath since March when COVID-19 began to wreak havoc at the long-term care home where she works.
Except for two weeks at home recovering from COVID-19, she has worked full-time throughout the pandemic, bearing witness to the devastation it left behind at the Ottawa-area long-term care home.
The 82-bed home was one of the first in Ontario to experience a widespread deadly outbreak. The first cases appeared in March, and, by the time the outbreak was over in June, 30 people — more than one-third of the home's 82 residents — were dead.
Like other front-line staff at the home, Ayers cared for residents when they were ill and then brought the bodies of those who had died down a hallway to waiting funeral home staff. That was the hardest part of those dark days at the home.
“It was heartbreaking.”
The personal support worker worries about what will happen when she and other long-term care workers there and at other homes have time to fully absorb what they have experienced since the pandemic began.
“I don't think any of us have really had the time to let it sink in and mourn. There just hasn't been time to do that. We are still working in a pandemic.”
Ayers fears the long-term emotional impact on front-line workers, and she is not alone.
Earlier this year, experts in post-traumatic stress disorder in the military warned that the pandemic was creating the circumstances for the development of moral injury and post-traumatic stress disorder among front-line health-care workers.
The Centre for Excellence on PTSD and Related Mental Health Conditions, which is funded by Veteran's Affairs and located at Ottawa's The Royal, created a guide aimed at addressing the looming crisis before it worsened.
In addition, The Royal opened a COVID Frontline Wellness clinic specifically to assist health workers experiencing COVID-related stress and mental health issues. The confidential service is aimed at long-term care, hospital and other front line health workers. The Royal is one of five hospitals across the province offering the services in partnership with Ontario Health's Mental Health and Addictions Centre of Excellence.
Getting help early is crucial, said Patrick Smith, CEO for the Centre of Excellence on Post-Traumatic Stress Disorder and Related Mental Health Conditions.
“We want them to reach out sooner rather than later to get clinical support,” Smith said. “Don't wait and hope it doesn't hit you later.”
Sometimes on the quiet early morning drive home from work, Ayers thinks about the past eight months at work and becomes upset. More often, though, she continues to get up and go to work with her colleagues, putting on a smile and “doing what we need to do” — for now.
Ayers's mother Anna Dunham, who also works at the same home, has not been so lucky.
When the first cases of COVID-19 were confirmed there in March, Dunham's doctor advised her not to go to work; her age and health issues put her at high risk if she became infected.
The 64-year-old health-care aide stayed home, as advised, but her heart remained at the long-term care home where she has worked for 34 years.
Every day, Ayers would call and describe the devastating path COVID-19 was taking through the home. Dunham chokes up as she talks about it.
“My daughter called me every day and told me about the residents passing away one after another. Some had been there 20 years. They are like family.”
Dunham felt guilty for abandoning the people she had come to know and love, and she was worried about her daughter. She couldn't shake feelings of growing anxiety.
Today she has returned to work, but it is not the same place she left before the pandemic. So many people she worked with for years are gone and some of those who recovered from COVID-19 haven't returned to full health.
“You can see it in their faces. They still look sickly.”
And Dunham isn't the same. She struggles with anxiety, guilt and fear that there will be another outbreak in the home. Some nights she is unable to complete her shift.
“I don't sleep well. My mind won't shut off. I think about the home and I am worried about COVID coming through the door again. I pray it doesn't because we would lose all the rest we have.”
What Dunham is experiencing is not unusual, her doctor told her.
“She said a lot of people have this.”
Ayers says she knows of other personal support workers who have sought counselling and one who suffers from post-traumatic stress disorder because of experiences during the pandemic.
There is a number posted on the door at the home that staff members can call if they are struggling and need someone to talk to. Dunham has not made the call yet, but said she plans to.
As difficult as she finds it, she says she wants to keep working until next July, when she plans to retire.
“I don't want to retire now, I have all these guilty feelings that I have deserted (the residents).”
Ayers, meanwhile, says the culture of silence that has long kept many personal support workers from speaking out might be causing more damage now by preventing some workers from talking to counsellors or friends about what they have experienced and their feelings.
Ayers says she encourages co-workers to talk to a therapist when they need to and tries to get the message across that “it's OK not to be OK” and to seek help. But not everyone is open to talking about their experiences at work, she said.
Some are afraid to speak, fearing for their jobs.
She says it is important for the voices of personal support workers and other front-line workers to be heard — for their own mental health and so the world better understands the trauma that long-term care home staff and residents have undergone during the pandemic.
“I just have come to the realization that everybody has a right to be able to voice how they are feeling, regardless of what their profession is.”
More information about the COVID Frontline Wellness program at The Royal is available here: theroyal.ca/covid-frontline-wellness.
Some provincial mental health resources for health care workers are listed here: camh.ca/en/ health-info/mental-health-andcovid-19/information-for-professionals.