What COVID-19 Innovations Can Teach Us About Improving Quality of Life in Long-Term Care.

What can we learn from this? The creativity demonstrated by LTC staff across the globe suggests great potential for improving resident quality of life on a more permanent basis. Consider the possibilities. Expanded use of technology could widen a resident's social circle, include geographically distant relatives who are unable to visit, and increase the frequency and spontaneity of contacts, particularly resident initiated. Residents could “attend” important family events, such as weddings, that might otherwise be impossible. Where technology is less accessible, outdoor spaces for visiting, reconnecting with cherished pets, or musical serenades have inspired and cheered residents. Some innovations were developed for the purpose of improving communication in even low-resource settings, with minimal expense and without the need for technology (one-third of the innovations reported require digital technology). Consider the impact of routine, predictable communication between staff assigned as liaison and family members in addressing the family's frustration and any resulting conflict—a simple, but not widely used, strategy. We believe that pandemic-inspired innovations should be tried, tested, and modified as necessary. Several recent literature reviews on relationships between social connection and a range of mental health outcomes for LTC residents confirm the significance of social connection for resident well-being with implications that clearly extend beyond the pandemic.27, 28, 29 Many innovations included in our table were created in response to COVID-19 and require future testing to provide evidence concerning their impact on resident outcomes. A few have been tested. Others have been implemented sporadically, generally viewed as “something extra,” rather than something to be expected. For example, one study found that synchronous communication between family and residents in locked-down facilities was more strongly associated with positive emotions than was asynchronous communication.27, 28, 29 Quality of life innovations were observed from across a range of national and organizational contexts, including widely different national and local economies, LTC financing and regulatory systems, workforce capacities, and digital infrastructure. Whereas many of these innovations could be implemented by some LTC providers leveraging their existing human or technological resources, many others would require the purchase of new equipment or the hiring of new staff. An important consequence of looking across countries is identifying strategies that might be adapted for use in other countries or cultures. The housing innovation seen in Chinese nursing homes, providing accomodation for direct care workers who have migrated to urban areas, might not immediately obvious relevance for other countries. However, finding affordable housing is a common challenge for direct care everywhere, Low income workers employed in high income communities are particularly challenged. Creative approaches to housing support, in these instances, could significantly improve recruitment and retention. We have seen strong, widespread commitment and corresponding innovations to increasing social connection for residents during the pandemic, but fewer innovations aimed at keeping families informed, and remarkably few reported innovations implemented for the purpose of maintaining resident physical fitness and function. The impact of this can be seen in the widely reported suffering of family members30 and the recent warnings about increased pressure injury risk.31 Whether the failure to address these latter issues in a more robust fashion reflects their perceived level of importance or the challenges faced in addressing them is unclear. In either case, they would benefit from more creative attention, both during and beyond the pandemic. Whether this reflects a continuation of pre-pandemic perceptions about what is most important, a consequence of crisis management, or both, is unknown. But this offers us an opportunity to reflect on and explore the consequences for both residents and their families. The commitment and creativity of staff around the world responding to similar challenges have reminded us that we have much to learn from each other and should be cautious about dismissing innovations that might seem relevant only for “other places or populations.” We hope these innovations, carried out under the most difficult circumstances, will inspire us to maintain what we have learned that can add to resident quality of life.