Clinical Resilience Among Practitioners Caring for Older Adults

Early in 2020, there was no way of imagining the impact this year would have upon our professions, our communities and our personal lives. Despite COVID-19 challenges, as professionals in aging we quickly adapted to continue our critical work. This maneuvering underscored the importance of taking care of ourselves, our colleagues and our community. Resilience—the ability to bounce back from stressful circumstances stronger than before—has been paramount during COVID-19. This post highlights some ways Chicago’s Rush University Medical Center supports its staff and students to meet challenges and foster resilience during the COVID-19 crisis.

Adapting Practice to the Changing Landscape 

The pandemic has called attention to existing gaps in social care that adversely affect the health and well-being of older adults. We have seen an influx of elders requesting services for the first time—often with tangible needs for services such as meal deliveries and transportation.

Additionally, the need to decrease the risk of exposure to COVID-19 means rapidly adapting practices by shifting many appointments to telehealth. For older adults with limited mobility or no access to consistent transportation, the ability to connect with service providers virtually has been transformative in their ability to access care. Yet other older adults have little understanding of or trust in virtual platforms and people from marginalized communities are disproportionally unable to engage in telehealth due to lack of Internet access or necessary devices.

Unfortunately, increased need for services has too often been met with decreased funding and service options. COVID-19 also has had a profound impact on the mental health of the older adults we serve—many of whom are experiencing profound loneliness. According to a recent survey by AARP Foundation and United Health Foundation, approximately 66 percent of adults have experienced some level of social isolation as a result of the spread of COVID-19. Among older adults in particular, a recent NORC survey found that compared to 2015–16, more older adults report feeling depressed and isolated and fewer older adults report being happy.

The Center for Clinical Wellness was intentionally designed with a focus on decreasing stigma and improving access to support services.

Professionals supporting these elders are simultaneously being called upon to provide formal and informal support to their colleagues, families and friends, including working from home while taking care of children in Zoom school. For those who cannot work from home, it can mean balancing the needs of the older adults they serve with the fear of exposing family and friends.

Personal Toll on Practitioners

While practitioners who care for older adults experienced burnout, compassion fatigue and vicarious trauma before the pandemic, COVID-19 has greatly exacerbated contributing environmental stressors. One study found that 64 percent of U.S. physicians acknowledged an increase in feelings of burnout due to the COVID-19 pandemic.

One way to support practitioners is to better understand individual ways of coping. According to Dr. Carol Dweck’s work on fixed and growth mindsets, some people thrive during periods of adjustment and change, while others have difficulty adapting. A fixed mindset describes someone who views their character and intelligence as static despite the many experiences they have. A growth mindset embraces learning and believes that skills and knowledge can be developed through effort and time. During the pandemic, a growth mindset helps extend our abilities to adapt to the changing environment and meet everyone’s needs.

Example of How one Health System Supports Practitioners

How do practitioners foster resilience and a growth mindset in a time of turmoil? First, look for the pieces that can be controlled, such as our connection to others and taking care of our own health and well-being. During the pandemic, leadership at Rush has encouraged staff and students to intentionally practice self-care to ensure they have the tools and bandwidth to help the older adults we serve.

Individual and group supervision create an intentional space to unpack the very situations that may be fueling feelings of burnout and overall fatigue, offering a pathway for emotional processing that can feel overwhelming to initiate on your own. Some departments at Rush provide a dedicated space in the form of virtual one-on-one clinical supervision with a social work manager or seasoned clinician to help practitioners process emotions and address challenges and stressors in the workplace.

Monthly group supervision or peer consultations also help staff connect with colleagues to share resources, experiences and ways to relieve personal and collective stress. When professionals have no dedicated space, it can be difficult to “turn off the tap.” Supervisions allow us to shift mindsets from the day-to-day hustle to thinking about the impact our work has on us as individuals.

‘This pandemic has highlighted the incredible resilience among the helping professions—including those who serve older adults.’

In 2018 Rush made a commitment to supporting resilience and wellness among staff and students when they hired a Chief Wellness Officer. This commitment to addressing professional burnout paved the way for the 2020 opening of the Center for Clinical Wellness. The Center offers free support for Rush staff and students in the form of counseling, wellness coaching and mini-wellness retreats. The Center was intentionally designed with a focus on decreasing stigma and improving access to support services.

Rush also supports families of employees through the Rush Wellness Assistance Program. These service offerings at Rush are just one example of a national movement that is increasingly supporting professional wellness by acknowledging the importance of addressing mental health openly to minimize stigma and prevent burnout.

Strategies for Practitioners

Unfortunately, not all organizations provide such supervision and wellness supports, putting the onus on practitioners to identify stressors in their work life and in areas where they can make changes. Taking a step back to see where boundaries were crossed to meet a deadline or squeeze in another client allows practitioners to prioritize their needs and provide the best care.

One useful technique a practitioner can use to re-center and focus attention is called the 5-4-3-2-1 technique—acknowledge five things one can see around them in this moment—four they are able to touch or feel, three they can hear, two scents they can smell and one flavor they can taste at that moment. Creating and maintaining connections with colleagues, friends, family and loved ones (humans and animals) also is integral to protecting overall health and well-being. Sending a “thinking of you” note, finding a place to meet outdoors or engaging with other professionals experiencing similar challenges, such as via the American Society on Aging, are a few ways to do this!

Above all, this pandemic has highlighted the incredible resilience among the helping professions—including those who serve older adults. This commitment is a testament to the dedication that helping professionals have to those they serve and to their work, and it calls for an increased societal recognition of their dedication and important work.

As we forge ahead through 2021, it is critical that we elevate this work to increase societal recognition, while also committing to being kind and gentle to ourselves and to those around us day in and day out.

Please join the authors at a related session convened by the ASA Health and Aging Network Constituent Group, “Resilient Staff, Resilient Organizations: Professional Caregivers Rising to the Occasion in 2020 and Beyond” on April 7, 11:30 a.m. to 12:30 p.m., PT.

Elizabeth Cummings, LCSW, is the manager of clinical excellence; Rebecca Lahey, LCSW (and chair of MHAN), is manager, Mental Health in the Social Work and Community Health department; Teresa Moro, PhD, LSW, is project director in the College of Nursing; Bonnie Ewald, MA (and member of HAN), is program manager of Strategic Development and Policy in Social Work and Community Health department, all at Rush University Medical Center in Chicago.