b'DEMENTIA CAREMoral distress refers to the negative feelings you have as aidentified as contacts. Like many long-term care homes, healthcare worker when you know the right thing to do inwe were faced with not only keeping residents in their a situation, but for some reason you are not able to do it.rooms, but also keeping non-isolated residents from It is an all-too-common experience in settings that do notentering isolation rooms. have enough resources, staff or support. We prepared a short isolation care plan for each resident, During the pandemic, we heard a lot about staffingwhich we adjusted and built upon as the isolation period shortages and how that makes it hard to get the workprogressed. Some rooms got stop sign banners across done. We heard about the stress of needing to isolatethe doors, some got door alarms, and for others we used residents or separate them from their families. All of thesevideo monitoring. Meeting the needs of each individual situations can make us feel like our values and integrity asresident in their room became a top priority, with staff healthcare workers are under threat and result in moralassigned to help with mealtimes and recreation, even if this distress. Unsurprisingly, moral distress is an importantwas not part of their usual duties. For most residents, these contributor to burnout. Even worse, it can make peopleplans seemed to work, and they got through their isolation feel numb or stop caring, which leads to poor quality care. relatively easily. But not all residents managed so well.Fortunately, we know how to respond to moral distress.By Day 7, it became clear that Mr. S was suffering more Healthcare workers can learn how to respond to ethicallythan most. Before the isolation, he was quite an active challenging situations in a way that protects their integrity.person who spent most of the day walking around the We can develop problem-solving and ethical reasoningunit greeting other residents and staff. In the first few days skills that help us to manage even the most difficultof isolation, he found it very difficult to stay in his room situations. This is called moral resilience. It was clear thatand would get into arguments with staff that sometimes we were going to need a lot of it to get through the became physical. He was given some as needed doses COVID pandemic. of an antipsychotic medication, and within a few days, he stopped leaving his room. But he also stopped showing Practical tool an interest in leaving his bed, and in eating or drinking. His In mid-March 2020 the rules around isolation of residentsCOVID test was negative, but he was not doing well.at risk of COVID were put in place. It was overwhelming to think what this would involve for staff and the potentialWe consulted our local infection control supports and his risks to residents who had to be isolated. My concernscare plan was revisited. We decided to bring him out of his about the residents and my desire to support peopleroom on scheduled supervised walks if he would wear a working in long-term care homes motivated the creationmask and wash his hands. We would make sure there were of the Dementia Isolation Toolkit (DIT). no other residents around, and the staff member would be wearing PPE. We prepared signs that told him when he The DIT is designed to be a simple and practical tool forwould have his walks, and we tried to make those times as people working in long-term care who may not havespecial as possible, by having staff cheer him on.access to a bioethicist when faced with a difficult situation. It provides a summary of public health ethics by explainingThis seemed to work. Mr. S got through his remaining how we try to balance the needs of individual residentsseven days without receiving any further medication and with the health and safety of groups such as the otherregaining some of the strength he had lost in the first residents, the workers and the community. week. He bounced back somewhat over the following few months, although he was never quite back to his usual self.An important focus of the DIT is to consider how to support residents during isolation. The DIT decision-makingWhile Mr. S didnt die from COVID, he was still a victim worksheet prompts care providers to consider which one of many older adults in our province who have resources and strategies can be used to minimize the harmsuffered in this pandemic. The pandemic has been hard of isolation and to use the least restrictive options. The and sometimes heartbreakingin long-term care, person-centred isolation care planning tool reminds us thatand many staff have felt themselves facing impossible effective and compassionate isolation is best achieved bysituations. But the most important lesson of the pandemic identifying the needs of the individual resident and having afor me is that there are always options. Even in those plan to meet them. situations where we feel constrained, we can still make small choices to help our residents. LTCTOverall, the DIT is designed to help people work through difficult decisions and to support them to find options thatDr. Andrea Iaboni is a Geriatric Psychiatrist and Sci-they might not have considered. This kind of problem-solving, flexibility and creative thinking are all an importantentist at Toronto Rehab, University Health Network, part of building moral resilience. where she is also the Medical Lead of the Special-ized Dementia Unit. She has worked in long-term In practice care supporting the mental health of residents since It was not long before I had the chance to put the DIT2013. To learn more about the Dementia Isolation into practice. A staff member on our unit tested positiveToolkit, visit: https://dementiaisolationtoolkit.com/.for COVID and most of the patients on our floor were www.oltca.com LONG TERM CARE TODAY 31'