Perceived Effects of COVID-19 on Occupational Engagement Among Skilled Nursing Facility Residents With Mild to Moderate Cognitive Deficits

PURPOSE: Residents of skilled nursing facilities with cognitive deficits are at high risk of occupational injustices, or being denied the opportunity to engage in meaningful, self-selected activities. This risk was amplified by the COVID-19 pandemic and resulting infection control procedures implemented within skilled nursing facilities. The purpose of this study was to investigate the perceived effect of the pandemic and associated infection control procedures on the occupational engagement of skilled nursing facility residents with mild-moderate cognitive deficits. Understanding residents’ perception of occupational engagement may help skilled nursing facility operators and clinicians improve the occupational engagement of residents.

DESIGN: This study used a qualitative approach to understand occupational engagement among skilled nursing facility residents with mild-moderate cognitive impairment in the Boise, Idaho, area. Inclusion criteria included residing in a skilled nursing facility for at least three months, age 50 and older, and the presence of mild-moderate cognitive deficits. Participants were recruiting using purposive sampling.

METHOD: Data were collected using a semi-structure interview developed to facilitate open discussion based on items from the Engagement in Meaningful Activities Survey. Interviews were transcribed and coded using content analysis.

RESULTS: Participants described examples of occupational deprivation, occupational marginalization, and occupational alienation related to COVID-19. Examples of occupational injustices related to COVID-19 were drawn from a variety of occupational categories including instrumental activities of daily living, health management, work, play, leisure, and social participation.

CONCLUSION: Study participants experienced occupational injustices related to the COVID-19 pandemic and resulting infection control procedures. Occupational therapy practitioners should be aware of contextual factors that may contribute to occupational deprivation and utilize their training in compensatory and adaptation techniques to facilitate the engagement of residents in meaningful activities. Occupational therapy practitioners should also educate facility and public policy leaders about the importance of occupational engagement, how contextual factors may contribute to occupational deprivation, and strategies that can be taken to mediate these factors and reduce occupational deprivation. When policies, such as infection control measures implemented to address the COVID-19 pandemic, prevent residents from having a choice about engaging in meaningful occupations, occupational therapy practitioners must advocate for their residents to prevent occupational marginalization.

IMPACT STATEMENT: These findings can help clinicians in skilled nursing facilities understand and address systemic factors, such as COVID-19 and related infection control procedures, that contribute to occupational injustices and therefore improve the well-being of residents with mild-moderate cognitive impairment.

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