Balancing Infection Risks and Residents Social Activity Preferences: Nursing Home Staff Risk Perceptions

Background and Objectives: Social activities are recognized as vital for older adults’ quality of life. The COVID-19 pandemic presented challenges for nursing home (NH) staff as they attempted to balance infection risks with residents’ preferences for social activities. The purpose of this study was to gain an understanding of NH staff’s experiences and actions accommodating resident preferences for social activities during pandemic restrictions. Research Design and Methods: This study used a convergent mixed methods approach to provide an in-depth description of NH staff’s (N = 24) risk propensity and decision-making. Quantitative data included self-reported demographics and risk perceptions using the Risk Propensity Scale. Qualitative data included semistructured individual interviews. Data were integrated to explain the link between individual risk perceptions and infection control practices related to social activities. Results: Participants were purposively sampled to reflect a range of direct care NH staff roles including certified nursing assistants (29%), activities staff (25%), social workers (25%), and licensed nurses (21%). Participants were on average 39 years of age, mostly White (79%), and female (88%). Most identified as risk-avoiders (58%). Guided content analysis of interviews revealed two main themes that describe staff’s behaviors while balancing infection control and residents’ social activity preferences: factors of decision-making (family influence, organizational, staff and resident characteristics) and staff influencing preference-based care (cognitive skills and technical skills). Discussion and Implications: Risk perceptions and resultant decision-making vary among direct care NH staff. Mixed interpretation offers insight on staff’s attempt to balance infection risks with residents’ preferences to engage in social activities.