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A tidal wave of grief and loss has rolled through long-term care facilities as the coronavirus pandemic has killed more than 91,000 residents and staffers — nearly 40% of recorded COVID-19 deaths in the U.S.

And it’s not over: Facilities are bracing for further shocks as across the country.

Workers are already emotionally drained and exhausted after staffing the front lines — and putting themselves at significant risk — since March, when the pandemic took hold. And residents are suffering deeply from losing people they once saw daily, the disruption of routines and being cut off from friends and family.

In response, nursing homes and assisted living centers are holding memorials for people who’ve died, having chaplains and social workers help residents and staff, and bringing in hospice providers to offer grief counseling, among other strategies. More than 2 million vulnerable older adults live in these facilities.

“Everyone is aware that this is a stressful, traumatic time, with no end in sight, and there needs to be some sort of intervention,” said Barbara Speedling, a long-term care consultant working on these issues with the American Health Care Association and National Center for Assisted Living, an industry organization.

Connie Graham, 65, is corporate chaplain at Community Health Services of Georgia, which operates 56 nursing homes. For months, he’s been holding socially distant prayer services in the homes’ parking lots for residents and staff members.

“People want prayers for friends in the facilities who’ve passed away, for relatives and friends who’ve passed away, for the safety of their families, for the loss of visitation, for healing, for the strength and perseverance to hold on,” Graham said.

Central Baptist Village, a Norridge, Illinois, nursing home, held a socially distanced garden ceremony to honor a beloved nurse who had died of COVID-19. “Our social service director made a wonderful collage of photos and left Post-its so everyone could write a memory” before delivering it to the nurse’s wife, said Dawn Mondschein, the nursing home’s chief executive officer.

“There’s a steady level of anxiety, with spikes of frustration and depression,” Mondschein said of staff members and residents.

Vitas Healthcare, a hospice provider in 14 states and the District of Columbia, has created occasional “virtual blessing services” on Zoom for staffers at nursing homes and assisted living centers. “We thank them for their service and a chaplain gives words of encouragement,” said Robin Fiorelli, Vitas’ senior director of bereavement and volunteers.

Vitas has also been holding virtual memorials via Zoom to recognize residents who’ve died of COVID-19. “A big part of that service is giving other residents an opportunity to share their memories and honor those they’ve lost,” Fiorelli said.

On Dec. 6, Hospice Savannah is going one step further and planning a national online broadcast of its annual , with grief counselors who will offer healing strategies. During the service, candles will be lit and a moment of silence observed in remembrance of people who’ve died.

“Grief has become an urgent mental health issue, and we hope this will help begin the healing process for people who haven’t been able to participate in rituals or receive the comfort and support they’d normally have gotten prior to COVID-19,” said Kathleen Benton, Hospice Savannah’s president and chief executive officer.

But these and other attempts are hardly equal to the extent of anguish, which has only grown as the pandemic stretches on, fueling a mental health crisis in long-term care.

“There is a desperate need for psychological services,” said Toni Miles, a professor at the University of Georgia’s College of Public Health and an expert on grief and bereavement in long-term care settings. She’s created two guides to help grieving staffers and residents and is distributing them digitally to more than 400 nursing homes and 1,000 assisted living centers in the state.

A recent survey by Altarum, a nonprofit research and consulting firm, highlights the hopelessness of many nursing home residents. The survey asked 365 people living in nursing homes about their experiences in July and August.

“I am completely isolated. I might as well be buried already,” one resident wrote. “There is no hope,” another said. “I feel like giving up. … No emotional support nor mental health support is available to me,” another complained.

Inadequate mental health services in nursing homes have been a problem for years. Instead of counseling, residents are typically given medications to ease symptoms of distress, said David Grabowski, a professor of health care policy at Harvard Medical School who has published on this topic.

The situation has worsened during the pandemic as psychologists and social workers have been unable to enter facilities that limited outsiders to minimize the risk of viral transmission.

“Several facilities didn’t consider mental health professionals ‘essential’ health care providers, and many of us weren’t able to get in,” said Lisa Lind, president of Psychologists in Long-Term Care. Although some facilities switched to tele-mental health services, staff shortages have made those hard to arrange, she noted.

Fewer than half of nursing home staffers have health insurance, and those who do typically don’t have “minimal” access to mental health services, Grabowski said. That’s a problem because “there’s a real fragility right now on the part of the workforce.”

Colleen Frankenfield, president and chief executive officer of Lutheran Social Ministries of New Jersey, said what staffers need most of all is “the ability to vent and to have someone comfort them.” She recalls a horrible day in April, when four residents died in less than 24 hours at her organization’s continuing care retirement community in northern New Jersey, which includes an assisted living facility and a nursing home.

“The phone rang at 1 a.m. and all I heard on the other end was an administrator, sobbing,” she remembered. “She said she felt she was emotionally falling apart. She felt like she was responsible for the residents who had died, like she had let them down. She just had to talk about what she was experiencing and cry it out.”

Although Lutheran Social Ministries has been free of COVID-19 since the end of April, “our employees are tired — always on edge, always worried,” Frankenfield said. “I think people are afraid and they need time to heal. At the end of the day, all we can really do is stand with them, listen to them and support them in whatever way we can.”

Coming Monday: The Navigating Aging column will look at the grief faced by long-term care workers as COVID-19 cases and deaths mount.

Join Judith Graham for a Facebook Live event on grief and bereavement during the coronavirus pandemic on Monday, Nov. 16, at 1 p.m. ET. You can watch the conversation and submit questions in advance here.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit  to submit your requests or tips.

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Aging Mental Health Navigating Aging Long-Term Care