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

doi:10.1093/geront/gnaf134

. 2025 May 10;65(6):gnaf134.

doi: 10.1093/geront/gnaf134.

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

Melissa McClean¹, Nahida Akter², Kaléi H Kowalchik², Jacqueline Mogle³, Erin Ann Kitt-Lewis², Anju Paudel², Joanne Roman Jones⁴, Joan G Carpenter^{1

5}, Liza L Behrens²

Affiliations

¹ Organizational Systems and Adult Health Department, University of Maryland School of Nursing, Baltimore, Maryland, USA.
² Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA.
³ College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina, USA.
⁴ Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA.
⁵ Corporal Michael J. Crescenz VAMC-Philadelphia, Baltimore, Maryland, USA.

PMID: 40259568
PMCID: PMC12129105 (available on 2026-04-22)
DOI: 10.1093/geront/gnaf134

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

Melissa McClean et al. Gerontologist. 2025.

. 2025 May 10;65(6):gnaf134.

doi: 10.1093/geront/gnaf134.

Authors

Melissa McClean¹, Nahida Akter², Kaléi H Kowalchik², Jacqueline Mogle³, Erin Ann Kitt-Lewis², Anju Paudel², Joanne Roman Jones⁴, Joan G Carpenter^{1

5}, Liza L Behrens²

Affiliations

¹ Organizational Systems and Adult Health Department, University of Maryland School of Nursing, Baltimore, Maryland, USA.
² Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA.
³ College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina, USA.
⁴ Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA.
⁵ Corporal Michael J. Crescenz VAMC-Philadelphia, Baltimore, Maryland, USA.

PMID: 40259568
PMCID: PMC12129105 (available on 2026-04-22)
DOI: 10.1093/geront/gnaf134

Abstract

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.

Keywords: Activity restrictions; COVID-19; Infection prevention and control; Person-centered Care; Risk attitudes.

© The Author(s) 2025. Published by Oxford University Press on behalf of the Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Conflict of interest statement

None.

References

1. Abbasi, J. (2020). Social isolation—The other COVID-19 threat in nursing homes. JAMA, 324(7), 619–620. https://doi.org/10.1001/jama.2020.13484 - DOI - PubMed
1. American Geriatrics Society Expert Panel on Person-Centered Care. (2016). Person-centered care: A definition and essential elements. Journal of the American Geriatrics Society, 64(1), 15–18. https://doi.org/10.1111/jgs.13866 - DOI - PubMed
1. Behrens, L. L., Anderson, H. L., Kowalchik, K. H., Mogle, J., Roman Jones, J., Van Haitsma, K., Hodgson, N., & Boltz, M. (2024). “I’m not a risk taker”: Risk perceptions of nursing home residents with dementia. Alzheimer Disease & Associated Disorders, 38(2), 168–177. https://doi.org/10.1097/WAD.0000000000000616 - DOI - PMC - PubMed
1. Behrens, L. L., Boltz, M., Kolanowski, A., Sciegaj, M., Madrigal, C., Abbott, K., & Van Haitsma, K. (2020). Pervasive risk avoidance: Nursing staff perceptions of risk in person-centered care delivery. Gerontologist, 60(8), 1424–1435. https://doi.org/10.1093/geront/gnaa099 - DOI - PMC - PubMed
1. Behrens, L. L., Boltz, M., Sciegaj, M., Kolanowski, A., Jones, J. R., Paudel, A., & Haitsma, K. V. (2022). Nursing staff perceptions of outcomes related to honoring residents’ “risky” preferences. Research in Gerontological Nursing, 15(6), 271–281. https://doi.org/10.3928/19404921-20220930-01 - DOI - PMC - PubMed

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[1] Abbasi, J. (2020). Social isolation—The other COVID-19 threat in nursing homes. JAMA, 324(7), 619–620. https://doi.org/10.1001/jama.2020.13484 - DOI - PubMed

[2] Abbasi, J. (2020). Social isolation—The other COVID-19 threat in nursing homes. JAMA, 324(7), 619–620. https://doi.org/10.1001/jama.2020.13484 - DOI - PubMed

[3] American Geriatrics Society Expert Panel on Person-Centered Care. (2016). Person-centered care: A definition and essential elements. Journal of the American Geriatrics Society, 64(1), 15–18. https://doi.org/10.1111/jgs.13866 - DOI - PubMed

[4] American Geriatrics Society Expert Panel on Person-Centered Care. (2016). Person-centered care: A definition and essential elements. Journal of the American Geriatrics Society, 64(1), 15–18. https://doi.org/10.1111/jgs.13866 - DOI - PubMed

[5] Behrens, L. L., Anderson, H. L., Kowalchik, K. H., Mogle, J., Roman Jones, J., Van Haitsma, K., Hodgson, N., & Boltz, M. (2024). “I’m not a risk taker”: Risk perceptions of nursing home residents with dementia. Alzheimer Disease & Associated Disorders, 38(2), 168–177. https://doi.org/10.1097/WAD.0000000000000616 - DOI - PMC - PubMed

[6] Behrens, L. L., Anderson, H. L., Kowalchik, K. H., Mogle, J., Roman Jones, J., Van Haitsma, K., Hodgson, N., & Boltz, M. (2024). “I’m not a risk taker”: Risk perceptions of nursing home residents with dementia. Alzheimer Disease & Associated Disorders, 38(2), 168–177. https://doi.org/10.1097/WAD.0000000000000616 - DOI - PMC - PubMed

[7] Behrens, L. L., Boltz, M., Kolanowski, A., Sciegaj, M., Madrigal, C., Abbott, K., & Van Haitsma, K. (2020). Pervasive risk avoidance: Nursing staff perceptions of risk in person-centered care delivery. Gerontologist, 60(8), 1424–1435. https://doi.org/10.1093/geront/gnaa099 - DOI - PMC - PubMed

[8] Behrens, L. L., Boltz, M., Kolanowski, A., Sciegaj, M., Madrigal, C., Abbott, K., & Van Haitsma, K. (2020). Pervasive risk avoidance: Nursing staff perceptions of risk in person-centered care delivery. Gerontologist, 60(8), 1424–1435. https://doi.org/10.1093/geront/gnaa099 - DOI - PMC - PubMed

[9] Behrens, L. L., Boltz, M., Sciegaj, M., Kolanowski, A., Jones, J. R., Paudel, A., & Haitsma, K. V. (2022). Nursing staff perceptions of outcomes related to honoring residents’ “risky” preferences. Research in Gerontological Nursing, 15(6), 271–281. https://doi.org/10.3928/19404921-20220930-01 - DOI - PMC - PubMed

[10] Behrens, L. L., Boltz, M., Sciegaj, M., Kolanowski, A., Jones, J. R., Paudel, A., & Haitsma, K. V. (2022). Nursing staff perceptions of outcomes related to honoring residents’ “risky” preferences. Research in Gerontological Nursing, 15(6), 271–281. https://doi.org/10.3928/19404921-20220930-01 - DOI - PMC - PubMed

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

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

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