Unique to Older Adults
Advice for Caregivers: Older Adults and COVID-19
The coronavirus (COVID-19) has caused a worldwide pandemic that has changed how we live, as governments worldwide seek to limit the spread of this disease. We are being asked to stay at home, businesses are closed, and there have been shortages of the basic necessities of daily life.
These are stressful times for all of us, and even more so for adults age 65 and older or individuals with multiple chronic conditions, since they are at higher risk for severe complications if they contract COVID-19.
One way to help your older loved ones, neighbors, or friends navigate these challenging times is to be sure they are aware of basic advice from the Centers for Disease Control and Prevention (CDC):
- The safest thing to do is to stay home. If you must go out for essential errands, stay six feet away from other people. (Six feet equals about two arm lengths.). If you are sick, you must stay home.
- Also avoid close contact with people who are sick. Keep six feet away from them at all times.
- Wash your hands often. Wash for at least 20 seconds (sing the Happy Birthday song twice).
- Clean and disinfect surfaces that you frequently touch.
- Avoid all cruise travel and non-essential air travel.
- If you are sick, or have concerns about COVID-19 and an underlying health condition, call your healthcare professional.
Social Distancing & Social Isolation
You may have heard the phrase “social distancing” when it comes to staying safe. Social distancing means staying home and staying physically apart from other people. This is the best way to prevent the spread of disease. It is strongly recommended by the federal government and your state or city may even have made social distancing mandatory.
Although social distancing is necessary, being physically separated from others can cause isolation and loneliness. This then may be a great time to introduce older family members to using the internet or other digital technology, especially if they’re been resistant to tech in the past. Karen Roberto, PhD, Director of the Institute for Society, Culture and Environment and University Distinguished Professor at the Center for Gerontology, Virginia Tech, Blacksburg, VA says that this technology can help enhance and support older adults keeping in touch with friends and family near and far.
But when you’re helping someone who is new to technology, keep things simple, advises Dr. Roberto. “Avoid ‘technospeak,’ write down directions, and have them practice, practice, practice.”
Portia Jackson Preston, DrPH, Assistant Professor of Public Health at California State University, Fullerton, offers these tips you can share with older adults on coping during this health crisis:
- Try to moderate news intake. In our current news cycle, some stories seem to change every hour, while others repeat the same information every day. It can be overwhelming. Try limiting the amount of time spent watching the news each day. Or, take the time to note how you feel before and after watching the news. Modify your habits. If you notice overwhelming feelings after watching the news, you may want to watch less frequently.
- Make sure to get outside. It is important to get fresh air and exposure to sunlight each day. Make sure to maintain a distance of six feet from others while outside.
- Stay connected with family and friends. We may need to be socially distant, but be careful to avoid being socially isolated. If you have access to a smartphone or computer with internet access, try using Zoom, FaceTime, Skype or other online platforms to see and speak with friends and family. You might also consider making phone calls or writing letters, or texting someone on a daily basis. (If you care for an older adult, consider making these face-to-face connections on their behalf so they can see friends and family members.)
- Create an intention. Tell yourself each morning that you will spend time doing something each day that will help you experience joy or relaxation. Setting this intention may make it more likely that you will follow through with it.
- Speak with your healthcare provider about any outstanding prescriptions that are due for refills soon. If possible, schedule mail delivery. Many healthcare providers are available online or on the phone. If you are caring for an older adult who cannot manage their prescriptions, make the arrangements for them.
Things to Consider if Someone You Care for is in Long-Term Care
If you are caring for someone who lives in a long-term care facility, you may have questions about their care and well-being during the coronavirus crisis. You’ve probably wondered whether it would be safer to take them out of the nursing home and move them into your home.
We put some of the questions you may be asking to Sharon K. Inouye, MD, MPH, Director, Aging Brain Center, Milton and Shirley F. Levy Family Chair Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center.
“These are very difficult and individual decisions for each family. There is no right or wrong situation, just a balance of the specific considerations,” says Dr. Inouye. “I had to consider this for my own mother. Ultimately, we were unable to move her out of her facility because our home was not set up for her safety (too many stairs, lack of adapted bathrooms, narrow hallways that would not permit her walker).”
Dr. Inouye noted other hazards at her home. Her children who are home from school might pose an exposure risk. Her family also has pets who could create fall risks.
“The facility where my mother lives has outstanding infection control processes and procedures in place, with a highly trained staff. So, with difficulty, we made the decision to keep her in the facility. Five weeks later, after one documented case of COVID-19, my mother remains safe without any additional cases. This turned out to be the right decision for our family, but it was a very difficult one—and obviously, had more cases emerged, it might have shifted the equation for us,” Dr. Inouye said.
Questions to Consider
- What kind of care does the person you’re caring for need? Can you meet their needs in your home environment? If they need skilled nursing or 24-hour care, this could be taxing for your family, says Dr. Inouye—especially if you’re working (even remotely) or if children or other family members have care needs, too.
Some people in long-term-care facilities need help with eating, dressing, toileting, managing medication, and other activities. Others, especially those with dementia or Alzheimer’s disease, need more help. The pandemic does not change those considerations.
- How safe and accessible is your home? Few homes are designed to minimize tripping and falls, which put the person you care for at higher risk for injury. If you have stairs, consider whether they can safely access needed areas of the house. Bathrooms should be fitted with grab bars next to the toilet and in the shower.
- Think about exposure sources. Do you have family members who go to work or have regular contact with others who may be exposed to the virus? You can’t guarantee that your home environment is safer than a long-term care facility where professional staffers use personal protective equipment (also known as “PPE”) and infection control procedures.
Also, consider whether all members of your household are able to maintain the recommended hygiene practices of frequent handwashing and cleaning of household surfaces to reduce infection risk.
- What conditions at a long-term care facility might make you consider removing someone? “If there are documented cases at the facility, and inadequate infection control processes (such as not enough protective equipment), then you might want to consider moving your loved one,” says Dr. Inouye. However, she notes that if the facility can provide adequate infection control, your consideration may be different.
- How can you make sure that the person you care for will be allowed back into a facility once you’ve removed them during this crisis? “This is a difficult area and there are no guarantees,” says Dr. Inouye. She advises that you learn in advance what the criteria are at the facility. If the person you care for is able to get tested to show they are negative, then they may be allowed back. However, as she notes, such testing is often unavailable in many areas. Bottom line: Find out in advance what the policies are at the specific facility.
- How will a move impact your family? It’s important to consider the impact of a move on other family members who will take on new responsibilities, even if they won’t be involved in direct care. Changing roles can be a stressor. If you’ll be making the decision to bring the person you care for into your home, everyone in your family should feel they were informed in advance. This can reduce stress for the entire family.
Questions to Ask the Management of the Long-Term Care Facility
- What is your quarantine policy? Find out the rules as they currently stand. Realize that they may change.
- How are you reducing infection risk? Does the staff have access to adequate PPE to protect them from infection? Do they have enough supplies to “decontaminate” as needed? Is the staff trained on the appropriate use of PPE?
- Are you screening staff members for signs of illness?
- Are you educating staff members on how to reduce their exposure to COVID-19 from other health care facilities and the community?
- What will happen to older adults who get the infection after moving out and then need medical care? Is a transfer to a hospital or intensive care unit (ICU) easier or harder from outside an assisted living facility?
- What will happen to someone who gets COVID-19 after moving out but then recovers? Will the facility let them re-enter?
By now, we’re all aware that COVID-19 poses heightened risks to older adults. The CDC reports that eight out of 10 deaths in the United States have been in people aged 65 and older.
But becoming infected with this potentially deadly virus isn’t the only risk that warrants our careful attention. Older adults face other COVID-19 related challenges, including issues that can impact emotional, physical, and even financial wellness. Reports of elder abuse (the mistreatment of someone because of their age) in its several terrible forms are sadly on the rise. But there are steps we can all take to help support those who need us.
“This is a test and I hope we pass it,” says Laura Mosqueda, MD. Dr. Mosqueda is Dean of the Keck School of Medicine, USC, and codirector of the National Center on Elder Abuse. Dr. Mosqueda shared her worries with us about the health and safety of older adults during this global pandemic. She is particularly concerned about four key issues that target older adults.
“To me, what’s really interesting right now is that we know that the dangers of social isolation are really significant for older adults. In fact, we’ve been making all kinds of public health statements about just how dangerous social isolation is,” Dr. Mosqueda notes. “And now we’re telling everyone to socially isolate and to practice social distancing.”
Vulnerability to Financial Abuse
Because of this social isolation, older adults are now potentially more vulnerable to things like financial scams. This is because they may no longer have friends or family members dropping in regularly. According to Dr. Mosqueda, “these days, when an older adult just needs to get a home repair or something done, they don’t have as many people around who might be advocating for their best interests.”
Troubles with Long Term Care Facilities
The number of older adults living in long-term care facilities who have died as a result of COVID-19 is also a cause for serious concern, says Dr. Mosqueda. But beyond that, other tragedies are occurring in nursing homes. “The problem is that the long-term care ombudsmen (the technical term for someone who helps address official questions, issues, or complaints) aren’t allowed into the homes during the pandemic to make sure that the facilities are fully complying with all regulations designed to keep residents safe and healthy.”
What’s more, she adds, nursing home chains are asking to be cleared of responsibility for any issues that may arise from the pandemic. Also, people aren’t being allowed to visit their relatives. This means that certain safeguards no longer exist, says Dr. Mosqueda. For example, if you care for someone with Alzheimer’s disease who lives in a nursing home, you may have more difficulty keeping an eye on their care and well-being.
Dr. Mosequda notes that these are also worrisome times for older adults who are living with caregivers. Because of added stress, caregivers might be already on the verge of yelling or getting physical. “Caregiving is a highly stressful situation to begin with, and now you throw COVID-19 into the mix.” Maybe the caregiver can’t get to their own support group, and their parents can’t get to their adult day care group. Maybe their kids are at home, they’re working at home, or their jobs are in jeopardy. “For people who have an older adult at home who requires care, or frankly who even doesn’t require a lot of care, it just seems to me that the potential for abusive action increases,” says Dr. Mosqueda. “You’ve got people in more highly stressed conditions who can’t get away from each other.”
How to Help
One way you can try to keep older adults safe is by connecting with them regularly. If you can’t call daily or a few times a week, see if there’s an organization in the community that can help. Perhaps the older adult is eligible for Meals on Wheels, or maybe you could enroll them in a Village to Village group in their neighborhood.
Consider having regular FaceTime or Zoom conversations with older adults and relatives and friends. Online board games are another option to increase important social connections. (Just be sure to confirm that the platform is reputable, ideally without “additional purchases” or requirements for detailed personal information.)
If the person you care for needs help with repairs around the house, help them problem-solve to find the best solution. Consider contacting the local repairperson yourself, and make sure to get references.