During the Coronavirus Crisis: Things to Consider if Someone You Care for is in Long-Term Care

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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 sister’s home (who lives closest to her mother). 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?

 

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