Q. My husband, Bill, is currently in a nursing home with frontotemporal dementia. We are not able to visit him at this time, which is especially difficult for him and for us. He is declining quickly, so I was trying to visit at least twice a week before, but I understand that it’s for the safety of the residents and staff.
I heard about coronavirus spreading in a nursing home in Washington state and now more recently in West Virginia, so of course I’m concerned about it happening here. I worry most about the staff and other residents who may appear healthy with no symptoms but still come to work and possibly infect residents. What are some good questions to ask the management at my husband’s nursing home to ensure that he is safe? Thanks for your help!
A. Family members all over the country are rightfully concerned about the safety of their loved ones who reside in nursing homes or assisted living communities during the coronavirus (COVID-19) pandemic.
Since the first nursing home case in Washington state, 147 skilled nursing facilities in 27 states have at least one resident with COVID-19, according to the Centers for Medicare & Medicaid Services (CMS). The fact that seniors in nursing homes are a particularly vulnerable population due to age and other factors has raised the following issues of concern for loved ones:
• Caregivers unable to assist loved ones/no visitors: It’s been about two weeks since caregivers have been allowed to assist staff with the daily care of their loved ones. How can we ensure our loved ones are receiving the support that they need? How can we protect them from social isolation and depression?
• Advanced age of residents and other medical conditions: The advanced age of many long-term care facility residents, their underlying health conditions, and their proximity to one another put them at risk for sickness and death. What is being done to protect them?
• Staff may come to work sick: Low wages in nursing homes and assisted-living centers force many staffers to work in multiple facilities. Certified nursing assistants often make no more than minimum wage, and nurses typically receive less than they do in hospitals. In addition, a sense of duty and financial stress may tempt employees to come to work sick, endangering senior residents who have underlying health conditions. What happens if staff have COVID-19 without symptoms, or if they come to work contagious days before showing symptoms?
• Staff are unprepared/don’t have adequate supplies: Just a couple of weeks ago, workers weren’t familiar with standard precautions concerning droplets from patients, surface contacts, and eye protection. Many long-term care facilities are currently having trouble getting supplies made in China, hard hit by the coronavirus. Facilities also had inadequate supplies of personal protective equipment and other items such as alcohol-based hand sanitizer. And supplies of test kits were limited.
What Questions Should You Ask Your Loved Ones Long-Term Care Facility?
Below are questions you can ask your loved one’s nursing home or assisted living facility administrator to ensure they are dealing with the coronavirus pandemic appropriately and that your loved one is safe:
1. What are you doing to reduce infection risk?
Residents and staff should follow the same basic steps to reduce risk of infection, experts said (you should also consider following these suggestions at home):
- Wash hands often with soap, for at least 20 seconds. The World Health Organization offers illustrated guidelines.
- Use alcohol-based (with at least 60 percent alcohol) sanitizer if soap is not available
- Avoid touching your eyes, nose and mouth
- Avoid close contact with those who are sick
- Stay at home if you’re sick, and even if you’re not
- Cover your cough or sneeze with tissue and throw the tissue in trash
- Clean and disinfect surfaces such as doorknobs, light switches and switch plates, and television remotes with alcohol or with disinfecting wipes
The government also told nursing home officials to cancel all group activities and communal dining. Residents and staff are being “actively” screened for fever and respiratory problems, according to a CMS memo.
2. What is your plan in case an outbreak occurs?
All senior living communities are required to have plans to prevent and monitor infections. Check with the facility to learn what their plans are if an outbreak occurs, and ask what they are doing to ensure they have enough medical and safety supplies in the event of an outbreak.
To protect their residents and staff, nursing homes may quarantine residents in the event of a coronavirus outbreak inside the facility.
3. During this pandemic, how are you dealing with my loved one’s needs?
Think about your loved one’s needs, and clearly iterate your concerns to the staff about their vulnerabilities. If you cannot enter the facility, you might want to ask specifically how your loved one is getting the care they need. If they need therapy, how are they receiving it?
4. What precautions and measures are you taking regarding the staff at the facility?
Make sure anyone involved in the care of your loved one knows the safety measures for COVID-19 as well as the symptoms. Anyone providing direct, hands-on care to your loved one should of course also be following measures recommended by the CDC, such as hand hygiene before and after contact with your loved one.
A CMS memo issued to states in early March stated that “(a)ll staff, including housekeeping staff, should have received in-service COVID-19 infection control training in addition to online infection control training and should be required to demonstrate what they’ve learned.”
A CDC Report urged that facilities nationally “should take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members and visitors, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures.”
Remember, It’s OK to ask your facility about their plans for staff who should stay home if they become sick.
Don’t move patients
Advocates continue to urge family members not to panic and say it is unwise for them to bring loved one’s home to try to avoid infection. “Moving an older adult from a long-term care center is risky and could have long-lasting impacts,” geriatrician David Gifford, chief medical officer of the American Health Care Association and the National Center for Assisted Living said. The CDC does not recommend such moves either. Others echoed that recommendation, saying germs are likely to flow more freely outside these communities than inside. Plus, residents are in nursing homes and assisted living because they need higher levels of care than generally can be provided at home.
Plan for Loved Ones Who Need Nursing Home Care in the Near Future
If you have a loved one who needs nursing home care or even if your loved one is already in a nursing home, if you haven’t done so already, the time to plan is now! Please contact us as soon as possible to make an appointment for an initial consultation. We offer phone appointments or video conference appointments in lieu of in-person meetings (but we are still open for in-person meetings, using safe social distancing practices):
Elder Care Fairfax: 703-691-1888
Elder Care Fredericksburg: 540-479-1435
Estate Care Rockville: 301-519-8041
Elder Care DC: 202-587-2797
About Evan H Farr, CELA, CAP
