What to Do About Your Relatives in Long-Term Care During the Coronavirus Pandemic
Whether you’re bringing a loved one home or helping them from afar, there are a few key questions to answer
People who live in nursing homes long term—usually older adults, many of whom have significant underlying conditions such as heart disease, lung disease, and diabetes—are particularly vulnerable to experiencing serious complications from COVID-19. And since the beginning of this epidemic in the U.S., some of the most severe clusters of the disease have been in long-term-care centers.
“Coronavirus in a nursing home can be like fire through dry grass,” New York Gov. Andrew Cuomo said at a press briefing.
The Centers for Medicare and Medicaid Services (CMS) since mid-March has instructed nursing homes to stop admitting most visitors and non-essential personnel, in an effort to prevent the introduction of COVID-19.
But the potential for the infection to quickly wreak havoc once it takes hold in this setting, plus the inability of families to visit their relatives and check on them in person, has many wondering whether they should bring a parent or loved one back home to wait out the storm.
It's difficult for families to know how to react to the ongoing news of outbreaks in nursing homes across the country. By mid-April, for example, about a quarter of reported COVID-19 fatalities in New York State were in long-term-care facilities. Just a month after two cases of the coronavirus first appeared in a nursing home in Virginia, 45 of the 160 residents had died, according to The New York Times.
The decision can be fraught with complications. Is being on lockdown in a nursing home safer than being in an imperfectly quarantined home? Can family and friends provide everything that's needed? And what are the financial implications of bringing someone home from a nursing home?
Of course, there’s no one correct answer to these questions. “People need to respect the wisdom and wishes of their parents, and trust their gut instincts on what is the right decision based on the best current news and evidence,” says Olga Jarrín Montaner, Ph.D., R.N., an assistant professor at Rutgers School of Nursing.
We consulted a number of experts to find out what families should take into consideration before pulling a loved one from long-term care—plus what you can do to help take care of relatives from afar.
Weighing the Risks and Benefits
If you’re thinking about bringing a loved one home, here are several questions to consider first.
Can you ensure a safe level of social distancing?
Given the frightening outbreaks that have occurred in nursing homes, it might seem like someone would have a lower chance of catching COVID-19 in a private residence.
Special Considerations for Assisted Living
If you have a loved one in assisted living, rather than a nursing home, the risk vs. benefit balance might be somewhat different. For one thing, Zimmerman says, assisted living facilities are subject to less regulation around infection control procedures than nursing homes are, so it’s important to find out what safeguards your loved one’s facility has in place.
And in general, assisted living facilities vary more widely than nursing homes in terms of the level of medical services they provide and the amount of medical staff they employ. As more and more people start getting sick with COVID-19, that could deplete assisted living staff even more.
Zimmerman recommends checking in with the management of your relative’s assisted living facility about their infection control practices and staffing levels. If the facility isn’t making changes that would ensure social distancing among residents—such as discontinuing with group meals—that should be cause for concern, she says.
Additionally, Zimmerman says, “If there was some serious concern that, given insufficient staffing, the basic needs of my family member could not be met, because there were not sufficient staff there, then I would certainly start to think about what would be the best way to take care of my family member’s welfare.”
Care for Loved Ones From Afar
If you decide you don’t have the resources to bring your relative home and keep them safe, there’s still plenty you can do to take care of him or her from afar. Regular phone calls or video chats are critical for virtually checking in on your loved one.
Zimmerman recommends making these check-ins do double duty, and keeping an eye out for any signs of illness that overtaxed staff may not yet have noticed. Stay in contact with your relative’s doctor so that you can alert him or her in case you notice anything worrying.
Last, if you haven’t clarified your loved one’s end-of-life wishes, have that conversation. “It’s more important now than ever to review and revise advance directives and physician orders for life-sustaining treatment (POLST) forms that clarify wishes regarding life-sustaining treatment options including hospitalization and ventilator,” Jarrín says.