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What to Consider Before Moving a Parent Into Assisted Living During COVID-19

Key questions to ask in a very concerning time


Part of the The Coronavirus Outbreak: What You Need to Know Special Report

Nicole Dunn was all set to move her mom, Barbara, into an assisted living community in St. Petersburg, Fla. in April. Then COVID-19 struck. The facility temporarily banned outsiders and “that meant us,” Dunn says. Her mother, who has dementia, continued to live on her own in Florida.

But in mid-May, the assisted living community, which had no known cases of COVID-19, started to welcome new residents again, although newcomers would be quarantined in their apartments for two weeks. So Dunn’s mother moved in.

The early days were rocky. “I had to constantly reassure her that this was a good place for her,” Dunn says. Even so, the benefits outweighed Dunn’s concerns about her mom living in a communal setting during the pandemic.

Coronavirus and Long-Term Care

Moving a parent into assisted living is an emotional decision in normal times. These days, families have to make especially complex calculations in the shadow of a virus that’s proven especially lethal for elders.

Changes in routine can be disorienting and a new home is a big change, especially for a parent with dementia.

About 45% of all COVID-19 deaths in the U.S. have occurred in long-term care facilities, according to The Kaiser Family Foundation. Most of the widely reported outbreaks have been in nursing homes, which differ substantially from assisted living communities.

In nursing homes, residents require care from a licensed nurse; some may be bed-bound or have feeding tubes. Assisted living residents, in comparison, can live somewhat independently, but need help with daily tasks such as hygiene, meal preparation, medication management and transportation.

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Concerns about moving into assisted living in 2020 go beyond whether residents may contract coronavirus, though. There’s also the issue of being able to see your parent after move-in; almost no assisted living facilities have been allowing visitors.

How to Start Researching Assisted Living Communities

What’s more, changes in routine can be disorienting and a new home is a big change, especially for a parent with dementia.

Still, you may believe an assisted living community would be the best place for your parent. If so, you could begin researching ones in his or her area, while waiting to see how the pandemic unfolds locally. Coronavirus epicenters are riskier, from a health standpoint, than parts of the country where COVID-19 cases and deaths have been rare.

Before the pandemic, visiting potential assisted living communities was a smart way to help choose one. But in-person tours are rare right now, of course. So, get a virtual tour via Facetime or Zoom with the opportunity to ask the facilities’ managers questions by phone.

Questions to Ask

The questions might include:

What are your protocols for testing residents and staff for coronavirus?  The Alzheimer’s Association’s goals for coronavirus testing in assisted living communities include daily testing of staff, testing all residents now to identify cases and administering additional tests later for residents showing symptoms.

That’s just the ideal, however. Assisted living communities aren’t close to that yet, partly due to lack of availability of COVID-19 tests.

That said, regular testing of staff is critical, says Sue Johansen of the senior-care referral service A Place for Mom, “because it’s the staff that comes and goes from the community and is exposed to the surrounding community at large.”

Argentum, a national trade association representing senior living communities, has been calling for assisted living communities to get federal funding and priority access to COVID-19 tests and personal protective equipment for front line staff.

Has your facility had COVID-19 cases? What is the infection rate there and how are you communicating with families about it? If there have been cases, ask how quickly the leadership notified families once they were diagnosed and how regularly updates are sent. Also, find out what the facility’s plan will be if a coronavirus outbreak occurs.

To get these answers, try calling to speak with the executive director.

If you leave a message and no one responds, that’s “a huge red flag,” says Cindy Hostetler of Care Weavers, a health care advocacy and navigation service for older adults in Charlotte, N.C. Lack of communication during the sales process probably won’t improve after your parent moves in.

What safety protocols are in place to prevent COVID-19 from spreading?  Among the things you’ll want to know: how frequently are high-traffic spots such as elevator buttons disinfected, and whether the community has shifted from congregate dining rooms to meals delivered to apartments.

Learn about the current move-in process, too. Are new residents quarantined or tested for coronavirus prior to or upon arrival in the facility?

What are you doing to maintain and support your staff? The key to a good assisted living facility is its staff. So, you’ll want to see what management is doing to attract and keep excellent workers.

Hero pay, additional sick leave and supplemental benefits such as assistance with groceries or transportation are tangible ways for assisted living communities to support their employees. The incentives can help limit turnover, which is a clear benefit for residents in developing relationships with staff.

Since some employees may worry about working in senior communities during COVID-19 and passing the disease to their own families, it’s also worth asking if the facility has been able to maintain its pre-pandemic staffing levels.

What are you doing to engage residents? Social isolation increases the risk of depression and cognitive decline in older adults and that’s been a particular problem during the pandemic. Many group activities that give life to assisted living communities, from art classes to pet therapy, have been put on hold.

At a minimum, staff should help its residents set up virtual visits or “window visits” when possible with family and friends outside, Hostetler says.

See if the facility has been creative in developing alternatives to keep residents entertained and active, mentally and physically.

That kind of creativity has been a relief to David Marshak. In late March, after his 92-year-old aunt Edith Guttenberg fell and received a pacemaker, he convinced her to move to an assisted living community near his home in Franklin, Mass.

Marshak has been pleased that the facility has had singers perform for residents through open windows; a parade of cars with families for Mother’s Day and Bingo games in the hallways with everyone six feet apart.

The facility is doing “as much as they can to have some sort of normalcy,” Marshak says.

Andrea Cooper
By Andrea Cooper
  Andrea Cooper has written for The New York Times, The Guardian, Sierra, Reader’s Digest and many others.    

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