Thoughts on Care Transitions During COVID 19

Helping transition someone, such as a family member or friend, from their home to a facility is often difficult and complex, especially during the COVID 19 pandemic. Even the mere decision to transition can result in a lengthy and tumultuous process that requires a great deal of thinking, evaluating, researching and understanding. This experience can require both physical and psychological endurance. As a social worker who has been part of many transitions, here are my thoughts on the process:

Physical Changes

HomeThe individual who is leaving their home is oftentimes leaving a space in which they have spent many years. For some, this home is the first home they purchased; their first home after a divorce; the home where they raised a family; the home that was there for them during the good and bad times.

BelongingsThe individual is often unable to bring many of their belongings to their new space. Although many facilities allow and encourage older adults to personalize their room and space, this is not possible all the time. For example, if the individual is moving to a nursing home facility, they are not only unable to bring their own furniture and bed, but they also are being asked to share their space with someone they do not know. 

• Roommate: Sometimes, an individual moving to a facility where they will share their room with another is happy with the company and connection. However, in thinking about people coming from all backgrounds and life experiences, we must consider that sharing space with others – sometimes others who have physical and mental health conditions that encroach cross boundaries – may not be an ideal situation. 

As a former nursing home social worker, I have been a part of many conversations where roommate changes were requested because of disturbances; concerns about safety and more generally; or just someone wanting their own space. After all, an individual likely had their own space for many years prior to being asked to downsize, sometimes overnight, to a shared room. 

Psychological Changes

LossThis transition can itself symbolize loss for an individual, however there also could be other reasons why they are experiencing a loss. For example, if the transition is occurring because of the loss of physical ability. Or, the loss of memory. Or the loss of a family member who cared for them. The loss of financial security that could have resulted in this move. Once moved in, an individual can feel the loss of their home, their former life, their independence and freedom. In most facilities, whether a nursing home or assisted living, individuals cannot move freely without checking in. Staff always seem to be in need of knowing where the individual is going and when they are coming back.  In nursing homes, even more so.

Anger/Depression/Anxiety: I group these emotions together because an individual transitioning into a setting may experience one, two or all three at any given time during the process and thereafter. Sometimes this is a result of the changes and loss. Other times these emotions exist because the individual is potentially unable to understand the benefits of this transition for their health and wellbeing. And, they may disagree about what is possible to achieve their health and wellbeing.  

Lastly, and most important in my work as a social worker, is the actual decision-making process itself. Are you including the person in the decision-making process? Why or why not? How have you brought concerns about them at home up? This is so important when talking about a transition because often moving is a result of someone being unsafe at home and needing more help. But we all know that it can be very challenging to accept things about ourselves, especially when someone else is telling us about it.

COVID 19

There is no right or wrong answer when someone asks about whether they should wait to transition an individual into a care facility because of COVID 19. This is a decision each person has the right to make on their own, but they also have a right to ask the facility questions so that they may be better informed about risk. Here are some questions below to consider asking:

  • How many residents were diagnosed with COVID 19?
  • How many staff were diagnosed with COVID 19?
  • What is the protocol for staff diagnosed with COVID 19, how long do they quarantine?
  • What is the visitor policy during the COVID 19 pandemic?
  • What is the screening process for both residents and staff with regards to COVID 19?
  • How are residents able to interact during COVID 19?
  • What is the screening process for incoming residents with regards to COVID 19?
  • What other safety precautions exist with regards to COVID 19?

My final thoughts on this multifaceted subject are:

Think about the decision and the individual. Consider how they will react, and how might you best be a resource of support for them. Think about how you are advocating with them. Think about realistic needs and ways to address them based on the individual. Know that older people are incredibly strong and resilient. They have lived through wars and social change movements, and have had life struggles and change just like any other aged person.  

So, when reading this list, and thinking about the individual in your life in need, don’t forget to share back with them their strengths and positive attributes, along with where they may benefit from extra support. It is critical that we do this in order to help reframe what needing help during later life looks and feels like.

So, how are you? Are you in the midst of making a decision like this? Have you already made the decision and are in need of someone to listen?

Resources:

  • The National Institute on Aging has a variety of educational resources to learn more about dementia and its’ impact. Here is a link to their website: https://www.nia.nih.gov/health/topics
  • When looking at different facilities for long-term or short-term care, I always consult Medicare to see their reviews of each facility. Here is the link to their website where you can type in your zip code and see the ratings of facilities: https://www.medicare.gov/care-compare/
  • It is difficult to cope with changes, especially as we see our loved ones and family members experience these changes. Here is a link to the Alzheimer’s Foundation of America’s website. There are a host of informational readings here about dementia but also about caregiving and ideas on how to approach specific scenarios that can be challenging for everyone involved. They also have a helpline with licensed social workers, not volunteers. https://alzfdn.org/caregiving-resources/fact-sheets-information/
  • Locating Area Agency on Aging. They are the local hub or resources offered by the county/state, and also can be helpful with general referrals and support. Here is a link to the website where you can find your local Agency on Aging. https://eldercare.acl.gov/Public/Index.aspx

Helpful Articles

From AARP – https://www.aarp.org/caregiving/health/info-2020/nursing-homes-coronavirus-faqs.html

From NextAvenue – https://www.nextavenue.org/moving-parent-into-assisted-living-covid-19/

From the CDC – https://www.cdc.gov/coronavirus/2019-ncov/hcp/assisted-living.html

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