Infection prevention strategies to prevent the spread of coronavirus pandemic are especially challenging in long-term care environments as residents may have a difficult time in following recommended infection prevention practices, such as social distancing, washing hands frequently, avoiding touching their face or even wearing a mask.
These kinds of preventable actions make residents with Alzheimer’s or a dementia-related disorder uneasy, which can lead to anxiety and fear — expressed as agitation, aggression or wandering.
Health care personnel in assisted living, nursing homes and memory care units should be following specific Centers for Disease Control and Prevention facility guidelines, including:
- Structured routines with the facilities kept as consistent as possible while incorporating the practices of frequent hand washing and social distancing.
- Be aware that it might not be possible to keep a mask on a resident with dementia, as he or she would be confused about wearing it and may constantly take it off.
- Activities are very important to alleviate boredom and can be adapted to resident rooms or at staggered times in very small groups in an activity room, with residents situated a distance apart.
- Staff can aid in providing some form of exercise, such as walking in a secured courtyard. Exercise helps to maintain well-being and health and can be an enjoyable activity.
- Common areas should be arranged to space residents at least 6 feet apart when feasible, and residents who are ambulatory should be gently redirected when they get in close proximity to other residents.
- Facilities should try to have consistent staff assignments to keep familiarity among the residents, and to limit the staff on the memory care unit only to those essential for care.
- Access to continual medical care and/or emergency procedures should continue under the guidelines outlined by the care setting.
As challenging as it is to maintain infection-prevention procedures among long-term care residents, it can be equally or perhaps more challenging when a resident is suspected or confirmed to have the virus. It would be difficult to restrict a resident to his or her room, and moving a cognitively impaired resident to a special COVID-19 care unit can cause disorientation and agitation, with increased risks of wandering or falls.
Administrators should determine if it is safer to maintain care of infected residents in the memory care unit with dedicated staff or to move them to a specialized COVID-19 unit. Should the latter be chosen, staff on the COVID-19 unit should be prepared and know biographical information of the resident, including habits and activities he or she enjoys. Additionally, it helps if the resident can take familiar objects to the new surroundings for security and comfort.
According to the CDC, changes in behaviors such as increased agitation, confusion, sudden sadness and/or increasing symptoms of dementia should always be evaluated as these symptoms may be indicators of worsening stress and anxiety as well as COVID-19 or other infections.