The other day, someone asked me whether, given the coronavirus outbreak, her 93-year-old aunt should go a skilled nursing facility for rehab following a week-long hospital stay.
Her question is an important one: What should you do if you or a family member are living in a nursing home or assisted living facility (ALF), or may need to go to a skilled nursing facility (SNF) after a hospital stay?
There is a lot to think about, but experts have two main pieces of advice:
- Don’t panic. The risk of contracting COVID-19 remains very low.
- Make sure the facilities are practicing good infection control–something they should be doing all the time, regardless of the immediate news.
No doubt, residents of care facilities are at high risk for severe illness or even death if they contract COVID-19, the disease caused by the novel coronavirus. And the multiple deaths at a Kirkland, WA nursing home only raised those concerns.
A high-risk profile
The director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci is very worried (start watching at about 16:20 minutes) about the risks to certain older adults: “The overwhelming weight of serious disease and mortality is in people who are elderly as well as those with comorbidities” that include heart disease, diabetes, asthma, or being overweight. And that, of course, is exactly the profile of many residents of senior care facilities.
But listen carefully to what Fauci is saying. We don’t know that older adults are more likely to contract the disease. We only know that the effects of COVID-19 are more severe for those seniors who do get it.
It also is important to keep the risks in perspective. The disease remains very rare in the US—there are only about 500 confirmed cases and fewer than two dozen deaths in a nation of 330 million people. By comparison, so far this year, there have been between 34 million and 49 million cases of flu and between 20,000 and 52,000 deaths. Residents of assisted living facilities and nursing homes should be far more worried about flu than COVID-19.
But that doesn’t mean COVID-19 is not serious. It is easily transmitted and there is no specific treatment, beyond normal care for someone with severe respiratory disease.
If you are living in a senior community, or have a loved one who is, what can you do to avoid contracting the disease? Start of course, with the advice we all should follow, such as washing your own hands regularly.
But beyond that, make sure that the facility is practicing good infection control. Unfortunately, many do not.
To learn if a specific facility is doing it right, you can ask a few basic questions. The Centers for Disease Control has a simple factsheet for consumers called the “Top 10 Infection Prevention Questions to Ask a Nursing Home’s Leaders.”
These questions were developed long before COVID-19 appeared, but they are more appropriate now than ever. They include: What does the facility do to ensure handwashing by staff, residents, and families; do facilities provide paid time off to staff who are sick to encourage them to stay home, do facilities have capacity to isolate residents who have an infectious disease? When was the last outbreak of infectious disease in the facility, and how did management respond?
Don’t be afraid to ask these questions. If senior staff resists answering or can’t give specific answers, look for another place.
You also can observe. Do staff wash or gel their hands before and after going into a patient’s or resident’s room? Does the facility have signs reminding staff of the importance of infection control? How is food being handled? How does the facility respond to a resident who is coughing or sneezing? How does it respond to visitors who appear ill?
If you still are uncertain, ask an aide or a nurse.
Back to the woman who was worried about her aunt.
First, I asked her a question: If her aunt returned directly home, would she likely do the physical therapy she needs to get back on her feet? If so, going home with the support of visiting aides and therapists might be a good solution. If not, the risk of her never restoring her mobility seems much higher than her risk of contracting COVID-19.
Overall, research suggests that post-acute care at home is not better than in a SNF, though it may be cheaper.
And keep in mind, those home care aides and therapists are seeing other at-risk patients. And it is possible that they also may be working part-time at a senior facility that itself may not have strong infection control.
Should her aunt (or anyone else) do her rehab in a nursing facility? Should a frail older adults move to an assisted living facility? The answer is what it always is: Absolutely, if it otherwise is the most appropriate setting for her care. But more than ever, it has to be a high-quality facility that practices strong infection control.