Let’s address the elephant in the room: even in pre-coronavirus times, senior living is often a hard sell. No one wakes up one morning and says “oh boy, today I get to move into that Assisted Living I’ve always dreamed about!” People enter senior living to meet certain needs, and the industry has evolved over the past 30 years to under the circumstances do a pretty good job. Not a perfect job, and there’s plenty of room for criticism. But overall, the various levels of senior living are often the best option available to those elderly who because of their frailties need help with activities of daily living, or because of their age-related isolation and loneliness need additional socialization and intellectual stimulation.
But what about during a pandemic, when vulnerabilities and fears intersect to result in severe lockdowns in senior living? The brutal answer is senior living under the coronavirus lockdown is an unattractive option, and should be considered only as a last resort. This is true because for most seniors, their families are their most treasured source of emotional comfort. Public health authorities have mandated that families can no longer enter senior living facilities because of fears of spreading the virus. When families will again be allowed to visit is highly uncertain (insert hyperlink to All Clear), and for planning purposes six months or longer is an appropriate guess. Additionally, group dining and activities are also forbidden, and residents are encouraged to not leave their room. Therefore age-related isolation during the current coronavirus lockdown is just as bad in senior living as it was at their former home.
What about care needs and safety? Here Assisted Living, Memory Care and Personal Care Homes are still strong options for help with activities of daily living. These communities are not immune to Covid-19. As of May 15, there have been 95 deaths state-wide in Texas Assisted Living communities, and 6 percent of all homes have had cases. While no deaths are acceptable deaths, and I do not to minimize the severity of the virus, this is actually a pretty good track record. Because of the vulnerability of the elderly population, there would be a fairly high number of deaths from Covid-19 among the same assisted living residents were they still living at home. And many of these residents moved to Assisted Living because they were unsafe at home for other reasons. So Covid-19 risks in Assisted Living and Memory Care are not as bad as they might appear given the alternatives.
What about Independent Living? The prospective resident at this level of senior living generally has the most discretion as to when to move out of a long time home. Their physical care needs are generally lower, and their primary motivation for moving is social. For this cohort, Independent Living is not an upgrade when residents are confined to their rooms, aren’t allowed out of the building, and cannot see their families. On the hopeful side, it is in Independent Living that restrictions on resident’s activities will likely be the first to be lifted in senior living. This is because independent living communities are not licensed to provide any healthcare related services provided, and regulatory oversight is the lowest. In addition, I am unaware of any Covid-19 breakouts to date in any Austin area Independent Living facility. Pressure will come much sooner to open this level of senior care, first to communal dining and activities, and later to allow residents to leave the building and return. It is likely the last privilege to be restored in Independent Living is visitation by outside visitors.
Nursing homes are another matter entirely. As of mid-May, nearly 500 deaths have happened in Texas nursing homes, 25% of all facilities have had cases, and about 36 percent of all Covid-19 deaths reported in Texas have happened there. The statistics outside Texas are even more alarming: over 40 percent of all U.S. coronavirus deaths have happened in nursing homes, in Europe over 50 percent, and Canada has suffered an astonishing 81% of all coronavirus deaths in nursing homes. Outside of a Medicaid-eligible elder who is in imminent danger living at home, it is difficult to recommend anyone enter a nursing home at this time. This is despite the fact 75% of all Texas nursing homes have had no instances of Covid-19. Without a vaccine, it is hard to foresee when nursing homes will re-open to outside visitors, or when severe social distancing within the community will be eased. Texas Governor Greg Abbott has mandated testing in all nursing homes, and the results will be illuminating.
Still there are times when moving to an Assisted Living or Memory Care is absolutely essential, even in times of a Pandemic. My three rules of when someone needs to move still apply:
- They a person is a danger to themselves or others
- When they would be healthier living elsewhere
- When caregiver issues are insurmountable
In these instances, even with coronavirus restrictions, it is appropriate to consider Assisted Living and Memory Care options.