The 2020 Pandemic’s unprecedented nature has left many of us grasping for answers to unexpected questions. In Senior Living, a question percolating in the back of the mind of many children responsible for elderly seniors is, “Should I bring my parents home because of the pandemic?” The answer is most often “no,” but is rarely clear cut, and it depends on the situation. Safety is the primary factor to consider, while isolation, adequate care, and financial considerations must also be taken into account. Also, the impact on the family can not be ignored. Below we discuss the five most central questions surrounding this question.
Where are Coronavirus risks highest in Senior Living?
From a safety perspective, the conundrum is figuring out the true risk of catching Covid in a Senior Living community. As a general guideline, the higher the level of care requirements, the higher the risk of a major building-wide outbreak of the virus. Skilled Nursing Facilities (“SNF”) and Memory Care communities are the most vulnerable to a rapid spread of the virus once it enters a community, as well as to the most deaths. This is true for three reasons:
- The resident’s health is already the most tenuous.
- Caregivers must lay hands on residents, help with the most intimate activities, and then move on to the next resident, who will likely need similar assistance. This personal level of care makes it more likely for caregivers to contract and spread the virus to multiple residents.
- Residents are often incapable of wearing masks or performing other actions that ameliorate the virus’ spread.
Assisted Living communities are also vulnerable to Coronavirus. Still, in my experience, the risk seems lower than in SNFs or Memory Care communities. Independent Living communities, while not immune to the Coronavirus, seem to have been the least likely to experience a widespread contagion within the building. Presumably, this is because fewer caregivers are traveling between apartments in comparison to SNFs. But I have seen cases, and even deaths, in Independent Living communities. We are in a pandemic, after all, and no place is immune. Even if family members were to take a loved one home, no one could guarantee their safety from the virus.
What are the other risks to consider in Senior Living?
Pandemic lockdowns in Senior Living communities, while well-intentioned, have had severe unintended consequences. As I poignantly wrote in my recent blog, “Mom May Not Catch COVID, But It May Kill Her Anyway,” isolation, loneliness, lack of movement, and falls are all hallmarks of the 2020 Pandemic lockdown. While some measures have eased since the early stage of the lockdown, family visitation, for example, other efforts, like meals delivered to the rooms, continue to this day in many communities. And with Coronavirus cases surging as of early December, it is likely Senior Living will soon be forced to return to the stricter lockdown measures, conceivably until vaccinations are completed in communities (hopefully by March 2021).
What are the risks if I bring my parent home?
Caregiving is a difficult task, and assessing whether the family can provide adequate care is the primary issue to consider. The most common reason seniors go to AL, MC, and SNF is that the high level of care required makes living at home no longer a viable option. The 24-hour nature of caregiving, the difficulty of transferring, fall risk, and incontinence are the primary reasons families choose for their loved ones to be cared for elsewhere. If these needs cannot realistically be met at home, then leaving Senior Living is not an option. Additionally, isolation at home may be every bit as bad or worse as in Senior Living if a busy family cannot give their Senior the necessary attention. Beware of the gilded cage.
What about the money issue?
Many families think they can bring their relative home and use the money that would have been spent on Senior Living on in-home care instead. This plan may be plausible if the care needs aren’t too high. Eight hours of daily caregiving for a 30 day month, for example, costs about $6,000, usually more than a month’s stay in many Senior Living situations. Eight hours of care are enough to allow someone to go to work as usual and have some free time on weekends. However, in many cases, this doesn’t account for overnight caregiving, when some seniors may get up multiple times a night and need supervision. Other scenarios abound where eight hours of paid caregiving isn’t nearly enough. Therefore this solution is situation dependent. Also, there is always a 30-day move-out notice requirement, meaning there will be at least one month when the family has to double pay.
There is a rule stating a SNF resident may not leave the facility for more than 72 hours for non-therapeutic reasons for someone residing on Medicaid. If this rule is violated, the former resident loses Medicaid eligibility (unless they transition to community-based Medicaid first). Medicaid eligibility can be re-established, but the process goes all the way back to the beginning, just as the first time Medicaid was applied for.
Can I bring my loved one home if the community is experiencing an outbreak?
The worst-case scenario is when a community experiences a large outbreak, where over half the residents and staff are infected with the Coronavirus. Severe outbreaks develop over several weeks, where there are a few cases at first, then more every time a new round of testing ensues. In such instances, with the benefit of hindsight, families say to themselves, “we should have moved Dad out.” Unfortunately, hindsight doesn’t always allow for simple solutions.
First, most coronavirus outbreaks are caught quickly. One example is when a staff member calls in sick, is told to stay home, gets tested, and eventually has a positive result. During this time, all the residents with whom the staff member had contact are closely monitored for illness. In many if not most cases of this sort, the infection scare goes nowhere. In some cases, the contact tracing catches resident infections early before transmission to the larger community. In these instances, which are the most common outbreak scenarios, moving a loved one home would be unnecessary and disruptive.
Second, what happens if you do move a loved one? Likely they would require isolation upon arrival at your home because of the risk they had to the virus before leaving the community. The rest of the family may have to take precautions, as well. And if they unknowingly brought the virus home, who will care for the senior? Outside caregivers are near impossible to find because of the risk, and now anyone who lives in the household must at a minimum isolate and perhaps deal with an infection themselves.
More often than not, moving a loved one home from Senior Living during the pandemic isn’t realistic for a variety of reasons discussed above. If moving a loved one home is possible and practicable, by all means, it should be given serious consideration. As in most instances during the 2020 Pandemic, solutions to this question are neither clearly indicated nor easy to implement.
As ever, feel free to call Texas Senior Living Locators at (512) 630-7133 for help with your Senior Living needs. We are here to answer all questions, talk through your options, and help to find the most appropriate care for your senior family member.