Coronavirus (COVID-19): Tips for Dementia Caregivers

Most likely, Alzheimer's and other dementias do not increase risk for COVID-19, the respiratory illness caused by the new coronavirus, just like dementia does not increase risk for flu. However, dementia-related behaviors, increased age and common health conditions that often accompany dementia may increase risk.

For example, people with Alzheimer's disease and all other dementia may forget to wash their hands or take other recommended precautions to prevent illness. In addition, diseases like COVID-19 and the flu may worsen cognitive impairment due to dementia.

As communities and care services begin reopening, it is important for caregivers to consider the risks and take additional safety precautions for people living with dementia.

Vaccines

Vaccines are an important step in protecting the health and safety of people with Alzheimer's disease or other dementia, as well as their caregivers, and the Alzheimer's Association strongly encourages their use.

Now that vaccines are widely available to the general public, most older adults have been vaccinated. But vaccinated individuals can still be infected with COVID-19, particularly if they are exposed to people who haven’t been vaccinated. Other protocols including personal protective equipment (PPE), rapid point-of-care testing and other safety measures must continue to be implemented to ensure a secure and safe environment for visitation.

For more information on the COVID-19 vaccines, see COVID-19 Vaccine: Answers for Dementia Caregivers and People Living with Alzheimer's.

Caregivers at home

Caregivers of people living with Alzheimer's and other dementias should continue to follow guidelines from the Centers for Disease Control (CDC), and consider the following tips:

• For people living with dementia, increased confusion is often the first symptom of any illness. If a person living with dementia shows rapidly increased confusion or other sudden changes in behavior, contact your health care provider for advice.
• People living with dementia may need extra and/or written reminders and support to remember important hygienic practices from one day to the next.
  • Consider placing signs in the bathroom and elsewhere to remind people with dementia to wash their hands with soap for 20 seconds.
  • Demonstrate thorough hand-washing.
  • Alcohol-based hand sanitizer with at least 60% alcohol can be a quick alternative to hand-washing if the person with dementia cannot get to a sink or wash his/her hands easily.
• Think ahead and make alternative plans for the person with dementia should adult day care, respite, etc. be modified or cancelled in response to COVID-19.
• Think ahead and make alternative plans for care management if the primary caregiver should become sick.​

  Improving the response to COVID-19 in long-term care settings

  The Alzheimer's Association is urging state and federal lawmakers to implement new policy solutions to address the issues impacting long-term care during the pandemic. The only way to end social isolation is to ensure every residential care community has access to rapid testing for all residents, staff and visitors. Join the Alzheimer’s Association and urge state and federal policymakers to implement new policy solutions to address the issues impacting these communities during the pandemic.

  Learn More

Long-term care settings

People living in long-term care communities are extremely vulnerable to COVID-19 due to the community nature of these settings. In addition, the large majority of people living in these settings are older with underlying chronic conditions that put them at higher risk for COVID-19.

According to some estimates, 34% of all U.S. COVID-19 deaths were long-term care community residents or staff.

We know the COVID-19 pandemic has been an especially difficult time for caregivers and families who have been unable to see their loved ones in person and we are encouraged that COVID-19 vaccines continue to reach more and more vulnerable residents in long-term care settings.

The Association supports the Centers for Medicare & Medicaid Services (CMS) guidance issued on March 10 and its efforts to enable visitation, reuniting residents with their families and reducing the harmful impact social isolation has had on these individuals.

Safety precautions for visitors and caregivers

Given the ongoing risk of COVID-19 transmission, and the fact that dementia-related behaviors may increase risk, the Alzheimer’s Association encourages visitors and caregivers to make appropriate considerations and take additional safety precautions when visiting care communities, including:

• Before your visit, check with the care community on its visitation policies.
• If you are unvaccinated, consider getting tested prior to visiting. Also, limit the number of unvaccinated people who visit at any one time.
• During your visit, follow community guidelines for visitation. Limit your visit to approved areas only and avoid going into other parts of the community. Keep your distance from other residents as much as possible.
• Conduct visits outdoors when feasible to minimize risk of transmission.
• If you have been exposed to anyone with the virus within 14 days, postpone your visitation.
• Inform staff immediately if you develop a fever or symptoms consistent with COVID-19 within 14 days of your visit.
• Bring your own face mask, put it on before entering the facility and wear it at all times. Masks should be well-fitted and be secured over your mouth and nose.
• Wash your hands often with soap and water for at least 20 seconds and avoid touching your face. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol.

There are always risks with in-person visits, but as long-term care communities begin to allow visitors and more of the country is vaccinated, these additional steps will help to mitigate risk.

CMS does note some circumstances where visitation should be avoided due to a high risk of COVID-19 transmission (note: compassionate care visits should be permitted with appropriate PPE). This includes situations where there are:

• Unvaccinated residents, if the care setting’s COVID-19 county positivity rate is more than 10%, and less than 70% of residents in the facility are fully vaccinated.
• Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated until they have met the two criteria to discontinue Transmission-Based Precautions.
• Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.

In-home care services

If you currently receive or plan to receive services from a paid health care professional in your home, consider these tips:

• Contact the home health care provider and ask them to explain their protocols to reduce the spread of COVID-19, including whether the provider has been vaccinated.
• Check the home health care professional’s temperature before they enter your home. Anyone with a temperature over 100.4° F (38° C) should be excluded from providing care.
• Ask the health care professional if they have been exposed to anyone who has tested positive and if so, do not allow them into your home.
• Ensure that the health care professional washes their hands upon arrival and regularly throughout their time in your home.
• If the health care professional has not been vaccinated, ask them to wear a mask.

Community-based care services

If you or someone you care for typically rely on community-based services, you may have experienced a disruption due to restrictions caused by COVID-19. As communities begin phased reopenings and these services become available again, it is critical to weigh the risks associated with restarting these care options.

Out of home care options, such as drop-in centers and adult day centers, which are congregate by nature, pose communal concerns for people with dementia. During the COVID-19 pandemic not all people with dementia are suitable for congregate centers and not all centers are suitable to provide on-site care for people with dementia.

Because people with dementia may be extremely vulnerable to COVID-19, because of age or medical conditions, and may have trouble following social distance guidance, adult day centers across the country have made changes to apply CDC guidelines and are safely serving people with dementia. It is best to visit a specific center to determine if you are comfortable with the safety protocols at that specific center.

You also may wish to consider adult day programs that offer virtual activities to maintain health and encourage social engagement. Additionally, some providers offer meal delivery.

In the hospital

While many hospitals are restricting or limiting visitors to help curb the spread of COVID-19 and protect patients and staff, there are still ways to support the person living with dementia during their hospitalization. CDC guidance allows care partners of persons with dementia to visit if they are essential to the person’s physical or emotional well-being.

If visiting in person

• Be sure to familiarize yourself with the safety requirements of the hospital beforehand.
• Bring your own face mask and put it on before arriving at the facility.
• Wash your hands regularly and avoid touching your face.
• Limit your visit to the room of the person living with dementia and avoid going to other locations in the hospital.

If you are unable to visit in person

• Communicate with the person through phone or video calls.
• Give your contact information to the attending nurse and ask for it to be written on the white board in the person’s room. Find out what kind of communication will be possible and how you can expect to receive updates.