Caregiving during the pandemic

Managing a loved one’s care in a nursing home or an assisted living facility has always been challenging. And it’s harder now that visitation is extremely limited to protect residents from COVID-19. So how can you check on your loved ones, make sure they’re being cared for properly, and let them know you’re there for them?

Direct communication

If your loved one is able to communicate well, a daily phone or video call is crucial. But remember that when you ask basic questions — “How are you feeling?” “Are you eating and drinking enough?” “Are you getting enough sleep?” — you may not get an honest answer. “They may just tell you what you want to hear,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Do some sleuthing to get a more realistic picture. “Listen to how the people sound on the call,” Dr. Salamon suggests. “Do they sound different in any way — sad or confused? Weak or tired? Ask how they’ve been spending their time and who they’ve seen that day. Did they get outside of their apartment or room? Did they walk anywhere? Look for clues that they may be getting sick, which staff in the facility may not have noticed.”

Talk to facility staff

Call or email facility staff to ask questions or advocate for your loved one. Start with the director of nursing or a caseworker. “It’s reasonable to tell staff you’re worried and you may be asking more questions than normal. Find out how often they’re able give you updates,” Dr. Salamon recommends.

Prepare a list of questions that includes the following aspects of your loved one’s health and well-being.

Socialization. “Ask if your family member is attending activities [if they’re offered] or just staying in their room most of the time. If they are not getting out, ask about the plan to get the family member back into a healthy social and physical routine,” suggests Dr. Susanne Hartmann, a geriatrician with Harvard-affiliated Beth Israel Deaconess Medical Center.

Mood. Does the staff feel your loved one is in generally good spirits, or is there more sadness? Is it affecting your loved one’s health or daily activities?

Muscle strength. “Is the family member having trouble getting up from a chair or feeling unsteady when walking? Too much inactivity can diminish muscle strength and potentially lead to falls. Getting into an exercise class — or physical therapy at the facility or through home care — could make a difference and reduce fall risk,” Dr. Hartmann explains.

Eating habits. Is your loved one eating and drinking enough? What is the staff doing to encourage nutrition and hydration? “A change in eating and drinking habits can indicate a change in mood and should be addressed by a doctor,” Dr. Hartmann points out.

Medication regimen. Have any medications been added or eliminated recently, and why?

Continence. “Ask if your loved one is making it to the bathroom on time. Do they signal when they need to go or do they soil themselves frequently?” Dr. Salamon asks. “If they are incontinent, what’s the plan to address it?”

Hygiene. Is your loved one able to bathe, brush teeth, and perform other bathroom activities? If not, ask how often the staff is providing assistance. For example, how often are showers given? If you feel it’s not often enough, what will it take to get care up to speed?

Thinking skills. Ask staff if they notice a change in your loved one’s ability to reason or have a conversation. If so, ask if it might be linked to something fixable, like medication side effects or a urinary tract infection.

If you detect a problem

Tell staff about your concerns, especially if you suspect a new problem. “If there’s not a physician on site at the facility, ask them to arrange a telehealth visit with a physician,” Dr. Hartmann advises.

Try to be on the call if possible. “We do a group phone call with the older person as well as the caregiver. That’s very helpful because you have a three-way conversation and everyone is on the same page,” Dr. Salamon says.

Some physicians, like Dr. Hartmann, are able to make house calls to adult living facilities.

Keep their spirits up

Social contact is important. Encourage loved ones to take part in activities at their facility. “This is more challenging than it sounds, as restrictions may change weekly depending on the pandemic,” Dr. Hartmann says. “But a lack of interaction has a devastating effect on an individual’s thinking skills.”

And try to connect with your loved one in any way possible. “Take advantage of visits if they’re allowed, or drop off or send a care package, a card, flowers, or a picture from a grandchild,” Dr. Hartmann says. “Social stimulation is the greatest way to combat the feelings of isolation and loneliness that so many people in facilities are experiencing.”

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Acts 4:18-31 And when they had summoned them, they commanded them not to speak or teach at all in the name of Jesus. But Peter and John answered and said to them, “Whether it is right in the sight of God to give heed to you rather than to God, you be the judge; for we cannot stop speaking about what we have seen and heard.”     

2 Chronicles 25:19 “You said, ‘Behold, you have defeated Edom.’ And your heart has become proud in boasting. Now stay at home; for why should you provoke trouble so that you, even you, would fall and Judah with you?”

1 Samuel 2:3 “Boast no more so very proudly, Do not let arrogance come out of your mouth; For the LORD is a God of knowledge, And with Him actions are weighed.

Proverbs 11:2 When pride comes, then comes dishonor, But with the humble is wisdom.

Proverbs 16:5 Everyone who is proud in heart is an abomination to the LORD; Assuredly, he will not be unpunished.

Micah 2:3 Therefore thus says the LORD, “Behold, I am planning against this family a calamity From which you cannot remove your necks; And you will not walk haughtily, For it will be an evil time.

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