Q. My granddaughter, Hailey, called the other day and she sounded happier than she has been in months. Her small business and other stores and restaurants in the DC Area are beginning to reopen starting today (Friday, 5/29). She told me that the stay-at-home order has been lifted and that several malls and restaurants will be reopening as part of Phase 1. She asked me to take a look at my calendar because she and other family members want to take me and my husband, who has moderate dementia, to our favorite restaurant for a belated 60th anniversary dinner.
Just last week, I read about seniors, who were around my age, dying of COVID-19. I am glad my granddaughter’s business will be reopening, and believe me, I want to have fun, too, but I’m not sure if it is truly safe for people like me and my husband to return to normal life so soon. He has diabetes and high blood pressure, as well as his dementia and a history of pneumonia. I am in the early stages of COPD, from having been a heavy smoker when I was younger. Aren’t those the kinds of chronic diseases that doctors have been saying make people more vulnerable to infection? Is now the right time to take a chance at going out, if we are planning to wear masks and maintain social distancing? What are some things we and our caregiver (my oldest daughter) should consider? Thanks for your help!
A. Stay-at-home orders are easing up in our area, yet people are still being diagnosed with new cases of coronavirus every day. As most of you know, seniors who contract COVID-19 face a high risk of developing dangerous complications. Since it’s possible to be carrying the virus and to transmit it to others even if you don’t feel sick, it’s especially important to be extra vigilant if you are planning to go out.
During the pandemic, many seniors have experienced loneliness and isolation. Being stuck alone inside and away from others is known to impact mental well-being, and it has also been associated with an increased risk of stroke, heart disease, dementia and premature mortality. So, after two months at home, many seniors (and others) want to go out into the world again. It is discouraging for them to see people of other ages resume activities. They feel excluded. Still, they want to be safe.
Caregivers Should Be Prepared to Make Difficult Decisions
When it comes to seniors going out again and receiving visits from friends and loved ones, there are no clear-cut answers. Family caregivers and seniors themselves should consider the pandemic’s spread in their area, their loved ones’ specific health conditions, the level of contact they’d consider having with others, and their degree of tolerance for risk. What process should caregivers and seniors use to make these difficult decisions? Here are some thoughts to keep in mind:
- Get advice from healthcare professionals: Medical professionals are certainly cautious, so getting their opinions about what’s safe and what’s not is a good place to start. Medical professionals typically provide guidance based on the needs you and your care recipient have, and then it’s up to you to decide what you should do. In many cases, if your doctor knows you and your loved one well and they give their blessing for your loved one to venture out of the house to reunite with family, then it is likely okay. If not, you should certainly heed their advice on the matter.
- Take news and information from the media under advisement, but don’t count on it completely for decisions: TV news channels are filled with politicians and public health experts imploring you to do one thing or another to safeguard your health, bolster the economy, or support your neighbors. You should weigh the information and perspectives they provide as a factor in your determination of what works best for you and your family, but not necessarily the last word on your situation.
- Make a list of risks and benefits: To make a decision, it’s typically helpful to make a list of pros and cons of a course of action and then decide which side of the ledger is more persuasive to you. This may take a lot of effort, but whether a senior loved one should go out so soon is a big decision. Give your decision a lot of thought and slow down if necessary. If you are uncomfortable making any changes, then stay put for now.
- Talk to family members: Once you have an idea about whether and how you and your loved one will resume activities outside of your home, you may want to confer with other close family members to get their feedback. They may have many opinions about what you should do and when, but as a caregiver, you and your loved one will be the ones to ultimately decide based on what’s best.
- Know that your decision doesn’t have to be set in stone: As the public health situation unfolds, it is wise to revisit what’s going on, plan, and adjust as needed, and reverse course if necessary. Safety is always most important — but trusting your own judgment is important too.
If You or a Loved One is in a Nursing Home: When Can Visitors Visit Again?
The Centers for Medicare and Medicaid Services (CMS) is urging nursing homes to continue barring visitors until they have gone at least 28 days without a new COVID-19 case originating on-site (as opposed to a facility admitting a coronavirus patient from a hospital). There are several other benchmarks to meet, too, as described in my recent article on this subject.
In Virginia, for example, long-term care facilities are “at least seven weeks away” from meeting the base conditions to enter phase three of the federal plan — the stage at which visitors can return — the state health department’s Division of Clinical Epidemiology says. Elaine Ryan, vice president of state advocacy at AARP, expects the wait to be considerably longer.
“The rising death toll is an indicator that nursing homes and assisted living facilities do not have this virus under control by any means,” Ryan says. “Nursing homes have been in the lowest rung from the outset of the pandemic for any kind of staff support, PPE, infection control, testing, tracing, even reporting of deaths. The prospect of opening doors to visitors in a way that protects the health and safety of everyone seems months away.”
If your Loved One Feels Sad and Lonely about Not Being Able to Go Out or Receive Visitors
Older adults have realized that the course of being isolated may be much longer for them than for everyone else. And, given this, sadness, loneliness, and some hopelessness may have set in.
If assistance is needed with seniors who are feeling sad, lonely, and isolated, the National Alliance on Mental Illness has compiled a COVID-19 information and resource guide, available at https://www.nami.org/covid-19-guide. The American Psychological Association has created a webpage devoted to this topic and recently wrote about finding local mental health resources. The Substance Abuse and Mental Health Services Administration has a 24-hour hotline, 1-800-662-4357. And the national suicide prevention hotline for those in acute distress is 1-800-273-8255.
Plan for Yourself and Your Loved Ones at this Time
During this time, it is as important as ever to plan in advance. If you have not done Long-Term Care Planning, Estate Planning, or Incapacity Planning (or had your planning documents reviewed in the past several years), or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please call us to make an appointment for an initial consultation. For those who feel safer in their homes, we offer phone appointments or video conference appointments in lieu of in-person meetings (but we are still open for in-person meetings, of course using social distancing, safe sanitation, and face masks):
Elder Care Attorney Fairfax: 703-691-1888
Elder Care Attorney Fredericksburg: 540-479-1435
Elder Care Attorney Rockville: 301-519-8041
Elder Care Attorney DC: 202-587-2797
About Evan H Farr, CELA, CAP
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