Deciding on a Health Care Facility During COVID-19

With pointed questions and a research app, evaluating a facility is doable.

Posted Jun 01, 2020

Wikipedia Commons, Georgia National Guard
Georgia National Guard disinfects nurisng home during COVID-19
Source: Wikipedia Commons, Georgia National Guard

The nursing home news is devastating for families as the coronavirus wreaks havoc with elderly patients. The spread of COVID-19 is also a serious concern in assisted living, skilled nursing facilities, and rehabilitation facilities. This is not the time to consider a nursing home for an elderly relative. Many states are less than transparent about the death toll. According to new figures released on May 27, 2020, by the state of Massachusetts, of the 80 different long-term-care facilities, each of them recorded 20 or more deaths among residents as a result of COVID-19 ("COVID-19 Command Center Releases New Nursing Home and Community-level COVID-19 Public Health Data").  

Despite nursing home concerns, some families have no choice if a loved one is being discharged from a hospital to a facility following an injury or serious illness or for COVID-19 recovery. Finding the right place is difficult. Based on daily updates from Yale School of Medicine and releases from the Gerontology Society of America, it is possible to stay up-to-date.

The biggest disadvantage to families at this time is that most places will not allow an outsider to visit or inspect. This may vary by state. It is helpful to get information from the local health department. For people who need to determine information about a nursing home and/or a rehab facility, which may be part of a specific home, here is a research tool and a series of 12 questions to help with the assessment.

A research tool and the telephone

Nursing Home Inspect uses data from the U.S. Centers for Medicare and Medicaid Services. It carefully details complaints and even lists fines levied against the home. Fines are listed for the past three years. However, fines under appeal are not included. Some rehab facilities also house nursing home patients, and if so, they will be listed with Nursing Home Inspect. 

There is also a list of deficiencies, ranging from simple to serious. Charles Ornstein, formerly a Los Angeles Times investigative reporter, who shared a Pulitzer Prize for Public Service, has devised a tip sheet: How to Use Nursing Home Inspect.

This service falls within ProPublica.org, which produces public interest journalism. After getting information from the app, it is important to make a phone call. Ask to speak with the director, the head nurse, or a social worker. Explain that you are looking for a placement for a family member, and before filling out an application, you would like some information.

Questions to ask should include:

1. How many residents reside at your facility?

2. What is the ratio of staff to residents or patients?

3. How many cases of COVID-19 have been reported over the past 30 days, including residents and staff?

4. Of the current residents, how many are in isolation at your facility, specific to COVID-19?

5. Of the current resident population, how many are now hospitalized with COVID-19?

6. What is the status at this point in time of those infected and those who have recovered?

7. How many people come to your facility on a daily basis: that is, aides, food service employees, and maintenance workers?  

8. How many residents/patients have aides who care for them from private agencies?

9. How many private agency aides come in each day, including those who work two or three shifts for one resident?

10. Of that number, how many have developed COVID-19?

11. What measures are you taking to keep illness at bay?

12. Do staff who have contracted COVID-19 provide a doctor’s note to return to work?

What about a person with dementia?

There are people with dementia who have refused to live with relatives, and a nursing home is the only option. A March report in The Lancet details why staying at home is a greater danger.

People living with dementia have limited access to accurate information and facts about the COVID-19 pandemic. They might have difficulties in remembering safeguard procedures, such as wearing masks, or in understanding the public health information issued to them. Ignoring the warnings and lacking sufficient self-quarantine measures could expose them to a higher chance of infection. (1)

An interesting study regarding dementia patients was released on May 26, 2020; it noted that a faulty gene linked to dementia doubles the risk of developing COVID-19 ("Dementia Gene Raises Risk of Severe COVID-19"). 

The above 12 questions will be helpful in finding a long-term care facility. But if you are looking for placement for a person with dementia, you should also ask about the memory unit, activities, and resources that are available for mental stimulation.

After the research, if one chooses a health care facility, stay in touch.

  • Call daily.
  • Ask to arrange a video chat.
  • Visit the facility outdoors and wave to your loved one.
  • Let the nurses know you care.
  • Send a thank-you note to the nursing station.

Caregivers are under even more stress than family members. Words of gratitude are a welcome gift to people dealing with very sick patients. Even loved ones who are temporarily in rehab facilities can become angry, depressed, and impatient. While visiting is off-limits, find out what gifts you might send to cheer someone up.  

Copyright 2020 Rita Watson

References

Wang, Hulai. (2020) Dementia care during COVID-19. London, England, The Lancet.