Visiting Loved Ones in Long-Term Care Facilities in the Midst of COVID-19

Long-term care facilities provide both medical and personal care to people, usually older adults over the age of 60, who are unable to live independently. In March 2020, long-term care facilities were identified as high-risk settings for outbreaks of SARS-CoV-2, the virus that causes COVID-19. During this time, U.S. health departments put specific guidelines in place to improve infection prevention and control (IPC) practices to help prevent outbreaks and limit the spread of COVID-19 in already affected facilities. Efforts to mitigate outbreaks in long-term care facilities were necessary to reduce overall COVID-19 mortality and associated disparities; however, these efforts greatly impacted the residents of these facilities.

“Visitation restrictions during the COVID-19 outbreak placed physical and emotional tolls on residents, especially those living with moderate to more advanced dementia or other disabilities,” says UT Health Austin geriatric psychiatrist Gayle Ayers, DO, in UT Health Austin’s Comprehensive Memory Center within the Mulva Clinic for the Neurosciences. “Living in social isolation like that is just not healthy in its own way.”

Feeling socially isolated creates an increased risk for depression, anxiety, and other expressions of distress. The prevalence of severe loneliness among residents of long-term care facilities is anywhere between two and four times as likely as the community population, which has been amplified by visitation restrictions in place due to COVID-19.

“While visitation is an important factor when it comes to the well-being of residents in a long-term care facility, we still have to be really careful about physical contact,” explains Dr. Ayers. “We try to advise family members of loved ones to redirect, redirect, redirect. While this tactic is mostly used to change the subject matter of a conversation to a more comforting topic, it can also be used to redirect physical contact. I would suggest bringing a wrapped gift or other meaningful objects, such as a hat, photo album, or framed picture, to your next visit. These items can easily be wiped down and passed to your loved one during your visit.”

You can also connect with your loved ones through:

• Personal devices for video chats, emails, text messages, and phone calls
• Cards and letters with messages of support and updates on family members
• Recorded videos and video messages shared through email or text messages
• Care packages with photos, drawings, favorite snacks, and forms of entertainment (i.e., books, magazines, puzzles)

“Unfortunately, there aren’t many great alternatives to visiting loved ones in long-term care facilities,” shares Dr. Ayers. “Even if you do not trust the precautions facilities have put in place, it’s important to try to find a way to visit that will work for you. You may want to think about visiting through a window or some other transparent barrier while talking to your loved one over a phone. There is also the option of video calling, but that can be very reliant on the facility’s staff, which can put certain limits and restrictions on visitation.”

Ways to prepare for your upcoming visit:

• Bring tangible props to help minimize physical interactions
• Prep loved ones by showing photos of or reminiscing about family members who will be visiting so they don’t get overwhelmed
• Try to keep to a set visiting schedule as routines bring feelings of comfort and safety
• Be patient and understanding, especially if your loved one is not up for a visit after your arrival
• In the weeks leading up to your visit, limit your public exposure as much as possible
• If possible, consider conducting your visit outdoors
• Check with the long-term facility about specifics regarding visitation and adhere to all local and state health and safety laws, rules, and regulations

“If you’re worried about your loved one’s well-being, reach out to the facility’s staff,” encourages Dr. Ayers. “These are the people who interact with your loved one every day. They can validate your concerns or let you know if you’re just picking up on a bad time. Your loved one’s mood can fluctuate depending on the amount of sleep they had the night before, whether or not they’ve eaten yet, or even if their blood sugar is low.”

While not all loved ones in long-term care facilities have access to, or the ability to use, the internet or a smartphone, there are an abundance of internet- and phone-based resources available to those who feel isolated and alone as they continue to navigate the challenges that have emerged since the start of the COVID-19 outbreak. These resources are also available to individuals with disabilities and older adults who do not live in long-term care facilities.

Resources available in the Austin area and beyond:

• AGE of Central Texas has created an online library of activities and resources for seniors and family caregivers who are quarantined at home. Their information and resource center and durable medical equipment lending remains open via phone at 1-512-600-9275 or email at ResourceCenter@AGEofCentralTX.org.
  
• Aging Services Council of Central Texas discusses COVID-19 resources (some of which are included in this listing) and additional online programming available to seniors.
  
• Alzheimer’s Association has provided a tip sheet for working with individuals with dementia during this pandemic. To apply for Respite Care funding, visit https://alz.org/media/texascapital/Respite-Form-Application.pdf
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  . They have also launched an online education program. For details and information regarding upcoming presentations, visit https://www.communityresourcefinder.org/.
  
• Area Agency on Aging of the Capital Area helps connect seniors and their caregivers to community services and supports, including food, basic needs assistance, and information about resident’s rights in long-term care facilities.
  
• Aspire to Age offers 20-minute virtual and phone check-ins with seniors. If you know a senior who may benefit from the program, call 1-512-347-7722.
  
• Big & Mini is a virtual intergenerational connection that matches seniors with a student from The University of Texas at Austin for video or phone chats. For more information, call 1-817-755-0775.
  
• Capital City Village volunteers help with greatly needed services, such as transportation to medical appointments, grocery shopping, home/yard help, technology/communications assistance, and friendly phone calls/video call check-ins. For more information, call 1-512-524-2709 or email info@capitalcityvillage.org.
• Family Eldercare offers a phone-based program that can be enjoyed from the comfort of home called Lifetime Connections Without Walls (LCWW). In addition to social and educational sessions, they will be adding special programming on COVID-19 for seniors. LCWW is open to persons ages 55+.
• Friendship Line (Institute on Aging) is a 24-hour/7-day/week crisis line for individuals with disabilities or who are 60 years of age or older. For anyone in the U.S., a toll-free number is available at 1- 800-971-0016.
  
• Heart & Soul Care’s mission is to provide free, life-enriching services to all seniors during the COVID-19 pandemic and beyond. For more information, call 512-222-9855 or visit https://www.heartandsoulcare.org/stayingconnected.
  
• South Asians’ International Volunteer Association (SAIVA) is providing virtual programming for seniors, including simple yoga/breathing exercises, that is open to all seniors. Email saivacommunications@gmail.com for more information and a link for the session.
  
• Well Connected (Covia) is a community made up of social groups accessible by phone for seniors. This program is free of charge to anyone in the U.S. and available in both English and Spanish.

For more information about UT Health Austin’s Comprehensive Memory Clinic, call 1-833-UT-CARES (1-833-882-2737) or visit here.