The high rate of sickness and deaths in nursing homes have families wondering whether their loved ones would be better off at home until the COVID-19 pandemic is over.
Federal regulations allow a resident to leave a facility at any time, though health experts advise to consider the risks and to think the process out thoroughly.
An agonizing decision
When the coronavirus first hit the United States, Jonathan Evans, a geriatric medicine specialist in Charlottesville, Virginia, had to travel to the Life Care Center of Kirkland in Seattle (the first nursing home breakout that had 37 deaths related to the virus) to find out how families were dealing with the crisis.
Evans was encouraged when he discovered people acting with courage and love in a time of great uncertainty and fear. And that’s having a profound effect on how he is helping his patients and families navigate this crisis in Virginia now.
He tells people that “there’s no wrong answer, and whatever they’re doing is based on love, and you can never be wrong to love your mother, father, or spouse.”
So, whether a family decides to bring a loved one home or to keep him or her in a nursing home, Evans wants to validate their choice and help them come up with next steps in either scenario.
“It’s a really tough question for which there is no easy answer,” says Susan Wehry, chief of geriatrics at the University of New England College of Osteopathic Medicine. “There’s not even a single answer.”
Understanding your motivation
Wehry explains that each case is different and it is important for families to ask why they feel it is necessary to remove their loved one from a nursing home.
“Are you afraid that your mom is going to get COVID-19? Are you afraid that your mom is going to die before you get to see her again? Are you afraid that your husband is simply lonely, getting depressed and getting anxious?” she asks. “Because when you can get yourself to really ask what is motivating you, what is the problem you’re trying to solve, then you can see whether or not there’s more than one solution to the problem.”
Make a alternative plan
Salli Pung, the long-term care ombudsman for the state of Michigan, urges people to think through practicalities of an alternative solution for the care of their loved one.
- How is your home handicap accessible?
- Is it wheelchair or rolling walker accessible?
- Is the bathroom large enough, safe, and accessible?
- Can you handle your loved one’s health needs from your home alone?
An “ombudsman” is an official appointed to investigate individuals’ complaints against maladministration, especially that of public authorities.
There are lots of details to consider that are easily forgotten about, Pung says, such as prescriptions that could run out, or trouble getting placed back in a nursing home if you change your mind.
Patricia Hunter, Washington state’s long-term care ombudsman, says it is important to sort through your options and come up with a game plan. Leaving a nursing home facility short term or long term begins by notifying the social work department or the nurse manager for the facility. There are state and federal laws about discharge planning and processes. Residents and family members should discuss with the facility what the terms are for leaving and returning and get everything in writing.
“If you’re worried about your loved one’s safety, have a Plan B in your back pocket,” Hunter says. “If you had to take your mother home, what would that look like? What would you need? Is it even feasible?”
State advocates like Pung and Hunter also look at the flip side and have families consider why staying put in a nursing home might be the best option, for the same reasons families made that choice in the first place.
CDC says, “There is no one-size-fits-all solution”
Experts at the Centers for Disease Control and Prevention (CDC) agree that there is no one-size-fits-all solution.
While the CDC has advised long-term care facilities of a variety of steps they can take to protect residents and staff, it has not issued guidance or recommendations about decisions to move nursing home residents out of a facility.
“This is a personal decision that each family should make in consultation with their healthcare provider based on their unique circumstances,” CDC spokeswoman Kate Grusich says.
AARP’s team of caregiving advocates say that decision also depends on the individual and the type of care they need, the level of support their family can provide, and how the facility is handling the coronavirus.
“It’s not a simple yes or no because everyone’s situation is very different,” says Bob Stephen, AARP’s vice president of family caregiving and health programs.
Families should consider three main things, he says: “Number one is what does the resident or family member want?” The second thing is to understand what’s going on in the facility. The third is the biggest area to look at: what is your loved one going to need in terms of care and what their medical professionals recommend.
Other questions to consider
- What are the pros and cons of moving your loved one?
- What does your loved one want?
- What are your loved one’s care needs?
- Can you provide appropriate care at home? (i.e. specialized care, meals, medication management, assistance in the bathroom and with hygiene, engaging your loved one in activities)
- Are there risks of COVID-19 exposure at home?
- Would you be able to do virtual or window visits with your loved one in the nursing home?
- If you move your loved one home and change your mind, can they be readmitted to the care home?
- Are the reasons for moving your loved one into a long-term care facility still valid?
- Is the nursing home adequately staffed and handling coronavirus well?
- Could professionals handle caregiving better than you could at your home?