At least half of older adults dwelling in long-term care services undergo from cognitive impairment with Alzheimer’s illness or different dementias. Memory care companies, designed to satisfy the distinctive wants of residents with dementia, are sometimes offered in devoted care items or wings of a facility. Some reminiscence care items could also be secured or present restricted entry (e.g., utilizing a code) to regulate entry and exits, and have devoted, specifically educated workers or groups working with residents.
The first step in caring for individuals dwelling with dementia in any setting is to know that modifications in conduct (e.g., elevated agitation, confusion, sudden disappointment) or worsening signs of dementia must be evaluated as a result of they are often a sign of worsening stress and nervousness in addition to COVID-19 or different infections.
Infection Prevention and Control (IPC) Guidance for Memory Care Units
Infection prevention methods to forestall the unfold of COVID-19 are particularly difficult to implement in devoted reminiscence care items the place quite a few residents with cognitive impairment reside collectively. For instance, residents can have a tough time following really helpful an infection prevention practices resembling social distancing, washing their palms, avoiding touching their face, and sporting a material face overlaying for supply management. Changes to resident routines, disruptions in every day schedules, use of unfamiliar gear, or working with unfamiliar caregivers can result in worry and nervousness leading to elevated melancholy and behavioral modifications resembling agitation, aggression, or wandering.
Healthcare personnel (HCP) working in reminiscence care items in long-term care facilities including nursing homes, skilled nursing facilities, and assisted living facilities ought to observe the IPC steering for these particular settings, that are thought-about supplemental steering to the Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings.
In addition to the present IPC steering for long-term care services, nursing properties and assisted dwelling services offering reminiscence care ought to think about the next:
- Routines are crucial for residents with dementia. Try to maintain their atmosphere and routines as constant as doable whereas nonetheless reminding and helping with frequent hand hygiene, social distancing, and use of cloth face coverings (if tolerated). Cloth face coverings shouldn’t be used for anybody who has bother respiration, or is unconscious, incapacitated, or in any other case unable to take away the masks with out help.
- Dedicate personnel to work solely on reminiscence care items when doable and attempt to maintain staffing constant. Limit personnel on the unit to solely these important for care.
- Continue to supply structured actions, which can have to happen within the resident’s room or be scheduled at staggered occasions all through the day to take care of social distancing.
- Provide protected methods for residents to proceed to be lively, resembling personnel strolling with particular person residents across the unit or outdoors.
- Limit the variety of residents or area residents at the very least 6 toes aside as a lot as possible when in a standard space, and gently redirect residents who’re ambulatory and are in shut proximity to different residents or personnel.
- Frequently clear often-touched surfaces within the reminiscence care unit, particularly in hallways and customary areas the place residents and workers spend plenty of time.
- Continue to make sure entry to obligatory medical care, and to emergency companies if wanted and if in alignment with resident targets of care.
When residents on a reminiscence care unit are suspected or confirmed to have COVID-19
- As it could be difficult to limit residents to their rooms, implement universal use of eye protection and N95 or other respirators (or facemasks if respirators are not available) for all personnel when on the unit to deal with potential for encountering a wandering resident who may need COVID-19.
- Consider potential dangers and advantages of shifting residents out of the reminiscence care unit to a designated COVID-19 care unit.
- Moving residents with confirmed COVID-19 to a delegated COVID-19 care unit may help to lower the publicity danger of residents and HCP; nevertheless,
- Moving residents with cognitive impairment to new places inside the facility could trigger disorientation, anger, and agitation in addition to enhance dangers for different security issues resembling falls or wandering.
- Additionally, on the time a resident with COVID-19 or asymptomatic SARS-CoV-2 an infection has been recognized, different residents and personnel on the unit could have already been uncovered or contaminated, and additional testing may be needed.
- Facilities could decide that it’s safer to take care of care of residents with COVID-19 on the reminiscence unit with devoted personnel.
- If residents with COVID-19 will likely be moved from the reminiscence care unit
- Provide details about the transfer to residents and be ready to repeat that data as acceptable.
- Prepare personnel on the receiving unit concerning the habits and schedule of the particular person with dementia and attempt to duplicate it as a lot as doable.
- Move acquainted objects into the area earlier than introducing the brand new area to the resident. Familiar objects resembling favourite decorations or footage may help make the particular person really feel extra snug; this is applicable to their new environment as properly if residents are moved to new areas.