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Healthcare

According to initial study, patients with dementia are at increased risk for contracting COVID-19.

Because of this elevated risk, many dementia patients are determined to stay at home, which eliminates some risks but raises others.

As dementia patients and their informal caregivers adapt to new risks of home care in a COVID-19 world, an expanded role for medically guided dementia care at home is emerging. This article examines known risks and some recommended responses.

Types of dementia most vulnerable to COVID-19

The 2020 Alzheimer’s Association study linked in text above identifies vascular dementia and pre-senile dementia as the 2 types most susceptible to COVID-19 infection. In addition, African-American patients with dementia exhibited nearly twice the probability of contracting COVID compared to white patients.

The mortality rate for dementia patients with COVID was reported to be 20.99%, with co-morbidities - such as cardiovascular disease, diabetes, obesity, kidney disease, and asthma - playing a role that has not been precisely defined. 

Research into COVID-related risks for dementia patients is still scant thus far. More importantly, it lags behind the immediacy of the problem at hand: How can we care for patients with dementia at home in a COVID-19 world?

Mortality rate for dementia patients with COVID

21%

Patients with dementia and COVID-19 experience a 6-month mortality rate of nearly 21%, and a hospitalization rate of nearly 60%, according to a 2021 study by Alzheimer’s Association.

Dementia care at home

With the onset of the pandemic, dementia patients who were already in residential facilities (skilled nursing and assisted living) faced new and rapidly changing risks and safety protocols related to institutional care. Dementia patients living at home, however, had to retreat more deeply into their immediate environments and rely to a greater degree on family/informal caregivers. 

Even though most people with dementia prefer to remain at home, there is evidence from the University of California San Francisco (UCSF) that home-care for dementia can pose elevated health risks - when it is not supported by a healthcare professional.

5 top practices to date

Minimal research has been performed on how to manage home-based dementia care during the pandemic. But a 2020 Alzheimer’s Journals study identified these measures, among others, for risk reduction. 

1. Manage the home as a “clean zone.”
This includes use of PPE, no high-risk visitors, and sanitization of all inbound goods.

2. Support family caregivers.
RNs, social workers, and home health aides should educate informal caregivers on how to handle behavioral problems and avoid triggers.

3. Technology support.
In-home care for dementia patients should include support for telehealth videoconferencing as well as technology to reduce physical risk, such as anti-wandering systems.

4. Cognitive and social engagement.
If outdoor activity is possible, it remains a preferred option. Otherwise, stretching, card games, cooking, and arts and crafts can be substituted. Human contact, either with a social worker or facilitated online contact with friends and family, is considered essential to reduce isolation.

5. Contingency planning.
Identify the “what-ifs” and related actions for worst-case scenarios including: 1. Sudden acute sickness of patient. 2. Sudden sickness of caregiver. 3. Need for specialist consultations. 4. Preventing caregiver burnout. 5. How to address extreme instances of patient delirium or hallucinations.

Note: SeniorBridge has added some practices based on our collective experience in providing this type of care.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide. 

SeniorBridge offers an integrated care management practice model that involves two components:
1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, nursing home admission, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on dementia home care support services, contact SeniorBridge.

Sources consulted:
Alzheimer’s Journals (2021)
University of California San Francisco (2019)
Alzheimer’s Journals (2020)

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