June is Alzheimer’s and Brain Awareness Month, and DHEC recognizes the vital work that healthcare facilities, healthcare professionals, and caregivers do in providing treatment and improving the quality of life of those afflicted with brain trauma and disorders. There are currently over 95,000 people living with Alzheimer’s disease and other related dementias (ADRD) in South Carolina. According to the South Carolina Alzheimer’s Disease Registry, 25% of the ADRD population in the state resides in a long-term care facility (LTCF), including nursing homes and assisted living facilities, while the remaining 75% live independently or with loved ones in the community.

It comes as no surprise that COVID-19 has been an unexpected hurdle in providing special care to each resident or patient afflicted with these diseases. The risk for persons with Alzheimer’s disease and other dementias poses a unique challenge for caregivers, families, and facilities. Changes to routines, use of unfamiliar personal protective equipment (PPE), and disruption to daily schedules can lead to fear and anxiety resulting in increased depression and worsening behavioral changes, such as agitation, aggression, and wandering. While the Centers for Disease Control and Prevention (CDC) recommends specific guidance to facilities for infection control and prevention, it also recommends keeping environments and routines as consistent as possible for patients and residents suffering from ADRD and other brain disorders.

As facilities and caregivers continue to care for patients and residents, the following tips can help improve brain health for those afflicted with these diseases while preventing the spread of COVID-19:

• Maintain the same environments and routines for the patients or residents while introducing frequent hand washing, social distancing, and use of cloth face coverings (if tolerated).
• Introduce virtual games and activities for enrichment and memory care.
• Use face coverings wisely. Face coverings should not be used for anyone with breathing issues or who is unconscious, incapacitated, or unable to remove the mask without assistance.
• Keep staff consistent in memory care units at facilities.
• Structured activities may need to occur in the resident’s or patient’s room, or be scheduled at staggered times throughout the day in order to maintain social distancing.
• Provide safe ways to remain active, such as staff going on walks around the unit or outside with the patient or resident.
• Limit the number of people in common areas while practicing social distancing.
• Frequently clean often-touched surfaces, especially hallways and common areas.

Those suffering from ADRD may not be able to communicate that they are feeling ill. It is important to be informed and able to recognize symptoms in order to protect our most vulnerable from COVID-19. Early signs to recognize for a patient or resident who cannot communicate their symptoms are cough, shortness of breath, difficulty breathing, fatigue, or vomiting. Emergency warning signs are trouble breathing, new confusion, inability to wake or stay awake, and bluish lips or face.

Family and friends that would still like to visit loved ones in facilities are encouraged to use messaging systems such as emails, phone calls, cards and letters, recorded video messages, care packages, and even song and poem dedications through the facility intercom. The Centers for Medicare & Medicaid Services (CMS)’s Civil Monetary Penalty (CMP) Reinvestment Program is a great funding opportunity for facilities wishing to procure technical equipment for communication purposes. Nursing homes can also benefit from applying to CMS’ COVID-19 Communicative Technology grant that provides funding for residents to communicate with loved ones.

Lexington Medical Center (LMC) Extended Care recently took advantage of this COVID-19 grant opportunity and purchased two iPads and three iN2L tablets for the nursing home. Though the facility encourages families to make phone calls and chat with loved one outside of the facility’s windows, the technology procured through the grant allows more residents the opportunity to connect with loved ones and to do is in the most convenient, readily accessible, and intimate way. The facility already averages 700 calls per month, not including the calls made by residents with their personal devices. The use of the virtual technology for tele-videos, texts, calls, games, and a myriad of other activities connects loved ones together and helps augment the quality of life for these residents, especially those most vulnerable to brain dysfunction and memory loss.

“Without this COVID-19 communicative grant funding and the opportunity for communities to purchase needed devices, our residents might not have the opportunity to see their family nor would their family see them, which could be detrimental to everyone,” states Debbie Bouknight, Lexington’s Life Enrichment Director. “It is both heartwarming and sometimes heartwrenching, but so worth it to see the interactions happen. I feel we would see far more decline in our residents’ physical and emotional well-being if they did not have these video visit opportunities.”

More ideas of how you can connect with loved ones during COVID-19 are available here.

DHEC would like to express its gratitude to all facility staff and loved ones keeping our Alzheimer’s and other dementias population healthy during COVID-19. Residents and patients suffering from these diseases are not just physically vulnerable during this pandemic, but they are also highly susceptible to mental anguish and confusion due to the necessary changes being made at facilities for infection control and prevention. We recognize the extraordinary cooperation between facility staff and families in ensuring excellent care for the quality of life of those afflicted with ADRD, as well as adapting to new forms of communication that keep loved ones both connected and safe.

Links

CDC – Considerations for Memory Care Units in Long-term Care Facilities

CDC – Supporting Your Loved One in a Long-Term Care Facility

USC, Arnold School of Public Health – Alzheimer’s Disease Registry

South Carolina Alzheimer’s Disease Report 2019: Annual Report

Alzheimer’s Association Facts Video