Long-term care facility residents and staff have represented about 40% of COVID-19 deaths in the United States. At the same time, the year-long visitation restrictions also took a tremendous toll on residents, family members, caregivers, and facility staff, especially with residents with Alzheimer’s disease or other dementia.
“Ongoing changes and restrictions related to COVID-19 impacted our most vulnerable population,” said JoMonica Taylor, Director of Residential Facilities Division in the Bureau of Community Care. “Amidst staffing shortages, increase in infection rates and lockdowns, facility’s staff remained a physical, emotional, and spiritual support to the residents, especially those with Alzheimer’s and dementia.”
DHEC worked with facilities over the past year to combat the spread of COVID-19 and find ways that facilities could still offer a connection between residents and loved ones, including tablets and other telecommunications, window visits, and isolation barrier visits.
Long-term care facilities in South Carolina are now required to allow visitation at all times for all residents in accordance with DHEC guidelines, including indoor visits, outdoor visits, compassionate care visits, and window visits. With long-term care facilities reopened and widespread vaccine availability, DHEC leaders that oversee these facilities express their appreciation to facility staff.
“DHEC would like to take this opportunity to express our appreciation to the facilities and their staff for their commitment to taking care of and keeping safe one of our most precious populations during this past year of uncertainty and change,” said Angie Smith, Director of the Bureau of Community Care. “DHEC stands along with the facilities and their staff and their commitment to the health, safety, and wellbeing of the Alzheimer’s and Dementia population.”
As a reminder, DHEC continues to help administer CMS’s Civil Monetary Penalty (CMP) Reinvestment Program, which supports projects that benefit nursing home residents and improve their quality of life. Many of the projects are designed to help alleviate and comfort residents suffering with dementia.
More information on the program and how entities can apply for funds to support an eligible project are available on DHEC’s website here.
DHEC recognizes Alzheimer’s and Dementia Staff Education Week by highlighting the importance of the training and education of the exceptional staff that care for patients all across South Carolina, including in nursing homes, community residential care facilities, and providers, such as in-home care providers and home health agencies. DHEC’s Healthcare Quality regulates 207 facilities that offer memory care services.
Providers and staff at Alzheimer’s care facilities are always learning as much as possible on how to both better prevent and improve treatments for dementias, but they have also been faced with the new challenge of educating themselves on COVID-19 infection control and prevention. These individuals have had to quickly adapt to evolving requirements and recommendations regarding physical contact, visitors, and daily routines for patients.
Changes to routines, use of unfamiliar personal protective equipment (PPE), and disruption to daily schedules are enough to confuse anyone, but Alzheimer’s and dementia patients are at an increased risk of depression and worsening behavioral changes, such as agitation, aggression, and wandering.
DHEC is proud of the amazing providers and staff at these facilities who have helped make these new transitions easier for Alzheimer’s and dementia patients, while still prioritizing their treatments and care. We have witnessed families and caregivers working with providers and Alzheimer’s care facility staff to develop new ways to improve the mental health of their loved ones suffering from dementias as well as their physical health.
DHEC celebrates these individuals and strongly encourages the community to continue to learn more about Alzheimer’s and dementia in order to help improve lives.
Know the Signs
Besides celebrating the individuals that care for people with Alzheimer’s disease and other dementias, DHEC’s Healthcare Quality wants you to know the onset signs of such healthcare concerns. According to the Alzheimer’s Association, some signs and symptoms that could indicate the onset of dementia or Alzheimer’s may include:
Memory loss that disrupts daily life
Challenges in planning or solving problems
Difficulty completing familiar tasks
Confusion with time or place
Trouble understanding visual images and spatial relationships
New problems with words in speaking or writing
Misplacing things and losing the ability to retrace steps
Decreased or poor judgment
Withdrawal from work or social activities
Changes in mood and personality
Upon receiving a diagnosis, caregivers and their loved ones are faced with a long list of questions. How long until the disease progresses? Can I afford long-term care for my loved one? How can I anticipate their needs?
Now facing the reality of living with COVID-19 for the foreseeable future, new concerns and fears start to emerge as well. It is due to the industrious efforts and ongoing education of providers and staff at Alzheimer’s care facilities and in the community that these patients can be cared for with the utmost respect, knowledge, and safety.
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.
It is not easy to care for a person with Alzheimer’s disease or related dementias. Frankly, it can be challenging. People with dementias might stop recognizing their caregiver or even have trouble feeding themselves, using the restroom or bathing.
According to the Centers for Disease Control and Prevention, Alzheimer’s disease and related dementias are now the sixth leading cause of death overall and the fifth leading cause of death among those over age 65. The CDC says nearly 6 million people in the United States are living with Alzheimer’s, a number predicted to nearly triple by 2060.
As the number of people with Alzheimer’s continues to increase so will the need for caregivers. And those caregivers will need guidance and resources to meet the challenge.
Tips for caregivers
With November being National Alzheimer’s Month, this is a good time to encourage caregivers and provide them with helpful tips. Here are some tips from the CDC website:
You might not be recognized. Sometimes people with Alzheimer’s disease or related dementia may forget certain people while remembering others. Try not to take it personally if you aren’t recognized.
Try to meet the person where he or she is. It’s best not to correct an Alzheimer’s patient about what year it is, where they are, or other things. This can cause agitation and reduce trust.
Routine is important. Alzheimer’s patients are usually most comfortable with what they know and are familiar with. Try to avoid major changes.
Discuss behavioral changes with the doctor. Some behaviors, such as aggression, can be related to undertreated pain, or may be side effects of various medications.
Above all, practice self-care. Your loved one needs you to be healthy to provide the best possible care.
More information and resources
The CDC provides various resources for caregivers of persons with Alzheimer’s disease or related dementias, including Dementia Dialogues — a program that began with the University of South Carolina’s Prevention Research Center.
Visit the CDC’s website for more information and resources for caregivers of people with Alzheimer’s.
Vernon Williams had begun to forget little things. He would begin driving, only to realize he couldn’t remember how to get to where he was going. Trips to the refrigerator ended in frustration. After church, people he had known for years greeted him. But he couldn’t recall their names.
“I just couldn’t remember exactly,” he said.
He wasn’t even thinking about Alzheimer’s disease then. Now, it’s his reality. Williams, 84, began to notice the early signs of the disease about two years ago.
That yellow film covering every conceivable outdoor surface signals two truths: Spring is right around the corner and pollen allergy sufferers are miserable.
It’s not just your imagination, there’s a lot of pollen out there. In fact, “the current pollen count is between the ‘high’ and ‘very high’ range,” according to a statement published Tuesday by Charleston Allergy and Asthma.
Three local allergists offer answers about the best allergy medicines, how genetics play a role in seasonal allergies and, perhaps most importantly, when we can expect all this pollen to disappear.