COVID-19 Forces Home Care Providers to Take a Tailored Approach to Dementia Care

Over the past few years, many home care providers have launched specialized dementia care business lines as a means to simultaneously boost their bottom lines and enhance quality of care.

But amid the COVID-19 virus, these providers have had to adapt and tackle additional challenges compared to peers.

Older adults are especially vulnerable when it comes to the coronavirus, with a higher risk of facing severe illness after being exposed. Additionally, older adults have the highest rates of dementia, including Alzheimer’s disease.

Nationally, there are more than 5 million people age 65 and older living with Alzheimer’s — a number that is estimated to grow by roughly 14 million by 2025, according to statistics from the Alzheimer’s Association.

In normal circumstances, dementia care is about exercising individuals’ brain power with new activities and daily tasks. A typical pillar of dementia care programs is also creating tailored approaches to care for each and every client.

“A perfect example is that not everybody likes arts and crafts,” Patti Walter, owner of Right at Home Northern Colorado, told Home Health Care News. “Not everybody likes puzzles. So a lot of times, in cognitive support, why do we want an individual to do a puzzle? We want them to do something that they aren’t normally doing. That’s why we focus on person-centered care.”

Omaha, Nebraska-based franchise company Right at Home boasts a network of more than 500 U.S. locations. Right at Home and Right at Home International are wholly-owned subsidiaries of RiseMark Brands, also based in Omaha.

Right at Home Northern Colorado, in particular, has been providing home dementia care during the public health emergency through its certified cognitive support program. The program takes a tailored approach to provide care, creating individualized care plans for seniors.

“The key to our approach is looking at their ability,” Walter said. “What can they do, and how can we empower them in their environment? This means that we have to know the individual. We spend a lot of time during the home assessment, talking to both the family and client before coming up with a plan of care.”

For Right at Home Northern Colorado, these care plans are ever-evolving, leaving room for enhancements and improvements. Every 90-days, an individual’s care plan is reviewed with both the client and family to see if goals are being met.

Since the outbreak of the COVID-19 virus, Right at Home Northern Colorado has seen increased agitation and sundowning among clients — two common symptoms in people with dementia. Sundowning is increased confusion that takes place during the late afternoon and into the night.

“Part of what we do in our program is to work with the family and educate them on reducing agitation,” Walter said. “These are difficult times. We, the individual that doesn’t have dementia, can change. If we see something that’s not working, we need to be flexible.”

It’s also crucial that providers caring for seniors with dementia keep a close eye on changes in behavior or worsening symptoms, as this could be a signal that the senior has contracted COVID-19 or a sign of increased anxiety, according to the CDC.

Right at Home Northern Colorado stresses the importance of consistency. For example, it’s imperative that clients remain with their usual caregiver.

Another challenge in-home care providers face during the COVID-19 emergency is related to the use of personal protective equipment (PPE).

While most home care clinicians and caregivers have taken to using PPE, for seniors living with dementia, it may be difficult to remember the need for new safety procedures, such as wearing masks. Additionally, a caregiver wearing a mask may be an unfamiliar and scary experience.

Traditionally, masks and other PPE have been infrequently used in home care.

“One of the things we’ve had to do with some of our dementia clients is to make the decision that we can’t wear a mask with them, because that frustrates them,” Walter said. “It scares them. They are already confused. They’re not going to understand that there is this virus out there.”

One method for caregivers who must wear masks is to begin the visit without one in order to establish normalcy and engage with the senior. After this, explain to them that you have to put on a mask, answering their questions as they arise.

“It’s the first time for [the senior] even though this is exactly what I’ve done three out of the last five days,” Teepa Snow, owner and trainer at Positive Approach to Care, said in during a recent CareAcademy webinar. “It’s like groundhog day with my PPE. I have to introduce it all over again.”

Positive Approach to Care is an Efland, North Carolina-based company that provides dementia care training, services and products across the globe.

Caregivers can also employ other methods, such as turning their body sideways when speaking to a senior with dementia, according to Snow.

“The reason I turn my body sideways is twofold, It gives [the client] a chance to see beyond me and realize I’m not blocking [them] in,” she said during the presentation. “And that I’m not trying to lean in on [them]. That’s really important when someone is just getting comfortable with you and trying to decide if they are okay with you being around.”

Getting dementia clients to understand the importance of frequent handwashing, a strategy to prevent the spread of the virus, is another obstacle caregivers may face.

“How do you get them to wash their hands,” Walter said. “You make a game out of it. You figure a unique way to engage each person.”

Another avenue for home care providers to consider is collaborating with adult day centers to explore options during the COVID-19 emergency.

In some ways, home care and adult day are natural allies when it comes to caring for seniors.

“The most significant way day programs and home care providers can work closer is by creating programs that really lend themselves to more continuity between them,” Scott Tarde, CEO and executive director at George G. Glenner Alzheimer’s Family Centers, told HHCN. “It’s not a competition. … It’s about how we can achieve the best outcomes.”

Chula Vista, California-based George G. Glenner Alzheimer’s Family Center is not-for-profit organization that provides adult day care and support services to families affected by Alzheimer’s and other forms of memory impairment disease.

George G. Glenner Alzheimer’s Family Center formed a partnership with home care provider Senior Helpers in 2018.

Collaborations, such as this one, are a potential breeding ground for innovative care models and will be crucial moving forward, as home care continues to navigate the public health emergency.

“With a little innovation and a specific focus on positive outcomes, there’s a true opportunity to create a much stronger partnership between day programs and providers throughout the country,” Tarde said. “The way I see it is it’s like a puzzle. When you take a hybrid approach, the outcomes can be impressive.”