Prevention and caring strategies
Those who have done some planning and made arrangements ahead of time fare far better should the worst happen, than those who have not. Not only is an ounce of prevention worth a very big pound of cure, but in the distress of bad news, should it happen, it’s nice to have all the supplies you need at the ready and a plan for what you will do. Clear thinking is not at its strongest when we’re dealing with something as scary as an active case of COVID-19.
Here are strategies to help you ahead of time:
- Current mask guidelines – The virus changes over time, which means we need to adapt. Stay up-to-date on the latest guidelines from the Centers for Disease Control (CDC) regarding the most effective mask strategies.
- Cleaning and disinfecting – CDC infographic
- Connecting with doctors. Ask how to handle up-coming appointments, especially those for monitoring or treating chronic conditions. Ask about signs that a problem is developing and what you should do. Find out about telehealth options.
- Stocking up. Shortages may occur, and even online delivery services are having later than usual shipping dates. Help your loved one stock up on the following:
- Medications. The recommendation is to have a 90-day supply. Doctors and pharmacies are making it very easy to get 90 day’s worth. They understand the value of stocking up.
- Groceries. Try to have several weeks’ supply on hand.
- Medical supplies (hearing aid batteries, ostomy supplies, oxygen, etc.) Confirm any changed delivery patterns due to the pandemic.
- Getting prepared in case of illness
- Supplies list for the home and sick room
- Planning steps for patients and families – Prepare to Care in conjunction with the National Patient Advocate Foundation. Emphasis is on those who live in a single family home or apartment. Includes planning for medications, money and bills, pets, choosing a medical decision-maker, and what to bring to the hospital if things get serious.
- Checklist for Older Adults – CDC. Emphasis is on those who live in long-term care facilities (retirement communities, assisted living, continuing care retirement communities…). Includes getting ready in case you get COVID, if there is an outbreak in your community, advice for administrators and staff (useful for families to know what questions to ask), and advice for families of residents.
Caring for someone who is sick
What if you, the primary caregiver, gets sick?
Clearly you must take care of yourself (see the 10 steps for managing at home), but you also need to have a plan in place for others to step in for a few weeks and manage the things you currently do for your loved one. A Care Manager can help with this. Give us a call at 707-477-0700.
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- Start by making a list of all the things you do and who might be able to take over in your stead:
- Fill pill boxes and order prescription refills
- Grocery shopping and other errands
- Monitor and order medical supplies
- Monitor and help to manage symptoms of chronic conditions (daily blood pressure and weight check, insulin testing for diabetics). Knowing when to call the doctor
- Pay bills and manage money
- Provide transportation to the doctor
- Work with the doctors and special therapists (physical therapy, speech therapy), home health or hospice nurses.
- Coordinate with outside services (home care, oxygen, meals on wheels, gardeners)
- Help with cooking and cleaning
- Assist with bathing, grooming, dressing, eating, toileting.
- Write instructions for things that are especially complicated. Concentrate only on those things that truly need to be done a particular way (e.g., a medical procedure, making a telehealth appointment). This is an extraordinary time, so allow leeway for things to be done differently from the way you might prefer. If there is not a long-lasting consequence to a deviation in method, that’s okay. The important part is that the task is accomplished rather than forgotten.
- Pick someone to coordinate all the helpers. It’s a job to orchestrate all the helpers and be sure everyone is coming through with their parts. Who would be best for this? Give them a call and ask if they can step in. Explain your list and answer questions. (You might also want to pick an alternate in case your first choice is also down with the coronavirus.)
Daily life and social distancing
Social distancing is an important first strategy to reduce the spreading of the virus. It’s something we can all do to pitch in. Social distancing results in fewer cases of COVID-19. Most importantly, it helps to ease the crush on health care workers and hospitals by avoiding a big spike in cases.
Your loved one has the best chance of getting through this if we can “flatten the curve” so there are enough resources (ventilators, masks, staff) to care thoroughly for any of us who need the help.
Over the months we will likely go through several waves of social distancing and shelter-at-home orders.
On a practical level, these strategies do bring up many questions about the safest ways to go about our daily lives. Below are suggestions for common situations:
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- Running errands – CDC infographic. Includes shopping for food and other household essentials, accepting deliveries and takeout orders, banking, getting gasoline, going to the doctor and getting medicine.
- Grocery Shopping and Online Deliveries – Consumer Reports
- Pets – So far there is no evidence of pets transferring the virus from one human to another, or even one animal to another. And while an extremely limited number of cats and dogs appear to have tested positive for COVID-19, the form of the virus they can get does not seem to be as deadly. Nevertheless, the Centers for Disease Control and the American Veterinary Medicine Association both recommend that you treat a pet like a member of the family.
- If there is a sick person in the household, have someone else care for the pet.
- Part of preparing is to have 30-days’ worth of food and supplies on hand.
- Last, just to be safe and protect the pet, keep it out of the sick person’s room (sadly, no snuggling).
- 10 minute at home exercise videos – AARP. Exercising just got easier! Follow along with any of these short workouts. No gym required!
- Stretch and tone
- Total body workout
- Chair yoga
- Lower body strength training
- Stretch and energize
- Cardio Sculpt
- Pilates workout
- Core strength
- Arms and Abs
- Upper body workout
- Energizing yoga
- Body toning circuit
- Indoor walking workout
- Activities. Boredom and a lack of purpose commonly lead to depression. Below are just a few ideas to help you prompt your loved one to stay mentally active and engaged:
- Check the local Senior Center for virtual classes. Many are responding with Zoom versions of their balance and chair yoga classes, book clubs and other “gatherings.”
- Pen Pal Programs: Writing to others is a great way to get outside your own situation, and to learn more about what’s happening, even around the world. Look for a pen pal program that protects privacy and has policies in place to keep the dynamics family-friendly. For examples, check out PenPal World (email only) and Global Pen Friends (snail mail and email). Or see if the local school has set up a pen pal program to help seniors connect with students who are also having to shelter-in-place.
- Free online games: From crosswords and scambles, to mahjong and solitaire, AARP offers free online games. Even some “arcade” games. No membership is required. Those who are paid AARP members also have access to the organization’s “Staying Sharp” brain games that focus on memory, decision-making and strengthening cognitive abilities.
- Tour World Class Destinations: Many of the world’s most visited sites are making virtual tours available for free. From hosted tours to live cams, your loved one can travel even while sheltering at home. Check out this sampling of the many options available.
- Write a life review: Use the online tools at Story Corps with prompting questions and the ability to upload photos. All stories are saved in the American Folklife Center at the Library of Congress in Washington, DC. Consider trying their new “Story Connect” program that allows a family member to conduct the interview in real time and create and store a 40 minute recording.
- Free social calls: Sponsored by Covia, a non-profit, public benefit organization, volunteers are vetted and background checked and then given training to conduct free one-on-one phone calls to engage isolated seniors.
- Free telephone classes: Free telephone classes sponsored by Covia, a non-profit, public benefit organization. Registered participants call in via a toll-free number at a set time each week, with some groups also offering the option to connect via computer, tablet, or mobile device. Most groups last 30 minutes to an hour and involve 12 participants. Classes cover a wide range of topics from art to zoology, music or meditation.
- Learn from the masters – Listen to Frank Gehry speak about architecture and design, gain chess insights from Gary Kasperov, learn about story-telling and humor from David Sadaris, or the art and soul of guitar from Carlos Santana. Over 80 masters of their craft are featured on the Master Class subscription (annual fee to gain access).
- Tips for the Sandwich Generation of family caregivers – National Alliance for Caregiving. Are you caring for aging parents while you still have kids at home? Welcome to the Sandwich Generation! This handout includes information on staying informed; talking with your kids; organizing your “care squad”; making contingency plans; talking to your boss.
- Stress and Coping
- Outbreaks can be stressful! – CDC. Includes ways to cope with stress, common emotional reactions; feelings when you have been quarantined with COVID;
- Emotional health – CDC. Includes taking care of your body; connecting with others; taking breaks to unwind; staying informed; avoiding too much exposure to the news; seeking help when needed.
- Coping with Cabin Fever – Healthwise. 10 tips to keep yourself in emotional balance and still stay safe.
- Don’t forget to take care of yourself! – Family Caregiver Alliance. Includes strategies for reducing personal stress; setting goals; seeking solutions; communicating constructively; asking for and accepting help; talking to the physician; starting to exercise; learning from emotions.
- Relaxation tools – Family Caregiver Alliance. Includes breathing exercises; guided imagery; muscle relaxation; mindfulness strategies.
Social distancing presents many challenges. Whether the person you care for resides in an assisted living community that is under lockdown, or lives independently at home, it’s easy for isolation to engender loneliness and depression. These are scary times! But we are social beings and feeling connected can go a long way toward easing the fears that are completely natural under these circumstances.
Video conferencing is an ideal way to beat the blues
It also gives you important clues regarding your loved one’s condition. Studies show that in-person visits are best, but when that’s not possible, connecting via programs such as Zoom, What’s App or FaceTime comes in as an impressive second best.
- Technology not your loved one’s forte? No problem. Candoo Technology, a corporate member of the Aging Life Care Association, has a program where you can order an iPad or phone and have it shipped Zoom- or Facetime-ready to your older relative. Candoo’s patient and friendly tech concierges will walk your loved one through the needed steps so video-conferencing can be an easy option.
- Check out these Facetime and Zoom How To Guides (video and .pdf) for Mac, PC, iPad and iPhone.
7 Ways to Boost Morale – AARP. Maintain your connection by sending snail mail postcards, providing regular physical reminders so they know you are thinking about them. Other strategies include sharing a virtual meal; having snacks and favorite treats delivered; starting a FaceTime book club of family members; sending a jigsaw puzzle of the family; playing a board game together (you must have identical sets, e.g. checkers, chess, Clue, Monopoly…); sending a hobby box with crossword puzzles or supplies for a craft your loved one has wanted to try (e.g., knitting or crocheting).
Working with facility staff to increase connection. If your loved one is on lockdown in an assisted living or skilled nursing facility, it’s important to respect building policy and support the staff in the difficult work they have to do. Below are the things you will want coordinate. (As care managers, we know most of the facilities in town and can make arrangements for you.)
- Inquire about the full range of measures in place to prevent COVID and what measures are planned if there is an outbreak.
- Find out who you can get regular updates from. Ask not only about your loved one’s condition, but also how many residents have contracted COVID to date.
- Ask about any program for helping residents do Zoom, FaceTime or Skype calls. Is there any technology you need to provide? What does it need to have and how does it get safely stored and protected?
- If you are in town, ask if it’s permissible to arrange a visit where you can wave through a window at each other. What would be required? (Wearing a mask? Standing in a particular spot? Arranging a specual time with staff?….)
Careful about Coronavirus scams
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Lonely and understandably scared older adults are falling prey to a new form of fraud: Coronavirus scams. From false promises of cures, or access to testing, to offers for hard-to get supplies (gloves, hand-sanitizer) and fake organizations asking for donations, your loved could easily lose money or give away personal financial information that leads to identity theft. Consider sending this coronavirus scam infographic from the Federal Trade Commission to the person you care for.
Advance care planning
Perhaps your loved one has already prepared an advance directive and named a medical decision-maker. Great! Of course we all hope none of that will be necessary, but just in case, find the document and review it. There may be things that need updating: contact information for decision-makers, or perhaps a change in who is making decisions.
Have your loved one talk with the medical decision-maker about desires should things get serious. (We have some discussion tips and information below that is specifically related to COVID-19). These are sensitive topics. As care managers, we can help facilitate this conversation.
And if the person you care for has not yet completed an advanced directive and named a decision-maker, now is an excellent time to get all of that in place. Let us help. Give us a call at 707-477-0700.
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Public health data and research
For those who want to stay on top of the latest data and breaking developments—or even contribute to scientific understanding of the pandemic—here are important credible resources:
Johns Hopkins Coronavirus Resource Center – Includes data about tests conducted; confirmed cases; and total deaths. All are displayed on a world map by country, a U.S. map by county (updated daily), as well as tracking of trending data displayed by animated maps.
Center for Disease Control – Includes number of U.S. cases confirmed; mortality rates; hospitalization rates and outcomes; and hospital capacity data.
National Institutes of Health – Information on latest studies concerning vaccines, testing, etc.
Stanford University Family Caregiver Study – Share your experience of caring for a loved one during the pandemic. The person you care for does not need to have COVID. This anonymous questionnaire is designed simply to help understand the issues family caregivers face in these unusual times. Your answers may contribute to the development of helpful programs.
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Weighing risks for the unvaccinated
Life is a series of trade-offs. Calculated risks.
In terms of risks, it is the unvaccinated who are getting infected and are ending up in the hospital, and even dying. (Those few vaccinated individuals who do get COVID do not often come down with an infection serious enough to warrant hospitalization.) The recommended federal safety precautions for the unvaccinated remain as they have been—masks, social distancing, vaccination, hand hygiene, avoiding crowds, and seeking well-ventilated venues.
As of July 26, 2021, the CDC specifically recommends that if you are unvaccinated you should:
1. Wear a mask
Wearing a mask over your nose and mouth is required on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and while indoors at U.S. transportation hubs such as airports and stations. Travelers are not required to wear a mask in outdoor areas of a conveyance (like on open deck areas of a ferry or the uncovered top deck of a bus).
2. Stay 6 feet away from others
- Inside your home: Avoid close contact with people who are sick.
- If possible, maintain 6 feet between the person who is sick and other household members.
- Outside your home: Put 6 feet of distance between yourself and people who don’t live in your household.
3. Get Vaccinated
- Authorized COVID-19 vaccines can help protect you from COVID-19.
- You should get a COVID-19 vaccine when it is available to you.
- Once you are fully vaccinated, you may be able to start doing some things that you had stopped doing because of the pandemic.
4. Avoid crowds and poorly ventilated spaces
- Being in crowds like in restaurants, bars, fitness centers, or movie theaters puts you at higher risk for COVID-19.
- Avoid indoor spaces that do not offer fresh air from the outdoors as much as possible.
- If indoors, bring in fresh air by opening windows and doors, if possible.
5. Wash your hands often
- Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
- It’s especially important to wash:
- Before eating or preparing food
- Before touching your face
- After using the restroom
- After leaving a public place
- After blowing your nose, coughing, or sneezing
- After handling your mask
- After changing a diaper
- After caring for someone sick
- After touching animals or pets
- If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
6. Cover coughs and sneezes
- If you are wearing a mask: You can cough or sneeze into your mask. Put on a new, clean mask as soon as possible and wash your hands.
- If you are not wearing a mask:
- Always cover your mouth and nose with a tissue when you cough or sneeze, or use the inside of your elbow and do not spit.
- Throw used tissues in the trash.
- Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.
7. Clean and disinfect
- Clean high touch surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
- If someone is sick or has tested positive for COVID-19, disinfect frequently touched surfaces. Use a household disinfectant product from EPA’s List N: Disinfectants for Coronavirus (COVID-19)external icon according to manufacturer’s labeled directions.
- If surfaces are dirty, clean them using detergent or soap and water prior to disinfection.
8. Monitor your health daily
- Be alert for symptoms. Watch for fever, cough, shortness of breath, or other symptoms of COVID-19.
- Take your temperature if symptoms develop.
- Don’t take your temperature within 30 minutes of exercising or after taking medications that could lower your temperature, like acetaminophen.
- Follow CDC guidance if symptoms develop.
Who is at risk of a serious bout with COVID?
By far and away it is the unvaccinated who are being hospitalized, and dying, of COVID. Getting vaccinated is the best insurance against the virus. This is especially true of those who are high-risk. According to the CDC, in addition to advanced age, high-risk conditions include the following:
- Heart, lung, and kidney conditions
- A compromised immune system due to an organ transplant, medications, or autoimmune disease
How to know if those around you are vaccinated
There is no verification system, so if you are in a public place and worried—for yourself or a loved one—you can’t assume that lack of a mask means a person is vaccinated. Weigh the risks as you have been these past months and make individual decisions based on the doctor’s recommendations and your own assessment of what feels safe, or safe enough.
Local rules prevail
Keep abreast of local infection rates and the recommendations of local health departments. Decisions by state and county health departments will be more attune to the severity of the pandemic where your loved one lives.
Be aware also that individual businesses may choose to be more cautious. For the safety of everyone—their employees and customers—local businesses have the right to require everyone wear a mask in their setting, vaccinated or not.
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"I'm vaccinated! What can I do?"
Local laws, rules, regulations and guidance can be more strict if there is a hot spot in your area. In terms of federal policy, however, based on the July 26, 2021 Centers for Disease Control and Prevention (CDC) update, fully vaccinated individuals* can go mask free in all settings EXCEPT in indoor public settings where vulnerable or unvaccinated people might be present and not have a choice about leaving these situations:
- health care settings
- trains, planes, buses, other public transport
* “Fully vaccinated” means two weeks past the final shot (shot No. 2 of Moderna or Pfizer, or shot No. 1 of Johnson & Johnson).
If you or your loved one have a condition that weakens the immune system, or are taking medications that weaken the immune system, you may NOT be protected even if you are fully vaccinated. You should continue to take all precautions recommended for unvaccinated people until advised otherwise by your healthcare provider.
For a handy reference of do’s and don’ts, download the CDC’s Choosing Safer Activities infographic.
Who is considered “vulnerable”?
The vaccine does not appear to be as effective for those who have a compromised immune system. This means people on medications that reduce immune response—cancer treatments, autoimmune diseases, transplant patients—or people with immune-compromised conditions (for example, HIV/AIDs). Talk to your loved one’s doctor about best strategies, given your relative’s unique situation.
If you feel sick
Even if you’ve been vaccinated, get tested, stay home, and revert to precautions for the unvaccinated, at least until a test confirms that you are COVID-free.
Not much change for the unvaccinated
Good news for the vaccinated, but nothing has really changed for the unvaccinated. There are lots of unanswered questions, in particular about young children who as yet are not eligible to receive a vaccine. Our focus here is on older adults and providing guidance to you as their family caregivers. You will need to check out local mandates about strategies to protect the children in your family.
State and local mandates still apply
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While the federal government has published its recommendations, you must follow state and local regulations. Plus, individual businesses have the right to maintain mask mandates to protect employees or customers who may not be vaccinated.