In a COVID-19 world, some of the tried-and-true guidance for helping aging parents or other loved ones live safely in their homes must be accompanied with new qualifications. Older adults are at a particularly high risk of serious illness or death from COVID-19. Because of that, frequent visits from family, help from friends and neighbors, and some home care and support services may now bring risk as well as help to your older relative—unless the people and activities are managed carefully.
Some fundamental facts remain unchanged, however:
- When an aging loved one begins to lose the ability to handle the daily tasks of life, help needs to be provided.
- When you are providing that help, the extra burden on your time and your emotions can be draining, and you may need help yourself.
- Human beings need social connections to thrive. Deprived of this, and feeling isolated and lonely, an older person’s physical and mental health can deteriorate.
Described in this article are the kinds of help available to you and your older relative as you work together to make his or her home life as safe, healthy, and happy as possible.
Talk with experts.
Start by seeking help from people who know about the range of services and care options in your older relative’s community. A local senior center or government services directory, for example, may help you identify services, some of which may be available at low or no cost. Services available for older adults often include the following:
- Telephone reassurance and friendly visits—Volunteers check in on older people and alert a designated family member if they notice a problem. Video chats or physically distanced outdoor visits can help to relieve social isolation.
- Chore services—Volunteers do odd jobs and minor household repairs. Some may do yard work, such as raking leaves or shoveling snow. During the pandemic, chore services should be limited to outdoor projects, with special care taken in choosing a person to make an indoor repair and ensuring that it can be done safely.
- Meal programs—Lunches for older adults used to be served at schools, senior centers, or other locations in the community, often with transportation to and from the meal. Most communities have replaced these gatherings with home-delivered meals that provide older residents the nutritional benefit if not the social interaction.
- Transportation services—Rides are provided to the doctor’s office or for other needs. These services must now be screened carefully to ensure that appropriate sanitation, distancing, and ventilation protocols are in place, and that they are being followed without exceptions.
- Adult day programs—This is a form of supervised care that is offered outside the home for older adults who can’t safely be left alone or who can benefit from the social contact of a group program:
- Many of these programs closed in the early weeks of the pandemic to protect the health of their senior customers. Some have reopened or have plans to reopen with thorough, virus-prevention measures in place.
- As you consider enrolling or re-enrolling your older relative in an adult day program, take the time to fully understand how the program will keep attendees safe from the coronavirus. Before the pandemic, the programs typically provided meals, activities, social engagement, occupational therapy, and some medical services. Services may now be more limited.
Family, Friends, and Neighbors
If other family members are available, get them involved from the start. Talk by phone or videoconference to understand what help your older relative needs. Have open and honest discussions about how each of you can contribute. Don’t wait to ask for help until you are at the breaking point and desperate.
In normal circumstances, the biggest need might be to have people spend time with your relative, and you’d divide those roles. You’d ask close friends for help, too. With some creativity you would find ways for friends to help that are easy for them and make a big difference to you.
That’s still the case, but how you spend time with your relative and who you allow into your relative’s home has to be considered carefully to minimize the risk of COVID-19. Think about ways you, other family members, and friends can help without coming into close physical contact with your older relative. It might be by
- Shopping for food or arranging for groceries to be delivered and leaving them by the front door
- Delivering a home-made meal (in a disposable, sanitized container)
- Ensuring that someone in the family talks by phone or videoconference with your relative once or twice a day, both for social connection and to help give structure to the day
- Stopping by for front-porch or front-step conversations or short walks outside wearing masks and maintaining physical distance
A core set of helpers, maybe just two or three, might commit to taking special care to avoid exposure to COVID-19 so that you feel safe in having them provide in-person support. These people will be key to providing the social connection your relative needs. They can also check to make sure your relative has a supply of masks and sanitizing wipes, as well as a two-week supply of food and medications.
Consider your older relative’s neighbors in the possible circle of helpers, too. A neighbor might be willing to check in on your relative (at the door or through a window) once a day or a couple of times a week and let you know if there are any problems. Another neighbor might be willing to put your relative’s trash out for collection, or even to shovel snow or rake leaves.
Geriatric Care Managers or Aging Life Care Experts
Geriatric care managers or Aging Life Care experts are professionals who can assess your relative’s needs and coordinate needed care and services. You might hire a geriatric care manager or Aging Life Care expert to assess your relative’s situation and develop a care plan.
You might pay one of these experts to do even more: to facilitate a family meeting, take on the hiring and management of home care workers, schedule medical appointments and transportation, order specialized medical equipment, or arrange for home repairs and modifications. The services of a geriatric care manager or an Aging Life Care expert are often well worth the expense when you live at a distance from your older relative.
Paid Home Care Services
Home care services can be used to provide daily care, or occasional relief or respite, for the primary caregiver. Home care providers can be hired directly, as individuals, or through an agency. These services, too, are now constrained by the COVID-19 pandemic. A new consideration is to find a provider who understands how COVID-19 is spread, takes care when not working to avoid exposure, and follows strict hygiene and safety guidelines while in your relative’s home.
With the exception of medically necessary, skilled nursing care, home care is typically not covered by Medicare and must be paid for by the family. Older adults with limited resources may qualify to have some of these services paid for through Medicaid.
Home care services can be made more affordable with a bit of creativity. If your older relative’s home has the space, you might look for a trustworthy person who is willing to provide a limited range of services, such as making dinner and keeping the home clean, in exchange for a room. If a neighbor and your relative have similar needs and both require only limited hours of care, you might arrange for a home care worker to spend a couple of hours a day in each home and share the cost.
You can’t control a service provider’s life when outside of your relative’s home. During this pandemic, however, it is reasonable to ask questions about a person’s understanding of COVID-19 transmission as part of the screening process, and to choose a person you feel confident will act responsibly to protect your relative from illness.
Paid home care services include the following:
- Companions, aides, and homemakers—Companions keep an older person company. Aides and homemakers also do basic household tasks, such as preparing meals, tidying up (but not heavy cleaning), helping with dressing, making sure your relative takes scheduled medications, driving your relative to appointments, and shopping for groceries and basic supplies.
- Home health aides and nurses’ aides—People with some medical training provide help with bathing, clothing, toileting, and basic medical care, such as giving medications and changing dressings.
- Nurses—Registered nurses (RNs), also called licensed practical nurses (LPNs) or licensed vocational nurses (LVNs), come to the home to monitor an older person’s health, change dressings, give injections, insert or remove catheters, and perform other medical tasks.
Your relative may need other specialized services, such as the following:
- Social workers assess and advise on social and emotional needs and give referrals to community services.
- Nutritionists advise on and create a plan for healthy eating, factoring in medical conditions and the effects of medication.
- Therapists help people regain strength and skills. Occupational therapists help with tasks of daily living. Physical therapists help with muscle strength and flexibility. Speech therapists help with speech and swallowing.
During the pandemic, you’ll want to limit the number of people who come in close contact with your relative. That might mean having a physical therapist train you or another family member to manage your relative’s exercises, for example. It might mean having some of the interactions by video or over the phone.
Hiring and Managing Home Care Workers
When hiring a home care worker, the first choice is whether to hire an individual directly or work through an agency. Costs may be lower if you hire directly, but you will also be responsible for finding a substitute if the person is ill, or a replacement if they leave, and for managing all aspects of the work arrangement. When you work through an agency, you have the confidence that background checks have been completed, substitutes and replacements will be supplied, and insurance and tax withholdings will be taken care of for you.
Substitutes present a special concern during the pandemic, however. If you’re working with an agency and have chosen a person you trust, make it clear that any substitutions must be cleared with you before entering your relative’s home.
As you screen candidates, either individual care providers or agencies, ask about experience and background; be clear about work expectations, hours, and fees; and ask for references. Ask specifically about how a candidate is minimizing their own exposure to COVID-19 and the steps they will take to minimize the risk of the virus to your older relative.
Once you have made your selection, put the details of the work in writing. Be specific about hours, responsibilities, rate of pay, and vacation and sick days. Let the care provider know how often you’d like to be updated on their work and your older relative’s status, as well as how you’d like them to share that information.
When the worker starts, take care to make the arrangement succeed through the following:
- Treat home care workers with respect and kindness.
- Help nurture a good relationship between the care provider and your older relative so that they get to know each other and come to enjoy each other’s company.
- Be flexible in your expectations, and don’t insist that tasks be done exactly the way you would do them. (It’s reasonable and prudent, however, to be a stickler for detail when it comes to protecting your relative from COVID-19. If you’ve found the right person, they’re likely to be even more careful and knowledgeable about this than you.)
- Keep communicating. Discuss any problems and work to resolve them. Share what you notice about your older relative’s changing needs.
- Monitor the work. If you can, drop in unannounced at times to make sure the care or services are being provided as agreed.
- Say “thank you.” Show your appreciation often and praise good work. Small gifts and bonuses are another way to reward this important person in your older relative’s life.
Morgan, H. (2020, August). Helping an older relative who lives at home (C. Gregg-Meeker & B. Schuette, Eds.). Raleigh, NC: Workplace Options.
Disclaimer: This document is intended for general information only. It does not provide the reader with specific direction, advice, or recommendations. You may wish to contact an appropriate professional for questions concerning your particular situation.