Should you move a family member back home from a care facility?

I'll have to learn to walk againAccording to the New York Times (April 17, 2020), about a fifth of U.S. virus deaths are linked to nursing homes and other long-term care facilities. That’s about 7,000 people.

It’s an extremely difficult time for families who have a loved one in a care facility. You’re not able to visit, and you and your loved one might be missing the physical touch that we as humans crave.  You might be too overwhelmed with caring for others at home to make the drive to the care facility, only to be allowed to peer through a window and touch hands separated by glass.

Two of my friends recently lost a parent who was in a nursing facility. Their parents didn’t die from Covid-19. One died from Alzheimer’s (yes, Alzheimer’s is a fatal disease) and the other had dementia and was recovering from a broken pelvis. Neither friend was able to get to the facility in time to say good-bye, partly because of the imposed lock-down on these facilities.

You might be worried that your loved one will contract Covid-19. What should you do?

Should you move your loved one home?

  • Consider why you moved your loved one to a care facility in the first place. Are you able to safely care for him/her at home?
  • How is your health? Have you been sick? Do you have a chronic condition that prevents you from taking on added stress?
  • Are you overwhelmed caring for children who are doing online schooling?
  • Are you working from home?
  • Is your loved one mobile? Continent? Can you bathe and dress him/her? Do they need a two-person transfer?
  • Can you hire in-home care? This option comes with the risk of having an outsider who has possibly been exposed to Covid-19 come into your home.
  • A person with dementia might have compounded anxiety during the pandemic. Anxiety increases when a person with dementia has their routine disrupted. The individual may not be able to understand what is going on, but pick up on the stress of those around him/her. Would you have the patience and time to devote to caring for such an individual?
  • Be honest with yourself, and consider your own health, psychology and emotional well-being.

If moving your loved one is out of the questions, consider these tips from The Alzheimer’s Association.

If your loved one is in a care facility:

By now, almost all care facilities are not allowing visitors through the door. 

  • Check with the facility regarding their procedures for managing COVID-19 risk. Ensure they have your emergency contact information and the information of another family member or friend as a backup.
  • Do not visit your family member if you have any signs or symptoms of illness.
  • Depending on the situation in your local area, facilities may limit or not allow visitors. This is to protect the residents but it can be difficult if you are unable to see your family member.
  • If visitation is not allowed, ask the facility how you can have contact with your family member. Options include telephone calls, video chats or even emails to check in.
  • If your family member is unable to engage in calls or video chats, ask the facility how you can keep in touch with facility staff in order to get updates.

What if the care facility has or had Covid-19 incidences?

  • Ask the facility about their quarantine procedures. What is your level of confidence that CDC guidelines are being followed?
  • How many people in the facility have been impacted by COVID-19? Are those affected staff, residents or both?
  • Is your family member able to follow social distancing procedures (with or without help)?
    • In some cases, the person may not be able to walk or move about on their own. This could help maintain social distancing.
  • Does the facility have and use personal protective equipment?
  • How many staff members interact with your family member on a regular basis? Is the facility able to limit the number of staff who work with your family member?
  • Is the facility adequately staffed to provide the level of care your family member requires?

The Centers for Disease Control has issued these guidelines for nursing home visitation in the wake of the COVID-19 outbreak:

Limiting Visitation: For facilities that are in counties, or counties adjacent to other counties where a COVID-19 case has occurred, we recommend limiting visitation (except in certain situations as indicated above). For example, a daughter who visits her mother every Monday, would cease these visits, and limit her visits to only those situations when her mom has a significant issue. Also, during the visit, the daughter would limit her contact with her mother and only meet with her in her room or a place the facility has specifically dedicated for visits.

Facilities should actively screen and restrict visitation by those who meet the following criteria: 1. Signs or symptoms of a respiratory infection, such as fever, cough, shortness of breath, or sore throat. 2. In the last 14 days, has had contact with someone with a confirmed diagnosis of COVID19, or under investigation for COVID-19, or are ill with respiratory illness. 3. International travel within the last 14 days to countries with sustained community transmission. 4. Residing in a community where community-based spread of COVID-19 is occurring.

Be kind to yourself, and try not to feel guilty about not being able to visit your loved one. Caregiver guilt is complicated, but you are probably doing the best that you can.

This pandemic lock-down is unprecedented. Hopefully, the restrictions will lift soon and you’ll be able to be with your loved one again. Until then, take extra good care of yourself.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Support your lungs with deep breathing exercises

Healthy Human Lungs 2d illustrationThe World Health Organization says about 80% of people with COVID-19 recover without needing any special treatment. But one person in six becomes seriously ill and develops difficulty breathing.

Professor John Wilson, president-elect of the Royal Australian College of Physicians and a respiratory physician says that people develop a fever and cough when the infection reaches the air passages that conduct air from the lungs to the outside. If it gets worse, the infection moves to the end of the air passages. In an article in “The Guardian,” Wilson explains “If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs.”

If the air sacs then become inflamed, the lungs fill up with fluid and inflammatory cells, which results in pneumonia. This condition severely impacts the body’s ability to take in oxygen and get rid of carbon dioxide. And coronavirus pneumonia affects all of the lungs, instead of just small parts.

I don’t know whether the condition of a relatively healthy person’s lungs is a factor in whether or not you would get pneumonia from the COVID-19 virus, but it certainly wouldn’t hurt to paying attention to how you breathe. It’s always a good idea, but it’s more important now than ever.

Breathing is something most of us take for granted.  In fact, the average person breathes 1,261,440,000 (one and a quarter billion) times in a lifetime without thinking about it.  Breathing is so vital to your overall health and well-being that Dr. Andrew Weil, best-selling author, educator and practicing M.D. says: “If I had to limit my advice on healthier living to just one tip, it would be simply to learn how to breathe correctly.”

Slow, deep breathing is probably the single best anti-stress medicine we have, ” says James Gordon, a clinical professor of psychiatry at the Georgetown University School of Medicine and director of the Center for Mind-Body Medicine in Washington.”  When you bring air down into the lower portion of the lungs, where oxygen exchange is most efficient, everything changes.  Heart rate slows, blood pressure decreases, muscles relax, anxiety eases and the mind calms.  Breathing this way also gives people a sense of control over their body and their emotions that is extremely therapeutic,” says Gordon.1

Most of us do not breathe correctly.  Typically our “normal” breathing is shallow. “The result is a vicious cycle, where stress prompts shallow breathing, which in turn creates more stress,” says Gordon.2

Abdominal breathing and pranyama (yoga breathing exercises) are natural, easy ways to increase your energy and feel more relaxed because they accelerate the intake of oxygen.

Here are some breathing exercises that might just help strengthen your lungs and help you to relax during this stressful time.

Abdominal Breathing

Abdominal breathing is done from the depths of the belly, rather than breathing from your chest and nose.  It is a simple method of relaxation that can be done anywhere, at any time.

  1. Sit or lie down with your hands on your stomach.
  2. Inhale slowly through your nose, filling your stomach and then your chest.  Your abdomen should rise as if you’re inflating a balloon.  Allow it to swell and return to normal.  Your chest should move only slightly.
  3. Try to get a rhythm going, counting to 4 on the in-breath and to 8 on the out-breath.
  4. Exhale as slowly as possible through slightly parted lips.
  5. Practice this for about 10 minutes.

Alternate nostril breathing (pranyama)

You’ll notice that one of the nostrils is more open than the other.  Don’t mind this, it’s normal.

  1. Close the right nostril with your thumb.
  2. Breathe in through your left nostril.
  3. Close the left nostril with your third and fourth fingers.
  4. Breathe out through your right nostril.
  5. Close the right nostril with your thumb.
  6. Breathe in through your left nostril.
  7. Repeat the entire sequence and continue for 3-5 minutes.

The effects from these breathing exercises are cumulative, so try to practice them a few minutes each day.  You’ll experience a more settled feeling immediately, and after a week or two you may realize that the mind chatter has quieted down, and that physical tension has diminished too.

Reverend Sharon Shanthi Behl wrote a chapter called “Breath Work” for my book Calmer Waters: The Caregiver’s Journey Through Alzheimer’s and Dementia. This excerpt includes a breathing exercise you can do with a care partner who gets agitated, as well as for yourself.

“When we say we are tired and have no energy, what we are really saying is that our energy is blocked. We need to breathe to live, and how we breathe can profoundly affect our degree of physical well-being; it can regulate our emotions, and it can deplete, sustain, or increase our experience of aliveness.

“Prana is constantly fluctuating and moving throughout the universe. According to yoga philosophy, it flows throughout the living body in exquisitely determined whirlpools and currents. The wonderment of the yogic system is asana and pranayama practice allows our innate energy currents to flow as nature intended.

Here is a lovely pranayama practice to use with an agitated individual who is “sundowning.” You may be familiar with this phenomenon. Mayo Clinic clinical neuropsychologist, Glenn Smith, Ph.D., describes sundowning as a state of confusion at the end of the day and into the night. Sundowning isn’t a disease, but a symptom that often occurs in people with dementia, such as Alzheimer’s disease. Smith lists several factors that may aggravate late-day confusion including fatigue, low lighting, increased shadows, and the disease’s disruption of the body’s internal clock. You might find that focusing your loved one’s attention on this practice calms them, and you. ”

Read these instructions slowly out loud as you demonstrate the movement.

  1. Let us do the Butterfly Breath together.  
  2. Face palms toward the heart center at center of the chest.  Interlace the fingers with thumb pointing up to the ceiling.  Place hands on the chest and keep your awareness at this heart center as you breathe deeply and slowly in and out the nose.
  3. Can you feel your heart beating? Can you feel how much you are loved?
  4. Notice the rise and fall of your breath. Feel the warmth of your hands on your chest.  

Add this option for yourself:

  1. Notice any feelings or thoughts as you breathe naturally.
  2. As you breathe in, see your feelings and thoughts like bubbles of air rising from the bottom of a lake.
  3. Breathe out and imagine the bubbles silently bursting as they reach the water’s surface.

If you are a caregiver, please remember to take care of yourself so you can take care of your loved one(s).

References

  1. Krucoff, Carol. “Doctors Empowering Patients by Promoting Belly Breathing,” Washington Post, June 2000.
  2. Ibid

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

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