COVID-19 visitor restrictions may be even harder on residents of assisted living homes than on those in long-term care because of the vital role family caregivers play in helping with essential care tasks, according to Matthias Hoben, an assistant professor in the University of Alberta’s Faculty of Nursing.
“In assisted living, the residents are more independent and don’t receive as many services, including 24-hour nursing care, so families are involved at a different level, carrying out more tasks for residents than they would in long-term care,” Hoben explained.
“When you implement visitor restrictions and families can’t visit and do these essential tasks, then the residents’ needs are not being met as well as they were before.”
Hoben said that gap has a direct effect on the quality of life for residents. But so far most reports of the gap have been anecdotal, so he is leading a research project to quantify the problem, with a survey for families of residents in assisted living and another for those who run assisted living homes in Alberta and British Columbia.
“We don’t have data that differentiates between long-term care and assisted living because most reports lump them together,” said Hoben. “We do know that in Canada over 85 per cent of all deaths have occurred in these congregate living settings for seniors—a number that is higher than in all other comparable countries.”
Important differences in care delivery
Assisted living and long-term care facilities (often called nursing homes) can appear very similar on the surface, Hoben said. Both offer seniors housing, meals and recreational activities, but long-term care includes 24-hour nursing care as well.
“These are the oldest patients who have the most complex care needs, the most cognitive and physical impairments, and multiple chronic diseases,” Hoben said. “The proportion of residents in long-term care with cognitive impairments such as dementia is up to 90 per cent.”
Assisted living was designed to keep people out of more expensive long-term care by offering a more home-like setting with more privacy and independence, but the staffing level and skill mix are lower, Hoben said. People in assisted living often rely on their families for socialization and to get them to doctors’ appointments or arrange for home care nursing visits.
“Locking out visitors may have had unintended consequences—not just loneliness and social isolation, but also a lack of advocacy and hands-on care normally performed by family members,” Hoben said.
Planning for future outbreaks
The survey for family members asks about their involvement in assisted living residents’ care before and during the COVID-19 pandemic, assesses their mental health and tracks how facilities have communicated with them.
“Many facilities have developed excellent practices, facilitating phone and video calls and integrating family members into their decisions to implement restrictions, while others have struggled,” Hoben said. “Our goal is to bring the pieces together and show how the whole system has been affected.”
Hoben said the different needs of those in long-term care and assisted living during a crisis must be understood to prepare for future facility-wide outbreaks such as the flu or gastrointestinal infections, which are common, as well as for possible future pandemics.
Right now, as facilities wait for the COVID-19 vaccine, Hoben recommended rapid testing be made available to identify and contain outbreaks as quickly as possible, and he suggested nursing and medical students could volunteer to teach care aides and family caregivers how to use personal protective equipment properly.
Hoben is a member of Translating Research in Elder Care, a U of A-based research program focused on developing solutions for improving the quality of care provided to nursing home residents, enriching the work life of their caregivers and enhancing system efficiency in Alberta and British Columbia. The research is supported by the Alberta Innovates COVID-19 Rapid Research Fund.