By Bonnie Burman, The Ohio Council for Cognitive Health
and Jennifer Brush, Brush Development and Consultant for the Ohio Council for Cognitive Health


All of us have been impacted by COVID-19 in many ways, both professionally and personally. The presence of the virus has also created some significant challenges for those living with dementia, especially for those living in long term care communities. In addition, as states work to reopen or partially reopen care communities, the common misunderstanding that individuals living with dementia cannot practice social distancing may result in their continued unnecessary and harmful isolation.

Individuals with dementia have the same needs as everyone else—to feel valued and respected. As dementia progresses in the brain, memories of facts and skills for complex thought fade but feelings such as happiness, love, frustration, and sensing respect remain. “Treatment” for dementia is socialization or elimination of boredom.

There are two enemies out there right now: the virus and isolation.

While public health officials at the state and local levels are currently working carefully, diligently and effectively to both curb the spread of COVID-19 and ensure that emergency operation plans for pandemics are in place going forward, social distancing among those living with dementia has posed unique challenges.

The question we are asking is…

“Are misunderstandings about dementia and best practices resulting in less than optimal engagement and unnecessary social isolation during COVID-19?”

And our answer is a resounding…

“YES!”

senior woman feeling isolated

Many individuals living with dementia can practice safe social distancing with the appropriate person-centered care practices and procedures in place. This is especially important now as states move to partially reopen care communities to visitors when social distancing can be practiced.

The Ohio Council for Cognitive Health and Brush Development are suggesting a focus on the following:

4 common misunderstandings about people living with dementia that may result in unnecessary and in fact harmful isolation:

  1. It’s impossible to keep people living with dementia 6 feet apart, so it’s safer to keep them in their rooms all day.
  2. People with dementia will never remember to wash their hands or to keep surfaces sanitized.
  3. Staff cannot effectively communicate with someone with dementia while wearing a mask.
  4. It hard to keep someone with cognitive impairment engaged in something for very long.

This article focuses on these challenges by 1) shedding light on the current issues; and 2) providing examples of responses that address the unique vulnerability of those living with dementia. Most specifically, there are cost effective and responsive ways to adhere to social distancing and other current health and safety protocols that do not result in social isolation and the unwanted/unintended behaviors that may result. We cannot ever be too busy to foster relationships and engage elders living with dementia in a normal, purpose driven day. Unnecessary social isolation as a result of COVID-19 for those living with dementia puts elders at risk for decline in mental and physical functioning, loneliness, and depression when, in fact, many can practice social distancing.

Why is this so important?

This is especially important because the vast majority of elders living in long-term care settings have some cognitive impairment even though it is not always diagnosed. Some of these elders living with significant cognitive changes live in separate memory care units. These units have been recognized for over 20 years but remain largely unregulated in many states. Standards and practices are still being defined and there is little consistency between them.

Approach

The recommendations, and the reframing provided, reinforce CDC published guidelines and provide care communities with evidence based, person-centered approaches and perspectives that will prove to be cost effective over time and will help them fulfill both their priority for safety and their important mission of ensuring maximum engagement for those impacted by dementia. Practical, person-centered approaches that add purpose to the daily routine of staff and residents while keeping everyone safe will be highlighted. These approaches will ensure that well-intentioned efforts of care communities don’t put those with dementia at risk for further cognitive or physical decline. These will include approaches that include engagement but also remain responsive to those who either need to stay in their rooms or apartments or those who want to stay in their rooms. Not everyone wants to be with other people.

What is person-centered care?

Person-Centered Care (PCC) is a philosophy of care that prioritizes the autonomy, enablement and self-determination of the person receiving care. Medical and professional staff as well as family members, partner with each