En español | In mid-April, Lori Vaughan's 85-year-old mother fell and broke her hip. She spent 13 days in the hospital before returning to her home in Connecticut with a live-in nurse in tow. Vaughan — who hadn't seen her mother since before the coronavirus hit the U.S.— spent the following month trying to determine how to safely see her. Finally, on Mother's Day, she packed her three kids into the car and drove nearly four hours round-trip so that she could surprise her mom with a “ridiculously short” visit. Everyone wore masks and remained outside.
"I think it was worth it, but we haven't figured out a long-term strategy,” Vaughan says.
Although stay-at-home orders are easing up in some parts of the country, questions about whether it's wise to visit older relatives still loom large. Seniors who contract COVID-19 face a high risk of developing dangerous complications, and it's possible to be carrying the virus and transmit it to others even if you don't feel sick. Yet isolation also has serious ramifications: Before the pandemic, an estimated 24 percent of adults 65 and older who live independently (not in nursing homes) were already suffering from isolation and loneliness, according to a report from the National Academies of Sciences, Engineering and Medicine.
"We already had a crisis of loneliness; this pandemic has blown it wide open,” says Alicia Arbaje, an internist, geriatric medicine specialist and researcher at Johns Hopkins University School of Medicine.
Social isolation clearly impacts mental well-being, but it has also been associated with an increased risk of stroke, heart disease, dementia and premature mortality. Those who maintain strong social bonds, perhaps not surprisingly, generally lead longer, happier and healthier lives.
While technology has been helping many families stay connected despite being physically separated, few would argue that FaceTime is as enjoyable as a real-life visit. And video chats simply won't cut it if you have an elderly parent who relies on you to stock the kitchen with food, water the lawn or take out the garbage. Managing these kind of logistics while keeping your distance is even more complex when the older person's cognitive skills are compromised.
Winnie Scherer, of upstate New York, has long worried about her elderly mother, who lives alone and has Alzheimer's disease. The threat of the coronavirus hasn't stopped her from visiting her mom and dropping off groceries. But for now, she and her daughters stay firmly planted on the deck. “She tries to coax us into going inside; she doesn't understand why we won't,” Scherer says.
Balancing the risks
Because experts believe the coronavirus is being spread by asymptomatic carriers (in addition to those who feel sick), any in-person visit carries some level of risk. “As much as possible, we should still be trying to limit contact with elders in order to keep them safest,” says geriatrician Christine Kistler, an associate professor of family medicine and geriatrics at the University of North Carolina School of Medicine. That said, she admits that there are some situations in which maintaining contact or reinstituting it after a long separation might be the right move.
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Arbaje agrees. “This pandemic is not over, but now that it's so prolonged, we have to make trade-offs,” she says. “Although there is asymptomatic and presymptomatic spread, I think if you have been feeling well and taking good precautions, and have access to protective gear, then you can try to resume some kind of [real life] connection.” Here's how.
Consider the likelihood that you're infected. No one's risk of carrying the coronavirus is zero, but if you've been healthy and at home for at least two weeks — you haven't even set foot in a grocery store — then the chance of you carrying the virus should be relatively low, Kistler says.
Prep the kids ... or leave them behind. Don't risk bringing young children to Grandma's house unless you're confident they understand that they won't be able to go inside or to hug her, Arbaje says. “You have to be really careful about how you talk about it. You don't want kids to feel like they're bad or dirty. They should know that what you're doing is out of love, not fear, and that it's temporary.”
Don protective gear. At a minimum, that means keeping a face mask on during your encounter. Your loved one should wear a mask, too. Arbaje also advises using some sort of eye protection, whether it's safety goggles or a regular pair of sunglasses. Although people can catch COVID-19 by inhaling infected droplets, it's also possible to transmit it by touching the virus and then touching your eyes. Masks and eyewear serve as physical reminders to keep your hands away from your face. Gloves may also be worthwhile in certain instances, such as if you're going to be handling your loved one's groceries.
Stay outside if possible. Some preliminary research suggests that virus transmission is less likely outdoors. It's definitely less likely if you make a point of staying at least 6 feet or more away. “If I'm getting as close as 6 feet, I'd keep a mask on,” Kistler says. “If you're sitting 20 to 30 feet across the yard or porch, then you probably don't need to.” If you have no choice but to go inside the house — perhaps you need to change a light bulb that your loved one can't reach or find an important bill she needs to pay — take your shoes off, keep your mask on, and wash your hands right away. And keep the older adult away from you, if possible, in another room, Kistler says.
Make it quick. The longer you're together, the greater the chance is of passing along the virus, if you are in fact carrying it, Arbaje says. “If you're talking through a closed window, it probably doesn't matter; otherwise, the longer you're exposed to the person, the higher the risk is,” she says. “About 15 minutes seems to be the cut-off point for what's considered ‘prolonged exposure.’ “If you're going to linger longer, be sure to stay at least 6 feet apart.
If you opt to hold off on in-person visits for now — which, as far as COVID-19 transmission is concerned, is the safest option — be sure to find ways to stay connected to each other so that you're physically distant but not absent from each other's lives. You should also encourage your loved one to tap into a wider network of friends and relatives remotely.
"My mother is 70, and she and her girlfriends have been having Zoom chats,” Kistler says. “I think maintaining a good social life, even while physically distancing, is vital to human health.”