En español | America's long-term care facilities are ground zero for the coronavirus crisis, accounting for more than a third of the nation's COVID-19 deaths. Although nursing homes have been hardest hit, assisted living facilities have also reported clusters of cases and deaths.
With these facilities in lockdown and the virus spreading rapidly, residents and their loved ones and representatives are desperate for up-to-date information. But getting it can be difficult. When it comes to government data and news reports on cases and deaths, assisted living facilities are often lumped into a “long-term care” or “congregate living” category with nursing homes, memory care communities, independent living facilities and others.
If you have a loved one in an assisted living facility, here are some key questions that experts recommend asking. (Here's a separate list of questions for nursing homes.) In seeking answers, “be very energetic,” says Eric Carlson, an attorney with Justice in Aging, a national nonprofit legal advocacy organization.
"Call as much as possible,” he adds. If you can't get through by phone, try emailing. And if that fails, contact the office of your state's long-term care ombudsman, which can help with complaints and refer you to the appropriate regulatory agency in your state.
1. Has anyone at the facility tested positive for COVID-19?
Inquire about residents, staff, vendors and anyone else who has access to the facility. If COVID-19 has been detected, ask how many people have tested positive, to give an idea of the level of the outbreak.
Also ask about who's being tested and how often. To identify positive cases, facilities need to be testing regularly. But assisted living facilities are less likely to have access to testing than nursing homes right now, Carlson says. Follow-up questions are important to get the full picture.
2. What is the facility's communication plan?
Nursing homes, which are federally regulated by the Centers for Medicare & Medicaid Services (CMS), are required to alert residents and their families or representatives of a positive COVID-19 case by 5 p.m. the next day following the occurrence. But assisted living facilities, which are regulated at the state level, may not be; requirements vary from state to state.
"The nursing facilities rules don't apply at all,” Carlson says. “CMS doesn't have any jurisdiction. So you really want to question what their protocol is in terms of notifying you of a positive COVID-19 case.” Ask both how and when the facilities will be contacting you if a case is confirmed.
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3. What is the facility doing to prevent infections?
Ask how staff members are getting screened; how the facility is being sanitized; how residents are being educated on handwashing and cough etiquette; and what social-distancing measures are in place.
Inquire about the stock of personal protective equipment (PPE) — masks, face shields, gowns and gloves — as there are nationwide shortages. If the facility doesn't have adequate levels of PPE to keep residents safe, ask what the plan is to obtain PPE and what safety measures are in place in the meantime. Also check whether the staff has been trained in how to properly use PPE.
Ask about visitation, too. Although the CDC is recommending assisted living facilities follow the federal ban on nonessential visits that applies to nursing homes, state regulations may not be as strict.
4. What level of medical care is the facility capable of providing?
Nursing homes tend to provide more medical services, particularly skilled nursing, than assisted living facilities.
"Generally speaking, people living in assisted living have fewer care needs than those living in nursing homes, so there are usually fewer staff available,” says Lori Smetanka, executive director of the Consumer Voice, which represents consumers on long-term care issues. “Staff education levels are often less than that of nursing home staff,” she says. And without federal standards, assisted living facilities may not be required to have a registered nurse on site, unlike nursing homes.
So it's important to gauge what medical care is available, COVID-related and otherwise, while facilities are in lockdown, Smetanka says. And if medical staff members are on site, ask how much extra services will cost. “Be aware of the terms of your contact,” Smetanka says.
If more specialized care may be needed away from the facility, learn about the protocols around reentry. “Getting back into a facility is much more fraught than leaving one,” Carlson says. “You would absolutely want to have a conversation about that so you don't have a surprise situation where the facility says that they're not taking back your mom or dad.”
Also ask about the staff, says Chris Corrigall, vice president of life enrichment at Aegis Living, which owns and operates 32 assisted living and memory care communities. Make sure there are adequate staffing levels and a plan to retain staff. “They are working on the front lines of this pandemic with the most vulnerable population in the United States,” he says. “How a company cares for its team is a good representation of how it's going to care for its residents.”
5. How are healthy-living programs being maintained?
Ask how traditionally communal activities like eating, exercising, socializing and entertainment are being adapted for social distancing, advises Amy Goyer, AARP's caregiving expert. “Also work out if services have been cut, be it physical, occupational or speech therapy, or visits from social workers or activity staff,” she says, as this can affect the residents’ health and well-being.
Ask what the facility is doing to facilitate social connections both internally and externally. “The social aspect is really difficult because of social distancing,” says Corrigall. “But socialization is really, really important.” Ask how you can regularly contact your loved one via phone or video call and whether window visits can be arranged.
Also ask about receiving regular updates on this “experience side” of the facility, Corrigall says. A coronavirus communication plan should, of course, focus on COVID-19 infection updates, but it should include information on other key areas, too.