On May 18, 2020, the Indiana State Department of Health (ISDH) updated its strategies for managing COVID-19 in memory care units, providing clarification on the use of outside caregivers and offering additional strategies for those memory care residents who are moved due to COVID-related cohorting.
Previous guidance stated that care in memory care units could be provided by family, volunteers, or staff. ISDH’s updated memory care guidance clarifies that care in memory care units may be augmented by family caregivers, private personal caregivers, and/or volunteer caregivers if the facility allows such outside caregivers and the resident or their representative provide approval. Long-term care facilities should apply similar restrictions to outside caregivers as with their own essential staff, including regularly screening for symptoms and ensuring adherence to all standard infection control practices.
ISDH’s updated memory care guidance also provides special care suggestions for memory care residents who need to be moved due to COVID-related cohorting and adapt to a change in their environment, as follows:
- Attempt to keep the living environment as familiar as possible, including personal items and surroundings.
- Minimize changes in daily routine.
- Maintain continuity of staff and relationships, as possible.
- Provide all caregivers personal information about the individual allowing for person-centered care.
- Help keep family and friends connected.
- Share photographs of family and friends; play familiar music.
- Assist with eating and drinking.
- Provide activities and a safe space for a person with dementia to walk about.
- Observe and respond to dementia-related behaviors that may be expressions of pain, hunger, fear, frustration, boredom, or overstimulation.
- Provide dementia care training to caregivers assigned to residents with dementia.
The original ISDH guidance issued on April 27, 2020, and updated on May 3, 2020, is listed below:
When a person in a memory care unit is suspected of being positive for COVID-19, ISDH recommends the following:
- Follow the infection control practices outlined in the ISDH long-term care checklist.
- Test all the residents and staff in the memory care unit for COVID-19 as soon as possible. To facilitate rapid testing, requests for an ISDH Strike Team can be made at striketeamrequest@isdh.in.gov.
- While test results are pending, residents are to be kept in the same unit but confined, if possible, to their rooms; roommates can be kept together while test results are pending.
- Once test results are back, residents should be separated based on their test results. The guidance further outlines a cohorting strategy based on the red, yellow, and green approach.
Those facilities that can separate COVID-19 positive from COVID-19 negative memory care residents into separate memory care units should do so. These units should be closed and prevent the socializing of residents with COVID-19 from those without COVID-19.
Those facilities that cannot create separate memory care units for cohorting must move COVID-19 negative residents out of the memory care unit, or move COVID-19 positive residents out of the memory care unit, whichever is least disruptive to the least number of residents. These residents should be moved to other areas of the facility and monitored for symptoms for fourteen (14) days. If possible, these residents should be placed in their own room, but if that is not possible, residents who are COVID-19 negative moving from the same memory care unit may be placed in the same room.
The guidance also states that while non-pharmacological approaches should be used to tailor care and promote safety, such as one-on-one supervision, if the consistent use of non-pharmacological practices is not effective, then the use of psychotropic medications may be appropriate when individuals living with dementia have severe behavioral symptoms that create the potential to harm themselves or others. Continued need for pharmacological treatment should be reassessed as required by the medication regimen or upon a change in the person’s condition.