Assisted Living Covid-19 Impact Activities of Daily Living for Seniors

Change vs Crisis road sign

Banning visitors from senior care centers increases anxiety through isolation. Stay connected through video calls, phone calls, postcards or even a letter. Free video calls with Google Hangouts, Skype, and others will go a long way towards elevating your loved one’s mood.

How Coronavirus (Covid-19) affects ADL’s, IADL’s and cost-effective healthcare solutions

Activities of Daily Living (ADL’s) are the basic self-care tasks we learn as children and which become almost reflex like. These include bathing, grooming, toileting, feeding, cooking, showers, dressing, ambulation and recently help with memory.

Instrumental Activities of Daily Living (IADL’s) add in tasks that require more cognitive function like making out a check, paying bills, driving, knowing and remembering a route to go from and to, using a phone, and shopping. All of these activities require both physical and cognitive skills and judgement to coordinate many parts. Unlike ADL’s these require more insight and judgement. ADL’s are more instinctual and are often the last to be affected. When ADL’s are affected due to physical or cognitive problems inevitable IADL’s are also affected.

Covid and ADL’s and IADL’s

When we see the corona virus complication added to the evaluation of ADL’s and IADL’s it complicates both. IADL’s in that going out, transportation, shopping all requires more coordination by the individual. If one were marginal at completing those tasks before Corona virus that could push them over the limit by increasing the difficult to complete those tasks.

If a person had a health care issue Corona Virus also can complicate the process of getting medications, medical care, and other supportive health care services. For example, if a family caregiver were sick or a paid caregiver became sick that would directly affect a homebound seniors’ ability to do ADLs and/or Independent Activities of Daily Living. Even short periods of under coverage for a person who has physical and or cognitive issues can have devastating consequences. We all have seen the commercial for medical alerts where the women “have fallen and can’t get up”. That risk rises dramatically when a person who needs assistance can not get it. They will try to walk or accomplish the task they need but with far less certainty than when they had the help they needed.

Worsening isolation especially for patients with Alzheimer’s Dementia and chronic illnesses.

Coronavirus / Covid-19 dramatically worsens isolation, loneliness, and depression. All of those exist to varying degrees in most frail seniors who are experiencing many other losses before we added on the isolation of COVID. COVID fears are VERIFIABLE.

The most negatively impacted are frail seniors with underlying medical conditions. That creates stress for the senior and their family. Families who want to visit and realize that their visits are one of the most positive therapies for the emotional health and wellbeing of their loved ones.

Those family and outside visits help to reduce an EXPECTED sense of abandonment that most seniors who need the services of a care home or nursing home experience. Many try to sugar coat the emotional costs of being sick, but I try to understand and then address them as best we can. No one wants to be in a nursing home, Skilled Nursing Facility (SNF) or an Assisted Living Facility.

Everyone thinks they want to be “at home” where that thought implies LIKE THEY WERE WHEN THEY DID NOT NEED HELP. However, when the supportive services help improve your independence, they accept it as the best Lemonade they can make from the lemons life and health have dealt them. Family, also have to accept those needs and realize that finding a safe, cost-effective, supportive care settling like TLCSR can provide the best, longest term, solution.

COVID adds to those negative feelings of isolation, loss, fear of death in a significant way. Facilities like ours that offer skype and Facetime visits can help offset those negative feelings. However, seniors with Dementia and cognitive loss have difficulty understanding, balancing fact, need, and relative risks. They more often just see what they want to see. They miss the visitors they use to get. That is the biggest problem with Dementia. The eventual loss of insight and judgment which compromises your ability to live, balance risks, and increases the need for supervision and help with your ADL’s. Covid-19 dramatically increases those deficits even if you do not have coronavirus yourself.

Employee and job training updates with Coronavirus.

Healthcare caregivers are one of the first line of Hero’s. They come to work to care for those most at risk of the virus. The staff at TLCSR are on heightened alert that they may be asymptomatic carriers of the virus. At Tlcsr and other senior care setting staff has taken on the responsibility of being safe outside of their work setting. Tlcsr as an aggressive education program to remind Staff that their practicing social distancing, using a mask, hand washing, and sanitizing while not at work is a crucial part of caring for our seniors at work. While at work we have instituted extra hand washing and sanitizing stations and systems.

We have instituted a no visitor policy. While many families feel “they are low risk to their family members” they fail to realize that they are also a potential risk as asymptomatic carriers to the other residents and staff. Because they choose to have their loved one in the shared living setting, we had to educate all that these measures protect not just their loved one but all who live there including the staff.

Dr. McGivney the medical director has increased education on all aspects of infection control. For example, some of the staff read that hand sanitizing with alcohol is “better” than hand washing at killing virus. Dr. McGivney gave that needed context in a Q and A session with the staff. They both are good to do and work differently. Hand sanitizing does not remove toxins from the hands as hand washing does. While the alcohol might technically “kill” virus better than soap and water there are too many individual elements to compare the efficacy of one versus the other. In fact, doing both as often as you can is critical. If you are in a room and have no sink use sanitizer which the staff carries around with them. If you can do a hand wash do so especially after a glove change or in between patients.

PPE - Can wearing a Mask INCREASE the individual’s risk of getting Covid-19?

Dr. McGivney makes clear there is a risk of getting COVID if the mask increases the number of times you touch your face or adjust the mask. That is right. A mask/face covering can unintentionally INCREASE an individual’s risk of getting COVID or any virus.

That happens IF YOU DON’T FIRST sanitize or wash your hands before you touch the mask or face area. While many people are now wearing masks, they often are not educated that the real risk is in touching their face. If you use gloves, or a mask and they cause you to touch your face and mask area, those are risky behaviors.

Dr McGivney teaches staff to hold their hands clasped like surgeons do in the operating room, so they do not let that hand wander up to the mask or to scratch their nose.

These points may seem minor. However, they are critical behaviors to learn.

Wearing a face covering protects others from you.

While many staff hear on TV the importance of wearing a mask many of our staff were confused with the two types of masks.

We need to distinguish face covering which is any barrier that does not filter all the inspired air. A face covering blocks aerosol droplets from an asymptomatic individual to those around us.
A Mask is more often referred to when you have a mask that is specifically fitted and tested to filter all incoming air.

The second type of mask is a fitted mask that forces all the inspired air to go through the fitted mask. Those are the N95 type masks or the big headset with side filters. Those also can be called respirator type masks. If they are not fitted and have any air coming in around the side of the mask they are less protective of the individual.

Using a specially fitted, mask that filters all the incoming air is required to protect the individual staff/healthcare worker/ caregiver. Those masks are hard to come by. Federal and State governments are correctly distributing them to hospitals, front line emergency workers, who go into less screened settings. Also, a tightly fitted mask is more difficult to wear if you are active and working.

New job stressors for caregivers

Our front-line heroes put themselves in harm’s way to protect us. Today they do so with inadequate PPE and education on infection control practices. For our staff, residents, and families having a more specific detailed explanation of what each infection control intervention does help them reduce their stress.

If I had to pick one factor it would be the sense of relief staff reported knowing they could work and keep their own family safe. Likewise, while visiting families had a general idea of Infection control the small details of “not touching your mask” and using both sanitizer and hand washing helped them feel safe.

Education continues to be the best PPE you can get. Working together and watching out for the other person’s risks and needs is also a top factor in beating this virus.

COVID and Telehealthcare

While a person who does not need help with ADL’s or IADL’s can use telehealth easily that is less true for a person who needs help with ADL’s or IADL’s. If you can do your own ADL’s even marginally you have a choice to stay home and do those basic personal care tasks yourself.

However, when you need help with these activities of daily living you often lack the insight, judgment, planning, and coordination skills required to use, coordinate, interpret a telehealth visit. The camera only shows what is presented to it. A person with mild memory loss often will not know or show the camera all that is wrong which is why you need a physically present personal care provider or better yet a doctor.

Moreover, when you are involved in Senior Care planning it is crucial to recognize that day to day variation IS EXPECTED in both physical and cognitive function. It is next to impossible for a strange Telehealth provider to know your baseline expected variations. That further limits the advice they can give over the telehealth contact.

While telehealth is a good added resource it is far from a substitute for an in-person chronic care team that includes a doctor and onsite staff. The family often fills the role of onsite family caregivers. Having the doctor sort through changes, plans and most of all the option to actively monitor for further changes is critical.

A doctor who does not EXPECT to visit, call, see the patient, and family often has fewer choices in care. Because the doctor does not expect to be on-site, doing a physical follow up, it is harder to dismiss any small issues.

For example, if they are having a TIA or after a fall a doctor who will be there the next day and expects to see them physically in an ongoing plan might elect to observe.

A doctor who is doing telehealth only and lacks the direct physical context is far more likely to send them to the ER where they can be adequately evaluated. They have less of an option for volunteers to observe with the frail senior, family caregiver team because they know they do not expect to play the role of an old-fashioned primary care doctor.

Chronic Healthcare Solutions

Crisis like Covid-19 further illustrates how Acute Healthcare is very different from Chronic Healthcare.

If we had an old fashion primary care doctor based system of care it would be much easier to coordinate care especially for those most in need. In doing so it would be far more cost-effective than the current disjointed, short term, patchwork acute healthcare system we now have.

It seems like legislators, Estate planners, big insurance companies, and many money / financial oriented supervisors of the $3.3 trillion-dollar general medical health care industry are missing the mark. They seem to be unaware of the financial facts that Acute care accounts for just 14% of the total $3.3 trillion in general medical healthcare costs.

Chronic care on the other hand accounts for a whopping 86% of the $3.3 trillion. One can only wonder how you can expect efficient, quality care, and value when you use an Acute Healthcare system to try to provide chronic care. We see you cannot.

We hope the reason why is due to lack of geriatrics education, knowledge, and lack of heavy primary care doctor influence in the general health care decision making.

All Long-Term Care is private pay. Medicare and general medical insurance DO NOT PAY for LTC

Another mind-blowing fact is that all Long-Term Care is private pay until you spend all your money and are broke. Then you qualify for Medicaid

Indeed, myths like Medicare for all is a good, practical, or cost-effective solution need to be reevaluated with facts. More accurately what is being proposed is Medicare and Medicaid for all. What people fail to realize is the quality and participation of primary care doctors in Medicaid are VERY LIMITED.

Moreover, many primary care doctors do not participate in Medicare. The new doctor alternative of “providers” is filling that gap in the Medicare Advantage Medicare world. While Medicare for all, Advantage Medicare, or Medicare / Medicaid are good minimums for society most doctors, patients, and communities will not choose that.

If Bernie Sanders and those that push Medicare for all or even the Affordable Care Act (ACA) expansion were to describe “Medicare for all” or “ACA for all” as Medicaid for all many would view it differently. They are not suggesting we go back 3 decades to a time when you had an expected, ongoing, relationship with YOUR PRIMARY CARE DOCTOR.

Now we go enrollment period to enrollment period and both doctors and patients lack any expectation for ongoing relationships. Fortunately, there are largely private solutions like the MD Franchise plan that use the hidden and untapped private pay sources of $3 trillion for Long term care and another $3 trillion in wellness care to help fund and subsidize the need for the Acute medical care.

Yes, those are $3 Trillion dollars each. Each costing as much as the total current Health Care system. While the MD Franchise plan does not include hospitals or surgeries those are very small costs in any relative comparison to chronic care, long term care, or funds spent on wellness.

New programs like the venture MD Franchise plan combines old fashion doctor standards, with new technology, geriatric education, and franchise small business owners to help restore what a doctor used to be before being demoted to the role of “provider”. The MD franchise plan also focuses on care away from Acute care toward Chronic care saving Trillions. Yes, trillions.

The current health care system is based on Acute healthcare needs, surgery, specialty visits. However, 86% of the general medical care costs ($3.3 trillion a year) are paid for chronic care. Alternatively, the Acute Care system is just 14% of the cost. If one were to better understand and refocus the system as the MD Franchise plan does the savings are in the trillions a year.

The care for those with chronic illnesses and the extended care systems that help them also benefit. Unfortunately, new systems require venture funding to begin. Dr. McGivney has piloted the program and is ready to roll it out with the right venture partner.

MD franchise system provides doctors and their local community unique ways to help each other

The MD Franchise system builds in accountability, responsibility for the doctor, patient, and extended local community. The lack of continuity and shared expectations of continuity is the single biggest deficit of the existing acute health care system accounting for TRILLIONS a year in waste and ineffective chronic care for those most in need.

Because the MD franchise system is based in geriatric education, combined with increased responsibility and continuity of care it is easily adapted to any community. Any community based on their culture, global location, and varied social and financial resources.

This plan restores personal duty, responsibility, as well as offering a main franchise that provides overarching supervision, education, for all involved. While this is a non-government program, we do envision the governments, foreign and domestic, considering it as the health care budget sores, and the government budgets are increasingly stressed.

Venture investors, please contact Dr. Shawn McGivney directly for more information on becoming a venture investor.

Useful Links:

Cost Comparison of Long-term Health care settings. Personal care, Assisted Living, Memory Care, and nursing homes.

Tender Loving Care Senior Residence, Costs Table

Tender Loving Care Costa Brava Costs page

Acute care vs chronic care and the role of Geriatrics in combining the two.

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