Caring for Aging Parents Under the Reality of COVID-19

I travel on airplanes a lot. Or at least I did before two weeks ago! Usually, my primary focus is on whether I can get a coffee refill and how much longer I can procrastinate doing work. So, basically, exactly the same as when I’m home minus the barking dog.

A big gust of turbulence can quickly change everything.

A bumpy ride doesn’t scare me, but it does refocus me, shifting my attention to the fact that I’m actually sitting in a tin can flying at 200 plus miles per hour 40,000 feet in the air and that there are other human beings with me. On the rare occasion we drop altitude suddenly, the worst-case scenario of plummeting out of the sky seems like a real possibility.

And now we’re all collectively plummeting out of the sky very suddenly. It’s hard to believe that a little over a month ago, I was getting ready to visit my dad on his 82^nd birthday, checking on my daughter at college, making summer vacation plans, and pushing the gas pedal hard at work. But then, on February 29^th, someone in a nursing home in Washington state died from COVID-19, known infections started to increase exponentially, and now here we are living out a really bad chapter in a history book from the future.

This is as fast and as big as change can get.

For me, this experience has been one of intense grief and worry. I’m worried about our daughterhood community, about our loved ones, about all frail and vulnerable people. I feel grief over a loss of vibrancy in our neighborhoods and economy, of lost jobs, and lost hope. In just this short period of time the trajectory of our lives has changed forever. There will be normal again someday, but it will be new normal. Frankly, I’m already nostalgic for the old normal.

Honestly, I’ve been struggling for the last week to find something useful to say to you all. I want to be able to offer lots of good advice and tips. But clearly this isn’t a “top five tips” kinda situation. Instead, here’s a little bit of what I’m thinking about right now.

I know many of you are terrified, like I am, about your parent becoming infected by COVID-19, and it’s also worrying to think about how you’ll take care of someone else if you yourself are sick. It’s even more terrifying to think about both of you being sick, or worse, passing it along. You’re probably already very well educated at this point on how to help your parents manage the basics, and how to protect yourself and your family – stay home, wash hands, etc.

But what happens when you face a non-COVID-19 emergency call? In the best of days, the loved ones we care for are much more likely to visit an emergency room or hospital. But now we really need to help keep them out of the physician’s office, emergency room and hospital. Not only do we need to preserve healthcare capacity for COVID-19 patients, but hospitals are now especially-contagious areas, to be avoided by frail and vulnerable older adults.

To help families cope with this new reality, the federal government has made some very big changes to healthcare coverage rules in just the last week – with the goal of helping you and your loved one get care at home as much as possible. Here are a few things to ask the physician about:

• Virtual Visits. Talk to the doctor to see if he or she will deliver something called, “telehealth.” The federal government just waived a whole bunch of rules to allow coverage for virtual physician visits.
• After Hours Care. Ask the doctor about whether you can get virtual help if something happens in the middle of the night. Calling 911 in an emergency is not a good option if there’s any way to avoid it!
• Emergent Care in a Skilled Nursing Facility (SNF). You no longer need a three-day prior hospitalization before admission to a Medicare-covered SNF stay. This means that if you feel like you need to go to the hospital, you could possibly go to a SNF instead and the visit will be covered. But, please talk to your doctor about this, in advance, and if you go this route, call ahead. SNFs vary significantly in what they can handle, and you want to make sure the facility is virus free and will take your parent without knowing if he or she is too.
• Nursing Home Quality. Medicare surveyors – the folks who go out and check the safety and compliance of nursing homes – are focusing on three activities to increase safety and infection control for residents. This includes responding to the highest need complaints and incidents only, conducting special surveys targeted on infection control, and providing a checklist facilities can use to self-assess their infection control.

Here are some other things the federal government is doing in Medicare and Medicaid:

• Copayments for COVID-19 tests are waived.
• Medicare Advantage plans have lots of flexibility to waive copays, prior authorizations, physician referrals, and copays on out-of-network providers. Don’t hesitate to call your loved one’s health plan and ask for their help.
• States can also greatly expand who can be a Medicaid provider and where they can provide services. This applies to long-term care providers, such as home care workers, nursing homes and assisted living. Check in with your State’s Medicaid website to see what’s changing.

I don’t need to share with you how important it is for all of us to stay healthy and to take special care to follow all the guidelines. If you have a loved one in assisted living or a nursing home right now, you’re understandably heartsick and worried. But please don’t blame the facility for following government guidelines to prohibit visitors. These buildings are all facing impossible and extremely challenging situations.

If you have mobile, relatively functioning parents, you have other issues and concerns – like convincing some of them to stay at home, and practice social distancing. This is as hard for them as it is for you – harder in some respects, since many of those you care for find great comfort in community, family, and stability.

I’ve scanned the internet for good resources and there are a lot. I really like the Caregiver Action Network’s website. But also, Denise Brown, at www.caregiving.com has a warm and welcoming place to go to get emotional and practical support. Also here’s a great article from our friends at dailycaring.com,  Coronavirus and Seniors: What you Need to Know that you should definitely read.

I am encouraged by all of the acts of love we see in the news to lift the spirits of people living in assisted living or nursing homes, by the work that many of my colleagues are doing to make sure low-income older adults have enough food, and by the hard work of so many healthcare and long-term care providers.

Here at Daughterhood, we will be in close contact with our Circle Leaders to make sure we can serve our communities, despite social distancing. Maybe that will lead to better options for virtual connection in the future! We’ll be posting resources and information regularly on the Daughterhood Facebook page so please follow and check it. And finally, we welcome hearing from you.