What to consider if you’re thinking of pulling a loved one out of long-term care

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As nursing homes across the country grapple with outbreaks of the new coronavirus, some Canadians are considering pulling their loved ones out of long-term care until the threat of infection is over.

But are you equipped to care for older adults at home? How do you ensure residents can return to a nursing home once it is safe?

Here’s what you need to know:

Weighing the risks

B.C. Seniors Advocate Isobel Mackenzie cautions against hasty decisions, saying many older adults now living in long-term care have complex, challenging health conditions that could quickly overwhelm family caregivers.

COVID-19 can spread rapidly in care homes, as illustrated by outbreaks in B.C. and Ontario. But that is not necessarily a foregone conclusion, Ms. Mackenzie says. She notes some of the outbreaks identified in B.C. involve only one or two people and that recent health orders – including restricting caregivers from working at more than one facility – can help to control the spread.

Paula Rochon, geriatrician and vice-president of research at the Women’s College Hospital in Toronto, adds there may also be a risk of spreading the virus when transferring a resident from one location to another. Since it’s possible for people who don’t have symptoms to transmit the virus, you could inadvertently infect others while moving a resident and vice versa.

Before you act, do a risk assessment, suggests Donna Duncan, the chief executive officer of the Ontario Long Term Care Association, which represents about 70 per cent of Ontario’s long-term care homes. That means, for example, asking yourself whether your home is safe for someone who has a tendency to fall, or whether you have the skills and knowledge to care for someone with advanced dementia.

For many residents, she says, “the reason they came to long-term care was because they couldn’t live at home.”

Assessing your ability to care for someone at home

Dr. Rochon advises asking yourself the following questions before you move someone into your home:

Do you have an adequate bed for them? Do you have the supports your loved one would need for basic things, such as showering or using the toilet? Are you able to provide and monitor the use of medications? How will you maintain connections with your loved one’s health-care providers? What is your plan if there is a medical emergency?

Dr. Rochon says transitions can be very difficult on individuals with advanced dementia. How would you manage their distress and deal with memory and cognitive problems?

“It’s important for people to really think carefully about what taking someone home might mean, and if it makes sense for them,” she says.

Discussing payments and policies

If you are able to provide care at home, how long do you plan to do so? And will your loved one still have a place at the nursing home when it’s safe to return?

While nursing homes in some jurisdictions may waive fees during a resident’s temporary absence, make sure you check with the specific nursing home of your loved one. Similarly, ask what the policies are, regarding whether residents would need to reapply or rejoin a waiting list for a spot when they return. In an e-mail, a spokesperson for the Winnipeg Regional Health Authority suggested having these discussions directly with the facility manager at the home in question.

In Ontario, the Ministry of Health and Long-term Care says during an outbreak in a home, all admissions and readmissions are stopped, so residents who leave temporarily are not allowed to return as long as the outbreak continues. Once the home is cleared of an outbreak and it’s safe for them to return, their readmission would be expedited.

However, the ministry says, if residents leave a home that does not have an outbreak, they will be prioritized for readmission – that is, they would be placed in a category that would allow them to be given the next vacant spot – but the nursing home will not hold their room for them. “[I]t would be irresponsible to let long-term care capacity sit vacant at a time when it is in such great need,” it says.

Finding other ways to provide support

Whether to remove someone from a nursing home is a very difficult decision. Most people will not be in a position to provide proper care at home, Dr. Rochon says.

“They shouldn’t feel guilty about it,” she says.

Instead, focus as much as possible on maintaining social connections with your loved one, she suggests. That includes keeping in touch by phone and using tablets to arrange virtual visits.

With reports from Kelly Grant and Wendy Stueck

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