Remote Caregiving Guide During COVID-19

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A Guide for Remote Caregiving During Covid-19 By Caregiving Expert Amy Goyer

Apart, Not Alone

A Guide for Remote Caregiving During Covid-19 By Caregiving Expert Amy Goyer

PART ONE: HEALTH & SAFETY

Amy Goyer is the author of Juggling Life, Work and Caregiving and a nationally known caregiving expert. An often-quoted media authority, she has appeared on numerous television news programs, The Doctors, Dr. Phil, and she is a frequent guest on NBC’s TODAY Show. 

Download the Guide: Apart, Not Alone

Get the Guide (PDF)

A Guide for Remote Caregiving During Covid-19 By Caregiving Expert Amy Goyer

The coronavirus COVID-19 outbreak has brought increasing changes for caregivers, many of whom are now remote. We may not be able to visit those we care for because they live in a nursing home or assisted living facility that is on “lockdown” with no visitors allowed. We may care for someone who lives at a distance. Or perhaps those we care for live in their own homes not too far away, but we are staying away for now.

Regardless of the situation, those we care for are likely at higher risk for developing a serious illness if they get COVID-19, so they need to physically distance themselves from other people — but the distancing can lead to greater feelings of isolation, which may have a negative impact on their health. Caregivers are struggling to stay connected and ensure their loved ones’ emotional and physical health and safety.

We all have an overabundance of information about COVID-19 coming at us all day, every day. It can be difficult to know what to trust. That’s why I recommend making the Centers for Disease Control (CDC) (cdc.gov/coronavirus) your primary source of information. You’ll get clear, unbiased and up-to-date recommendations there. The CDC website also has a section pertaining to older adults and those with health conditions that make them more at risk for developing a serious illness from COVID-19.

Here are some things you can do to ensure your loved ones stay as safe and healthy as possible.

GET PREPARED

  • If you don’t live near those you care for, create a plan for what would happen if they should become sick. How will you know? How will they get medical care? Talk with their doctors if you need help and go over the plan frequently.

    • Most hospitals are not allowing visitors, so you might not be able to advocate for them in person. Find out how you will be able to coordinate care remotely, especially if you are the power of attorney for health care. You might try the hospital websites first, and then try calling.

    • Ask if you can send key documents now to have them on file at hospitals, such as advance directives (www.americanbar.org) and current health information, including:

      • Power of Attorney
      • Living Will
      • 5 Wishes document
      • Do not Resuscitate orders (DNR)
      • Provider Orders for Life Sustaining Treatment (POLST) or Medical Orders for Life Sustaining Treatment (MOLST)
      • Medical history
      • Medication lists
      • Emergency contacts
    • Also, be sure that these documents are readily available to be taken to the hospital with your loved ones. I recommend keeping printed copies in a labeled folder that emergency personnel can find easily, perhaps by the front door if those you care for live at home.

    • It’s a good idea to be sure all key members of the care team have these documents. Sharing them electronically ensures they can be accessed anywhere by using secure apps like Dropbox or Google Docs, or a caregiving app like Carezone.

  • Learn which hospitals those you care for may go to if they get sick with COVID-19 or another illness. If hospitals become full, your loved ones may be sent to one that is farther away.

  • It’s important to remember that 911 is a local service. If you don’t live in the same area as the person you are helping, and you do not have a personal emergency response system in place for them, you won’t be able to call 911 on their behalf. You will need to know the phone numbers of their specific police/fire departments. If you do contact first responders on behalf of those you care for, be sure to convey their age, health conditions, medications, allergies and whether or not you suspect they may have COVID-19.

  • If those you care for become sick, contact their doctor if possible and ask if they should come into the office, go to the hospital, and/or be tested for COVID-19, and if so how and where to go for testing (some communities are setting up separate testing sites).

  • Plan for what will happen if you get sick. If you become unable to check in with those you care for remotely, be sure that another family member, friend or caregiver is informed and prepared to do so in your place. Ensure someone will notify any care providers and your loved ones’ emergency or health monitoring system of the change in contact persons.

ASSEMBLE OR REINFORCE YOUR CARE TEAM

  • Make a list and get contact information of people who can help, including family, neighbors, friends, and paid caregivers. Talk about how their roles may be changing due to COVID-19. Suggest tasks and find out what they are willing to do. People who weren’t doing as much to help before may be more willing to pitch in now.

  • Find out if there will be any changes in care provision. Will care providers still be available? Are staffing levels changing? Has the schedule been adjusted?

  • If you and your family or care team are unable to meet all of the needs, existing and new organizations are stepping up to help older adults and those who are more at risk during this COVID-19 outbreak. AARP.org has created a new Community Connections site where you can search for organizations and informal groups that have gathered to offer volunteer services for things like social phone calls, grocery shopping, providing financial assistance and providing emotional support. (The site is growing every day as groups submit their listing, so it’s worth checking back later if you don’t find resources today.)

HELP THOSE YOU CARE FOR PROTECT THEMSELVES FROM COVID-19

The CDC says that older adults over age 65 and those with chronic underlying health conditions such as heart disease, diabetes and lung disease, as well as those with asthma and pregnant women, may be at higher risk for serious complications from COVID-19.

Even if you can’t be with those you care for in person, you can consistently remind them to take precautions to protect themselves. The World Health Organization (WHO) puts forth the following 5 key things to do on a regular basis:

  1. Hands — wash often. It’s important to wash hands properly, and the CDC also has a good, 20-second hand-washing video.

  2. Elbow — cough into it (though the ideal is to cough or sneeze into a tissue – then throw into a lined trash can).

  3. Face — don’t touch it.

  4. Space — keep a safe distance (the CDC recommends staying 6 feet apart).

  5. Home — stay if you can. The CDC says those who are older or have health conditions that make them more at risk should stay home except for medical care. In most areas of the U.S. it is still alright to go outside to our yards or take walks as long as we can stay at least 6 feet away from other people.

The CDC advises to clean and disinfect frequently touched surfaces daily. Disposable gloves can also be worn but are only effective if you don’t touch your face while wearing them. Everyone should wear a cloth covering over their mouth and nose when in public; those who are symptomatic should wear a covering whenever they are in the company of others.

IF THOSE YOU CARE FOR LIVE IN FACILITIES

If you care for someone living in a nursing home, group home or assisted living facility that is currently on “lockdown” or banning/limiting visitors, your usual routine of visits and connections has been disrupted. It’s more important than ever that you advocate for them and remain in contact with the facility.

  • Ask what the facility is doing to protect residents with the COVID-19 outbreak:

  • Are residents mixing and eating meals together or must they stay in their rooms? 

  • What new cleaning protocols are being followed?

  • Is the facility fully staffed?

  • Are activities, exercise and social interactions still taking place and how?

  • Are delivery people allowed in the facility?

  • Are packages and food being wiped down when they enter the facility?

  • Are the air quality and air circulation good?

  • Are residents getting outside for fresh air?

  • How are sick residents being cared for and separated from those who are not?

If you think the facility is not managing COVID-19 precautions adequately, or if you have concerns about the care being given, contact the local long-term care ombudsman. You can find them through the Eldercare Locator (https://eldercare.acl.gov/) or go to ltcombudsman.org or The National Consumer Voice for Quality Long Term Care.

  • Insist on regular communication from the facility about the condition of those you care for, the facility and other residents. You should be notified immediately if any staff or residents test positive for COVID-19.

  • If you talk with the persons you care for, reinforce the importance of their participation in any safety measures the facility is taking.

  • Find out if and how you can send them things like food, personal supplies, gifts, books, games, technology etc.

  • Ask staff if you can come to the facility and see your loved ones through a window and talk on the phone — so they have a visual connection.

  • Suggest that staff help you talk with those you care for using video chat functions like SkypeZoom, What’s App, Facetime (for iphones) or the video function on Android phones. Ask them to send you photos of those you care for (this can help you identify changes in their condition too).

  • You might write to your state government officials asking that they encourage all facilities to create ways for people to communicate with and see loved ones without putting their health and safety in jeopardy.

  • If those you care for become ill and do not go to the hospital, find out how to be in close contact about their treatment and health status.

  • The CDC has recommended: “Because of the ease of spread in a long-term care setting and the severity of illness that occurs in residents with COVID-19, facilities should immediately restrict all visitation to their facilities except certain compassionate care situations, such as end of life situations.” Therefore, if those you care for are in a situation that you believe fits this description, contact the facility to ask if you might have an exception to the visitation policy. If they agree, you will be required to take extra safety measures.

IF THOSE YOU CARE FOR LIVE IN FACILITIES

  • If your loved ones don’t already have an emergency or health monitoring system to help them contact help in an emergency, and/or to monitor their safety in the home and communicate with family, now is a good time to look into it. Terminology for these systems varies, including “medical alert systems” or “personal emergency response systems” (PERS). Services offered vary widely and may include wearable alert devices, voice communication, video communication, automatic radar fall identification, air quality, and temperature alerts, motion sensors and access to 24-hour emergency contact centers. Integrated systems that combine multiple features for emergencies and remote caregiving are also available.

  • Contact your local area agency on aging (AAA) to find out about any extra home and community-based supports that might be available in your loved ones’ area during the COVID-19 outbreak, such as home-delivered meals. Find your AAA by searching in the Eldercare Locator (https://eldercare.acl.gov/).

  • Stay on top of service delivery changes if your loved ones have been attending adult day services centers, senior centers or community centers, or receiving home-based services such as home health care.

  • Talk with your loved ones about COVID-19 safety precautions, including:

    • Visitors — Tell those you care for to only allow essential visitors in their homes. Discuss the risks of family gatherings or even individual family visitors and make decisions about boundaries.

    • Mail and packages — According to the CDC and WHO, as cited by USA TODAY, the risk of catching COVID-19 from a package or mail Is very low. To be safe, wash hands immediately after discarding packaging (and no face-touching before doing so).

    • Food and grocery delivery — The Food and Drug Administration (FDA) website provides the following guidance: “Coronaviruses are generally thought to be spread from person-to-person through respiratory droplets. Currently, there is no evidence to support the transmission of COVID-19 by food.” Whenever possible, use “unattended” or “contactless” delivery (the food is paid for online or through an app and the food is left at the doorstep so there is no direct interaction with the delivery person). Just as with mail and packaging, wash hands immediately after handling any delivery packaging. As an extra precaution, you can tell those you care for to wipe the food containers with sanitizing wipes or spray.

    • If those you care for have home care services, talk with the providers about COVID-19 safety requirements, such as washing hands immediately upon entering the home and frequently thereafter, cleaning surfaces and any other precautions you wish them to take.

MEDICAL AND DENTAL CARE

  • It’s best to avoid non-urgent in-person medical and dental appointments right now, and according to the Medicare.gov website, Medicare will be covering telehealth appointments:

    “Due to the Coronavirus COVID-19 (COVID-19) Public Health Emergency, doctors and other health care providers can use telehealth services to treat COVID-19 (and for other medically reasonable purposes) from offices, hospitals, and places of residence (like homes, nursing homes, and assisted living facilities) as of March 6, 2020. Coinsurance and deductibles apply. If you have coverage through a Medicare Advantage Plan, you won’t have to pay out-of-pocket costs (called cost-sharing) for COVID-19 tests. Medicare also covers virtual check-ins and E-visits.”

    Some states are also allowing Medicaid to cover telehealth, and other insurance companies may as well, so ask doctors if appointments can be done over the phone or video chat — and make sure they include you.

  • Ask the doctor if there are options for mobile lab tests, x-rays, ultrasounds EKGs, etc. If they don’t know, you can do an online search or check with mobile doctors (doctors who make house calls) as they are usually more aware of these services.

  • This is an emotional and stressful time for many people, and it may be especially scary for those who are more at risk. Your loved ones may not be sleeping or eating well; they may be more anxious or depressed. Be on the alert because this could make them more vulnerable to falls, accidents, cognitive changes (which may be temporary), skipping medications and other health problems unrelated to COVID-19. Remember, they may need more emotional support right now.

  • If those you care for become hospitalized, find out the best ways to stay in close contact with the treatment team, make health care decisions if necessary and be kept up to date about their condition.

MEDICATIONS

  • Many pharmacies now have caregiver support that includes the ability to manage medications for those you care for, including CVSWalgreensWalmart and Sam’s Club. Go to the pharmacy website, use their app or call the pharmacy directly to find out how to become designated as caregiver or include them in your family Rx management plan.

  • The CDC is recommending that everyone have a two-week supply of prescription and over the counter medications on hand, so order refills of prescriptions as soon as your loved ones’ insurance company will allow it.

  • Ask the pharmacy if their prescriptions are eligible for a 3-month supply. You may need to talk with the doctor and the insurance company about prescription refill coverage.

  • If your loved ones are not already using mail order medication delivery, consider starting — visit the insurance company website or call to find out how to get signed up.

  • Find out if the local pharmacy delivers, and if there is a cost. If not, consider moving prescriptions to a pharmacy that does, or ask a family member, friend or neighbor to pick up and deliver medications (see note above about “unattended” or “contact-less” delivery.)

  • If your loved ones absolutely must go to a pharmacy to pick up prescriptions themselves, remind them of the precautionary measures. Encourage them to use a pharmacy that has drive-thru service.

It is difficult to control another’s living environment and personal habits from a distance. This situation is highly unusual and unprecedented; it may feel frustrating. All you can do is your best to remotely stay as informed as possible about changes in the condition of those you care for. Talk with them as frequently as possible, reminding them of the importance of adhering to the recommended precautions. Role model staying matter of fact and calm, while being very clear about the serious nature and risks of COVID-19. They may be physically alone and socially isolated right now but reassure them that they are not without your support and caring.

DO YOUR BEST

PART TWO: THE ESSENTIALS

While the basics of health and safety are critical priorities during the coronavirus COVID-19 outbreak, as remote caregivers we must also be concerned about the practical everyday matters of those we care for, including managing meals, shopping, staying cognitively and physically active, and managing the emotional aspects of isolation.

SHOPPING AND MEALS

  • Take an inventory. Talk about what food, household and personal supplies
    they currently have at home. You will likely need to do this at least once a week. If they have trouble doing this on their own, you might ask specific questions about:

    • Food, for example:
      ▪  Canned goods
      ▪  Beverages
      ▪  Fresh and frozen vegetables
      ▪  Protein (meat, fish, beans, nut butter, etc.)
      ▪  Bread

    • Household supplies, for example:
      ▪  Laundry supplies
      ▪  Dishwashing supplies
      ▪  Cleaning supplies
      ▪  Paper products (toilet paper, paper towels, napkins)
      ▪  Plastic bags (trash bags, storage bags, etc.)

    • Personal Care supplies, for example:
      ▪  Incontinence
      ▪  Bathing (shampoo, conditioner, soap, etc.)
      ▪  Shaving
      ▪  Hair care
      ▪  Deodorant
      ▪  Lotion

    • Health and medical supplies, for example:
      ▪  Medications
      ▪  Glucose testing
      ▪  Wound care (bandages, etc.)
      ▪  Medical equipment (blood pressure, oxygen, etc.)

  • If you live nearby, and are still going in stores when necessary but are avoiding close contact with those you care for, you could shop and deliver supplies to their doorstep and then leave for a “contactless” delivery. Some families choose to go into the house but still stay 6 ft away from those they care for and are careful to disinfect any surfaces they touch, including door handles.

  • You can order online groceries, as well as personal and household supplies, and have them picked up or delivered.

    • Explain how online ordering for pick-up works. If they, a neighbor or caregiver will be picking up the supplies, they can stay in their car (be sure they wash hands after opening the trunk and handling supplies).

    • If supplies will be delivered, if at all possible, use “unattended” or “contactless” delivery and related safety precautions as outlined earlier.

    • Remind loved ones not to invite in delivery persons.

    • If they are not capable of carrying supplies inside and putting them away, you could ask a neighbor or paid caregiver to do so (and ask them to follow safety precautions).

    • Online shopping and pick up or delivery options include services like InstacartAmazon FreshAmazon Prime NowPeapod and Shipt. Or go directly to a stores’ website, including Walmart Grocery DeliveryKrogersFry’sSafewayAldiPublixWegmansWhole FoodsSprouts, etc. If you don’t see it listed here, call or check the local grocery stores’ websites and ask about delivery or pick up services.

    • You may be able to set up regular, repeated delivery if you can estimate when they will run out of key items.

    • Note that there may be a wide range of delivery dates for many of these services, from an hour to a day to several days or even a week depending on what you are ordering and how busy they are (most are experiencing a huge increase in demand right now). You may be able to pay extra for expedited delivery.

  • Order meals to be delivered.

    • For meal delivery, remind those you care for to follow the safety precautions outlined in Part One of this Guide.

    • Many restaurants have been able to stay open for pick up and/or delivery, sometimes with a limited menu. Call their favorite eateries and ask about delivery options and menu. It might be a special treat to brighten their day.

    • If those you care for are capable of placing orders, explain how meal delivery services work, such as Grubhub and DoorDash.

    • Contact the local area agency on aging via the Eldercare Locator and ask about home-delivered meals (or do a zip code search on the Meals on Wheels website). Meals may be delivered along a sliding fee scale, from no cost to full price, according to the ability to pay.

    • If those you care for are struggling to get food, try your local foodbank.

    • Make sure those you care for are able to safely store and date leftovers.

  • Cooking at home.

    • It might be helpful to discuss meal plans during this challenging time, even if those you care for are normally able to manage meals. It will also help in creating shopping lists with plenty of time for grocery pick up or delivery.

    • As you talk about what they are eating, try to keep on top of their nutritional needs and special diets. Make suggestions if you are concerned that they aren’t getting the nutrition they need.

    • Remember that cognitive and physical changes may be attributed to a change in their eating habits. Discuss with their doctors if needed.

  • Meal reminders and socialization.

    • Those you care for may get caught up in their anxiety, watching television etc. and forget to eat, which could lead to health problems. You might want to call around mealtimes to remind and encourage them, including talking over how they will get their meals. If they live in a facility, discuss whether they will go to the dining room as usual or eat in their rooms. If they live at home discuss whether the meal will be delivered or if they are cooking and if so, what are they preparing.

    • Mealtimes are traditionally a social time, so to encourage a good appetite you might eat at the same time while talking on the phone or video chatting.

  • Research indicates that loneliness and social isolation are bad for health, in fact it is the equivalent of smoking 15 cigarettes per day. Therefore, it is a very high priority to create social interactions with those we care for.

  • While physical distancing may be necessary right now, social isolation does not have to be – we can still remotely communicate and socialize with those we care for. Telephones remain the preferred mode of communication for many people, but technology makes this pandemic different than, for example, the flu pandemic of 1918. Today we have the ability to connect virtually if all parties have the technology, know how to use it, and connectivity is available (wi-fi and/or cellular service).

  • First, consider preferred and available devices and technological delivery modes, including mobile/smart phones, computers, tablets, smart speakers (like Amazon Echo etc.), and integrated monitoring and communication systems.

    • If those you care for don’t already have devices set up, you could ship them a device that you’ve already set up, or ship it to a neighbor or caregiver who could set it up, clean it and place it in the home (observing safety precautions for “contactless” delivery.) If they live in a facility and you don’t already have technology set up, talk with the facility staff about shipping a device, using devices set up in the facility or if a staff member might use their own device to facilitate contact.

    • Available video chat apps for smartphone, tablet or computer include SkypeZoomFacetime (for Apple devices), WhatsAppHouse Party, or Marco Polo. Android phones also have a built-in video chat feature.

    • Program a smart speaker so your loved ones can just say, “call Amy” and it will call you. You can also set it up to receive your calls and they won’t have to move to pick up. They can just say “answer phone” or another command you set. Many smart speakers have an option for integrated screens as well, and include built-in video chat features. Consider a device or tablet that has a built in chat feature, such as Portal for FacebookAmazon Echo ShowGoogle Nest Hub.

    • Use an integrated monitoring and communication systems — as discussed in Part One of this Guide, there are integrated systems that combine multiple safety, monitoring and communication features for emergencies and remote caregiving. If those you care for have a system like this, you may be able talk with them via the system hub, without the need for them to pick up the device. This can be helpful for those who are less mobile, or who are in the middle of cooking or cleaning.

  • Get Creative about communication.

    • Call frequently. A regularly scheduled time for calls might be helpful to keep up a routine and give those you care for something to look forward to.

    • Group calls that “conference” in more than two people help create a feeling of levity or even a fun, party atmosphere. It’s a good way to have family discussions, meetings or celebrations. Share meals, celebrate birthdays and anniversaries, have “happy hour” or a coffee date, discuss books you’ve read or television shows, or create a support group to discuss anxieties and concerns and provide encouragement.

    • Sing or share music by using the “speaker” function or watch an online concert together.

    • Call when watching a favorite TV show or movie and watch together (with each of you watching in your own home).

    • Share things by photo or video. Some examples:
      ▪  Photo albums
      ▪  Scrapbooks
      ▪  Your garden
      ▪  Grandchildren
      ▪  Food
      ▪  Pets and animals, etc.

This helps stimulate their minds, adds a sense of normalcy and makes them feel more in touch with what’s happening in the world around them.

SOCIAL CONNECTIONS VIA TECHNOLOGY

COGNITIVE STIMULATION, EXERCISE, EMOTIONAL SUPPORT

  • Physical Activity

    • Ensure that they are staying physically active by maintaining their usual activities such as walking inside or outside, doing standing or seated exercises, and stretching. Remember that physical activity is good for the brain also.

    • Be aware of their physical abilities and limitations, it might not be a good time to start a new activity unless you are sure they are capable, and you’ve discussed with their doctor and/or physical therapist.

    • If they live in facilities, find out if activities are still taking place and if not, are they receiving 1:1 exercises or physical therapy.

    • To help with motivation, you could even video chat with them and do exercises together.

    • Music is a good motivator to encourage marching in place, dancing, arm raises, stretching, etc. Choose music that matches the activity, such as military marches for marching or walking, big band music or disco for dancing, and relaxing music for stretching.

  • Cognitive Stimulation

    • Discuss current events with your loved ones on the phone or video but remember that too much COVID-19 news can be overwhelming, depressing and anxiety-provoking.

    • Encourage them to continue their usual activities, such as reading, cleaning, doing puzzles, etc.

    • Consider playing games with them over the phone/video. Trivia games work well or play a board game with them as you move both theirs and your pieces around the board while they watch.

    • Interview them about their life story and create a scrapbook or memoir in their honor to be shared with family and friends.

    • Laughter and humor are healthy! Tell them jokes, share funny anecdotes, ask them riddles.

    • Ask them to recite a poem they remember or read one to them and encourage them to join you.

    • Sing! Even in times of stress or if cognitive abilities are changing, music may remain accessible and satisfying, offering a mood boost as well as a cognitive one.

  • Emotional Support

    • Be aware that this can be a scary time for people of all ages, but especially for those who are more at risk for developing a serious illness as a result of getting COVID-19. Acknowledge and validate their fears rather than minimizing or telling them they are overreacting. And also give them the most accurate, up to date information that it is necessary for them to know in order to ensure their safety. Take into consideration their mental health and pre-existing health conditions as you communicate and make decisions about changes in their situation. Remind them that we are all in this together.

    • Your loved ones may need more emotional support than usual during this time. Reinforce anything they are doing to follow safety precautions and protect themselves; let them know it’s the right thing to do right now.

    • Many people are worried about other family members being safe, children being out of school, businesses closing, impacts on your work situation and finances. Reassure them that you and your other family members are also doing your best to stay safe, that the children are going to be fine etc. Try to show them evidence of this with photos and videos.

    • Minimize change, which is always more difficult in times of stress. Evaluate the pros and cons of any changes in their care plan and determine what is best for their mental health as well as their physical health and safety.

    • Be patient and gentle. People are on edge, and understandably so; tempers may flare more easily. Those you care for may be distracted, so you may need to explain things multiple times — and that’s ok. It’s important for your loved ones to remain in the best possible mental and physical health right now so do what you have to do.

I hope this Guide is helpful as you navigate this challenging, unpredictable time. New information emerges almost every day. Be flexible and try to take it one day at a time and remember to put effort into caring for yourself as well, including your own mental and physical health. You are under added stress right now too, so be just as patient and gentle with yourself as you are being with those you care for.

NOTE: Aloe Health will update this Guide as new information and research about COVID-19 becomes available.

Amy Goyer is the author of Juggling Life, Work and Caregiving and a nationally known caregiving expert. An often-quoted media authority, she has appeared on numerous television news programs, The Doctors, Dr. Phil, and she is a frequent guest on NBC’s TODAY Show. 

Amy’s current work is the perfect fusion of her professional and personal life; she has worked in the field of aging at the local, state and national levels for more than 35 years, and has been a caregiver for her grandparents, parents and sister as well as other friends and family. Connect with Amy on amygoyer.com. 
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