How to Help Protect a Family Member in a Nursing Home

Residents of care facilities can be especially vulnerable to respiratory illnesses. Here’s what you can do to help.

The Life Care Center in Kirkland, Wash., on Sunday. The nursing home is full of older residents, who can be especially vulnerable to respiratory illnesses.
Credit...Grant Hindsley for The New York Times

More than 10 people in the United States have died and over 200 have been sickened after contracting the coronavirus that continues to spread around the globe.


The deaths have occurred in California and Washington State, including several residents at a nursing facility in the Seattle suburb of Kirkland.

The death toll at a facility with a population vulnerable to disease and infection, and indications that the virus was spreading for weeks, raises difficult questions: Are nursing homes and assisted living facilities in the United States prepared for a serious public health threat? If you have a loved one in a facility, should you be concerned about their health and safety? And what, if anything, can you do?

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More than 4 million Americans live in or are admitted to nursing homes and skilled nursing facilities each year, according to the Centers for Disease Control and Prevention. Here’s an explainer of the issues often found in nursing homes, and how you can help protect a family member if they live in one.

To begin, research the facility where he or she lives, specifically looking at staffing and sanitation ratings.

Charlene Harrington, a professor emeritus at the University of California, San Francisco, School of Nursing, who studies nursing homes, suggests using Medicare’s Nursing Home Compare tool, which lists “every Medicare- and Medicaid-certified nursing home in the country.” The website ranks staffing levels, health inspections and other categories.

Understaffing has been one of the more significant issues facing most nursing homes, said Professor Harrington, and hand washing is a huge problem.

“They don’t have enough staff, and so they hurry and they don’t wash their hands between residents,” she said.

Long-term care facilities can also be breeding grounds for infections.

Of the 15,000 nursing homes in the country, “almost 3,000 of these have a one-star rating on their health inspections,” according to a statement released in June by the Centers for Medicare and Medicaid Services.

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Between 1 million to 3 million serious infections, including diarrheal diseases and antibiotic-resistant staph infections, occur every year in these facilities, according to the C.D.C. These infections kill as many as 380,000 people each year.

When you spend time at your loved one’s home, look to see that basic protocols, like frequent hand washing and sanitation, are being followed. If something isn’t being met, be gentle yet firm when talking to an administrator, or even take your needs and concerns to the facility’s director of nursing.

Family members should monitor their loved ones “to make sure that if they do come down with the virus, that they’re being cared for, that they’re being hydrated,” said Dr. David Dosa, a geriatrician and professor of medicine at Brown University, where he studies disaster preparedness. “That they’re being treated like somebody should if they have a viral illness.”

With your loved one, be sure to ask questions about what they ate for lunch, whether they had juice or tea, what activities they have done during the day. Even if they have cognitive issues, you will probably receive an honest response.

Check with the facility to learn what their plans are if an outbreak occurs, and ask what they are doing to ensure they have enough medical and safety supplies in the event of an outbreak.

To protect their residents and staff, nursing homes may turn away visitors and quarantine residents in the event of a coronavirus outbreak.

If you cannot enter, speak with an administrator or the director of nursing in a respectful and succinct way.

Think about your loved one’s needs, and “just very carefully and clearly iterate” your concerns to the staff about their vulnerabilities, said Richard J. Mollot, executive director for the Long Term Care Community Coalition, a nonprofit advocacy group based in New York.

He also recommended, if you cannot enter the facility, that you ask specifically how your loved one is getting the care they need. If they need therapy, how are they receiving it?

If there’s an emergency with your loved one, do not hesitate to call their physician, whether inside the facility or not. Remember that you can tell these facilities to send your loved one to a hospital, or send an ambulance for them yourself.

“It’s not a prison,” Mr. Mollot said. “People can leave.”

If you suspect or are worried about abuse or neglect, you should speak with senior staff at the facility, like the licensed nurse and the administrator.

“And if you don’t get satisfaction there,” he said. “I would call the police and explain to them. The police have a duty to protect residents in facilities as well.”

It can be hard to remove a resident out of these types of facilities, especially if they are extremely frail, have a chronic condition or otherwise need constant care, experts agreed. And it could be a very hard and difficult situation for you and your loved one.

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Nursing homes and skilled nursing facilities provide basically 24-hour support for residents; this type of care could be difficult to replicate at home, said Dr. Michi Yukawa, a geriatrician professor at the University of California, San Francisco, who also works as a medical director at a nursing home.

“It’ll be resource-intensive,” she said, noting that it depends on how much care your loved one needs.

“Some nursing-home residents could be managed for a short period of time,” she said.

“I think the best the families can do is to visit them as often as possible, and make sure there’s hand washing going on,” Professor Harrington said, adding that families need to be “really vigilant.”

If you are going to move your loved one, be sure to have a plan that accounts for all their medical and logistical needs — like if they need help bathing or taking medicine. You’ll have to inform the nursing home of the move, and ask for a discharge planning meeting.

“If you want care from a home health agency, the nursing home should assist you with making the necessary arrangements,” said Robyn Grant, public policy director at the National Consumer Voice for Quality Long-Term Care, a leading advocacy group. “Alternatively, you can hire private caregivers or plan to provide care yourself and/or with other family members.”

If you hire a home health agency, Ms. Grant recommends you “ask the agency what precautions and measures home health staff will take when caring for your loved one. Then monitor to ensure those measures are being taken.”

Make sure anyone involved in the care of your loved one knows the safety measures for Covid-19 as well as the symptoms.

“Anyone providing direct, hands-on care to your loved one should also follow measures recommended by the C.D.C., such as hand hygiene before and after contact with your loved one,” Ms. Grant said.

Family members and visitors should follow these basic guidelines from the C.D.C.

And if you’re considering another facility, she said, “give careful consideration to the facility you select,” and try to find out if the nursing home has any confirmed Covid-19 patients.

“After that, research a facility’s past performance to see if they have a history of infection-control violations,” Ms. Grant recommended. “Educate yourself about good nursing home infection-prevention practices” and then ask about the facility’s infection-prevention plan.

Lastly, try to visit the home, if possible, and observe that “they appear to be practicing good infection prevention.”

The majority of older adults do not live in long-term care facilities, yet they are still a vulnerable population, Katie Smith Sloan, the president and chief executive of LeadingAge, an association of nonprofit providers of aging services, said in a statement.

Fewer than 5 percent of older adults live in nursing homes, she said, and 2 percent live in assisted living.

“While the focus is on nursing homes, there are many older adults living in community who don’t have the benefit of heightened awareness of and plans for infection control and awareness,” she added. “We all need to be mindful of older adults’ needs and proactive in following recommendations from public health officials regarding coronavirus prevention.”

Mike Baker contributed reporting.