How caregivers can use a masterplan to help older people minimise going to the doctor during this pandemic. Muriel Gillick reports for The New York Times.
There are many older adults who are not in nursing facilities but who need help with personal care (bathing, dressing or eating) and assistance in areas such as finances and cooking to live independently. These older adults depend on caregivers, either paid home health aides or unpaid family members, for their day-to-day existence. Both family caregivers and those they care for need to rapidly adapt if they are to remain safe during the coronavirus epidemic.
The best strategy for older adults with caregiving needs is to shelter where you live, the same approach that is being used for the entire population in some of the hardest hit communities in the country. They need to stay away from sites where people congregate, including, whenever possible, health care institutions.
Older people may well develop acute symptoms that have nothing to do with COVID-19 and will benefit from caregiver intervention to avoid having to visit health care providers to manage those problems.
Family caregivers are advised to redouble their efforts at “social distancing,” both for their own safety and to help protect those they care for. To be sure, many people have already taken such steps. But as the reach of the virus spreads, for those who are not already using technology to interact with pharmacies, banks, grocery stores and health care providers, this is the time to start.
A first step should be arranging for mail order delivery of medications for the older adult, preferably a three-month supply of all chronic medicines. It also means arranging for home delivery of groceries and over-the-counter medicinal supplies, making sure to include any necessary disposable undergarments or nutritional supplements. Checkers and Pick ‘n Pay have very organised delivery services. Dischem also has an excellent delivery system.
In many areas grocery delivery slots are very hard to come by right now, so you may have to plan ahead and try multiple stores’ options. Setting up automatic bill paying of credit card charges as well as for power and telephone services can lighten the load on the caregivers’ shoulders if they handle the finances of the older adult.
To minimise the need for visits to the physician’s office or hospital emergency room, caregivers should consider utilizing simple medical technology such as a home blood pressure cuff, a pulse oximeter (to measure the amount of oxygen in the blood), a digital thermometer, and a digital step-on scale.
By learning to use these devices, caregivers will be able to collect valuable data that they can provide to primary care physicians, nurse practitioners or physician assistants who, in turn, will be better equipped to offer medical advice or prescribe treatment over the telephone or the internet. This information can enhance telemedicine visits, when those are available, and substitute for them among the many seniors who do not have access to video technology.
As an example, if an older adult experiences dizziness and has a low blood pressure reading, the clinician might propose as a first step increasing the fluid intake or cutting out a diuretic pill. If the individual reports shortness of breath and proves to have gained weight and to have swollen ankles, along with a history of heart failure, the clinician might advise increasing the diuretic dose — all without the patient and caregiver having to risk exposure to the virus by venturing to a medical appointment in person.
If the patient shows symptoms that suggest COVID-19, checking oxygen levels with a pulse oximeter can help the health care providers decide whether the next step in the evaluation should be the physician’s office or the hospital emergency department.
In a time of crisis, using technology and partnering with the health care team to address acute symptoms can benefit both older adults and their caregivers. These strategies may even prove useful in more auspicious days.
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Muriel Gillick is a professor at Harvard Medical School and the author of “The Caregiver’s Encyclopedia: A Compassionate Guide to Caring for Older Adults.”
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