COVID-19: Guidance and advice for carers of older people at home

Credit: Ben Small

If you are providing care to a loved one at home, this may feel like a daunting and overwhelming time, particularly if the person or people you care for are at higher risk during the COVID-19 outbreak. Depending on your age and health conditions, you may also share that risk.

The information included here gives clear and accurate advice about what you can do to support those in your care, while also looking after yourself. It includes the following:

• What is COVID-19 is and how is it spread?
• Reducing the risks of COVID-19 while providing care at home
• Caring for an older person with suspected or diagnosed COVID-19
• Looking after older people’s health and wellbeing
• Supporting older people with dementia
• Looking after yourself

What is COVID-19 and how is it spread?

• COVID-19 or ‘coronavirus’ is a new disease that emerged in 2019 and causes respiratory infection.
• The most common symptoms of COVID-19 are fever, tiredness and a dry cough. Some people may have aches and pains, nasal congestion, a runny nose, sore throat or diarrhoea. These symptoms are usually mild and begin gradually. A shortage of breath is a main symptom as someone becomes more unwell.
• Some people become infected but don’t develop any symptoms and don’t feel unwell yet may be contagious.
• About 80% of people recover from COVID-19 without needing special treatment.
• Around one in six people will become more seriously unwell and will develop difficulty breathing.
• Older people, and those with underlying health problems like high blood pressure, heart problems, diabetes, or respiratory problems are more likely to become seriously unwell with COVID-19 and are more likely to die.
• People can catch COVID-19 from others who have the virus.
• The disease spreads from person to person through small droplets from the nose or mouth. These are spread most when a person with the virus coughs or sneezes.

Reducing the risks of COVID-19 while providing care at home

There are things you can do to reduce your risk and the risk of COVID-19 for those you are caring:

General protective measures

• It is important that you take the following WHO recommended measures to protect yourself from infection, and that you support those you care for to also do so.
• Regularly and thoroughly wash your hands with soap and water. You should wash your hands for at least 20 seconds, including the palms and backs of your hands, between your fingers, your fingers, fingertips and nails. Regularly remind older people you care for to do this and help them where necessary.
• Wash hands before and after you eat or before you assist the person you are caring for to eat; after you use the toilet or assist someone else to; after providing any physical care or having any physical contact with the person you are looking after; after touching animals; after you touch your own nose, eyes, or mouth; and after you have touched anything which may have been touched by others, including door handles, surfaces, handrails, phones, light switches and phones.
• Avoid touching your eyes, nose and mouth. If you must touch your face, wash your hands thoroughly before and afterwards if possible. Regularly remind people you care for not to touch their eyes, nose and mouth.
• Make sure you cough or sneeze into a tissue. Throw the tissue away immediately. If you do not have a tissue, cough or sneeze into your elbow. Then, immediately wash your hands thoroughly. Try to be two metres away from the older person you care for if you need to cough or sneeze.
• Remind people you care for to do the same. Try to maintain a two metre distance from the person you are caring for if they cough or sneeze. if you need to help them blow their nose, throw the tissue away immediately and wash your hands and theirs.
• Ask older people you care for and other household members not to go out unless completely necessary. If they have to go out, they should avoid groups, stay two metres away from people and wash their hands immediately on returning home.

What you can do as a carer

• Stay at home as much as possible, only going out if it is unavoidable to collect food or medicines. Ask a family member, friend or neighbour to do this for you if possible. If you have to go out, avoid any groups and stay two metres away from people.
• Ask people not to visit you at home to reduce the risk of infection for you and those you are caring for. If someone needs to deliver any essentials, including food or medicines, ask them to bring them to your door and then step back two metres while you collect them. Do not invite the person in.
• If you usually have other people visit you to provide care, or to support you in providing care to others, ask them not to come if possible.
• If health workers or carers have to visit to provide medical help or care, ask them to take precautions by wearing protective equipment and washing their hands.
• Make sure you know how to contact a health provider if you are worried the older person you care for might have COVID-19. The most appropriate place to go for help will depend on where you live and the facilities available. Your local advice may not be to go immediately to your nearest health facility. Try to find this information in advance so you are prepared, should the person you care for, or you, feel unwell.

The home environment

• While you and those you care for are isolating at home, it is important to keep your environment as safe as possible.
• Clean the home regularly, including surfaces you touch frequently. This includes tables, chairs, door handles, light switches, toilet flushes, taps, phones and other screens or electronics.
• Clean the home using household cleaners and disinfectants, following guidelines on the product. Wear gloves while cleaning the home if possible.

Caring for an older person with suspected or diagnosed COVID-19

• Be aware of the main symptoms of COVID-19 and watch out for any sign of them.
• If you suspect the older person you care for has a fever, check their temperature if possible. Check your own temperature if you feel unwell with a potential fever.
• If the older person you care for has any of the main symptoms, support them to isolate themselves from others in the household to the greatest extent possible.
• Contact a health provider and follow the advice you are given. If you are advised to travel to a health facility, do not use public transport unless unavoidable. If possible, both the older person and you should wear a mask.

If you cannot access a health facility, or if you are sent home from a facility, you may have to look after the older person you suspect or know to have COVID-19, at home. There are things you can do to care for the person while reducing the risk to yourself and others:

• If at all possible, isolate the person in a room separate from yourself and other members of the household. If this is not possible, try to keep as much distance as possible.
• Keep the house, and particularly the room the person is in, well ventilated.
• Ask the person not to move around the house.
• Try to limit the number of people in the household providing care and having contact with the person. If you are the main carer and can provide all the necessary care yourself, limit other household members contact with the person.
• If you are at higher risk of COVID-19 and there is someone else in the household able to provide care ask them to do so, as long as the older person is happy with this.
• Ensure the person drinks water regularly to stay hydrated.
• Encourage the person to eat and try to ensure nutritious meals are available.
• Make sure the person takes any medication, as instructed by a health worker. This could be medication to treat the symptoms of COVID-19 or medication for other health conditions. Ibuprofen is not recommended for people with COVID-19 due to potential complications. Paracetamol can be taken to lower a fever.
• Encourage the person to rest and sleep when needed.
• Monitor the person’s symptoms and seek medical help if they seem to be getting worse.

You should seek help immediately if you notice the following:

1. Increased trouble breathing

2. Persistent pain or pressure in the chest

3. New confusion or you are unable to rouse the person

4. Bluish lips or face

• Wash your hands with soap and water after any physical contact with the person, their bedlinen, or any surfaces they have touched.
• The person who is unwell should wear a mask as much as possible, if available. You should also wear a mask while providing them with care. Masks should be changed frequently, and particularly if they become damp. Avoid touching your mask while wearing it and wash your hands immediately after removing it.
• If you need to help the person with personal care, washing, dressing and toileting for example, wear gloves if possible and wash your hands immediately afterwards.
• If the person is unable to get out of bed, try to help them to change position regularly. Wear gloves and a mask while doing this and wash your hands immediately afterwards.
• Make sure the person has their own linen, towels and eating and drinking utensils.
• If you and others in the house are sharing a toilet and washing facilities with the person, this area should be cleaned after each time the person uses it. If possible, the person should clean it themselves. If this is not possible, you should try and leave time after the person has used this area, before you clean it. It should be cleaned before you or other people in the household use these facilities. Wear gloves and use household cleaners.
• If the person uses any assistive aids, a walking frame, for example, clean them after use.
• Laundry should be washed regularly at a warm temperature using normal detergents. Try to use gloves and try not to shake the laundry before it has been washed.

Looking after older people’s broader health and wellbeing

• It is important that you take care of the general health of those you are caring for, including any specific conditions they already have.
• If the older person you are caring for becomes unwell, they should continue to take any medication they have been given by a doctor for other illnesses or health issues. You should remind or support them to do this in your normal way.
• Try to have at least two weeks supply of their medicines, and any medicines you take.
• If the older person you care for has any underlying health conditions, particularly diabetes, hypertension, heart or lung problems, seek medical advice immediately if they have a cough, fever or shortness of breath.
• If the person you care for needs medical help or advice not related to COVID-19, find out if there is a way they can avoid going out to a health facility, for example through asking for a health worker to visit at home, or seeking advice over the phone.
• It will be important to think about think about the mental health of the person you are caring for, as well as their physical health, during this stressful time. Many people will feel anxious and stressed about what is happening, and the restrictions imposed.
• Look out for signs that the person you are caring for might be struggling with their mental wellbeing. Are they feeling sad, withdrawn, anxious or confused? Try to be encouraging and supportive and ask for help if you need it.
• Remind or support older people you care for to stay mobile and active, taking some light exercise around the house if possible, or in bed if they are unable to get up.
• Sleep is important for wellbeing. Do what you can to support the person you care for to get sufficient rest.
• Try to think of ways to occupy your time. Do some activities together.
• Encourage friends and family to stay in touch from a distance, by phone for example.

Plan for all eventualities

Put a plan in place for if you were to become ill. Talk to friends and family about how they can help provide care if you are unable to. Reach out to any organisations or home-based carers you currently receive support from to agree how they would help if needed.

Document the care needs of the person you are caring for including:

1. List all medications, the person you are caring for is taking, when they are taken and what dosage, where to find them at home and where to get more
2. Make a list of relevant health and care facilities and providers you use or get support from, including contact information
3. Give some information about daily routine – what the person you are caring for likes to do, when and what they eat, when they sleep etc.

Supporting older people with dementia and other cognitive impairments

Coping with the uncertainty and changes caused by COVID-19 could be particularly difficult for an older person with dementia.

The following suggestions – which may also be helpful for those providing care to someone without dementia – could help you support them.

• Protecting against COVID-19: people with dementia may find it difficult to understand public health information and to remember to follow guidance like washing their hands. Keep reminding the person you are caring for and help them to take these measures where necessary. You could try using memory aids, such as notes and pictures and also  provide encouragement and celebrate accomplishments when the person you care for remembers. Consider how much information to impart about COVID-19 and the crisis situation, to avoid inducing anxiety, but enough to convey the importance of following the guidance.
• Maintaining a routine: for a person with dementia changes in routine can be difficult and can cause increased anxiety, and irritability. They could lead to changes in behaviour, increased walking around and delusions. This can in turn be challenging for you as a carer. Do what you can to keep things normal. Try to maintain any activities you would usually do around the house and keep to regular meal and bedtimes.
• Plan your days in advance: with changes to your day’s activities because of the restrictions caused by COVID-19, try to plan your days in advance, replacing any activities you can no longer do, with new things around the house. Once your days are planned, try to stick to them as much as possible to maintain a consistent routine.
• Managing challenging behaviour: there is not yet any evidence to suggest that COVID-19 has an impact on a person with dementia’s cognitive status, but changes in routine and increased stress may have psychological impacts and lead to changes in behaviour. If you see this in the person you care for, try to be as reassuring as possible and try to maintain your routine. You may want to consider keeping a diary of when challenging behaviours are seen to try and understand why they might be happening.
• Thinking about wellbeing: it will be important to try and maintain the physical and mental wellbeing of those you are caring for. Some suggestions:

1. Given the challenging and potentially anxiety provoking situation of the COVID-19 pandemic, make sure you encourage the person to talk about any fears. Listen, reassure, comfort and try to maintain a positive attitude
2. You could try and to practice relaxation and mindfulness together
3. You could also think about using your time together to learn something new, for example, a new handicraft
4. Try to promote cognitive stimulation. You could listen to music together or discuss special objects, reminiscence therapy is effective, for example looking at photos or other personal items such as  old newspapers or magazines, letters or postcards. This can help to reactivate family memories and can be reassuring
5. Do some  physical exercise together. Although you won’t be able to go out, try to stay physically active with some light exercise around the house
6. Do some light activity together, such as taking care of plants or animals
7. Try to ensure the person you are caring for can enjoy some fresh air, in the garden or through the window
8. Try to ensure you maintain a balanced and nutritious diet for the person you are caring for with mealtimes at a regular time each day.

• Sleep: try to encourage a good sleep routine for the person you are caring for, and avoid napping during the day, particularly due to lack of things to do. This could affect the person’s sleep at night

Looking after yourself

• It is important that, as a carer, you look after yourself at this time. It is a stressful and difficult situation for everyone, and your health and wellbeing are important. Many of the suggestions listed above will be important for you, as well as those you are caring for.
• Remember your own risk in relation to COVID-19, particularly if you are older or have underlying health conditions, and take the measures described above.
• Make sure you look after your own health. If you are taking any medication, remember to keep doing this and try to have two weeks supply. Avoid taking Ibuprofen due to its risk of complications.
• Try to take some regular exercise and stay active. Find ways to do this around the house and in the garden if you have one. If you go out for longer walks, maintain a two metre distance between yourself and other people.
• Remember to eat well. Your diet is as important as that of the person you are caring for. Try to make sure you have a balanced and nutritious diet and stay hydrated.
• Make sure you get adequate rest and do what you can to ensure a good night’s sleep.
• Try to plan ahead. Talk to family and friends about any help you might need if you become ill or you find your situation too difficult. Also make sure you have any necessary information from your health services about what you should do if you or the person you are caring for displays symptoms of COVID-19.
• It is important to stay connected with friends and family, particularly during periods of isolation. Find ways to stay in touch, by phone for example.

Try to take a break. You may find you are having to do more, particularly if other carers who usually support you are not visiting. Do what you can to make some time for yourself. Try to schedule small amounts of relaxation time into your day.

Download the document here

Resources

www.who.int/news-room/q-a-detail/q-a-coronaviruses

www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html

www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/

www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html#treat

www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

www.alz.co.uk/news/adi-offers-advice-and-support-during-covid-19

www.francealzheimer.org/coronavirus-confinement-comment-prendre-soin-de-son-proche-malade/

www.carersuk.org/help-and-advice/coronavirus-covid-19/coronavirus-further-support