CDC Issues Guidance for Memory Care Units

The Centers for Disease Control and Prevention (CDC) has issued guidance related to infection control in units where there are residents with cognitive impairments.

According to the CDC, at least half of older adults living in long term care facilities suffer from cognitive impairment with Alzheimer’s disease or other dementias. Memory care services, designed to meet the unique needs of residents with dementia, are often provided in dedicated care units or wings of a facility. Some memory care units may be secured or provide restricted access (e.g., using a code) to control entry and exits and have dedicated, specially trained staff or teams working with residents.

Important to caring for any person living with dementia in any setting is to understand that changes in behavior (e.g., increased agitation, confusion, sudden sadness) or worsening symptoms of dementia should be evaluated because they can be an indication of worsening stress and anxiety, as well as COVID-19 or other infections.

Infection prevention strategies to prevent the spread of COVID-19 are especially challenging to implement in dedicated memory care units where numerous residents with cognitive impairment reside together. For example, residents can have a difficult time following recommended infection prevention practices such as social distancing, washing their hands, avoiding touching their face, and wearing a cloth face covering for source control. Changes to resident routines, disruptions in daily schedules, use of unfamiliar equipment, or working with unfamiliar caregivers can lead to fear and anxiety, resulting in increased depression and behavioral changes such as agitation, aggression, or wandering.

The CDC's recommendations include the following:

• Keeping residents' environment and routines as consistent as possible while still reminding and assisting with frequent hand hygiene, social distancing, and use of cloth face coverings (if tolerated). Cloth face coverings should not be used for anyone who has trouble breathing or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance;
• Dedicating personnel to work only on memory care units when possible and keeping staffing consistent, and limiting personnel on the unit to only those essential for care;
• Continuing to provide structured activities, which may need to occur in the resident’s room or be scheduled at staggered times throughout the day to maintain social distancing;
• Providing safe ways for residents to continue to be active, such as personnel walking with individual residents around the unit or outside;
• Limiting the number of residents or spacing residents at least six feet apart as much as feasible when in a common area, and gently redirecting residents who are ambulatory and are in close proximity to other residents or personnel;
• Frequently cleaning often-touched surfaces in the memory care unit, especially in hallways and common areas where residents and staff spend a lot of time; and
• Continuing to ensure access to necessary medical care and to emergency services if needed and if in alignment with resident goals of care.

The guidance also addresses approaches for working with memory care residents with suspected or confirmed COVID-19.

Contact: Elliott Frost, efrost@leadingageny.org, 518-441-8761