COVID-19 has changed how we currently provide care. As a precautionary measure, residential care homes may have had to restrict visitors including family members from visiting their loved ones, group activities are being reduced, residents are being placed in isolation and staff may be wearing PPE including facemasks or face shields for routine care. Homes with suspected or confirmed cases of COVID-19 are required to place resident’s in isolation which can be particularly challenging when caring for a person living with dementia.
1. Changes to the care routine
Whilst these strategies outlined above are necessary, they can be very confronting for a person living with dementia. Depending on what stage of dementia a person is living with, or how it’s affected them, may affect how well the person will understand the changes. A person living with dementia may really struggle with disruption to their daily routine, changes to staffing and social isolation . A person with dementia may not be able to communicate directly how they’re feeling, but instead we might see a change in the behavioural and psychological symptoms of dementia which they display.
Below are some tips to minimise the disruption:
- Staff should monitor residents’ for changes in their behaviour and communicate changes immediately. A thorough care plan should be available so all staff are monitoring behaviour and their responding to it in the same way
- Where possible consider if regular staffing can be maintained
- If there isn’t a suspected or confirmed case of COVID-19 in your facility, maintain routine to minimise disruption 
- If you change in behaviour is noted, a delirium screen should be completed to rule out illness or physical causes of behaviour change. Unmet needs should also be considered as a trigger for the behaviour. 1
- If activities and visitors are reduced, allow opportunities for the person to access outside areas on a regular basis.
- Arrange virtual visits to enable the person to connect with their family or friends via an ipad or computer 
2. A person living with dementia has a suspected or confirmed case of COVID-19
It can be particularly hard to manage a person living with dementia who has COVID-19. It is likely that they won’t remember that they need to stay in their room or maintain social distance. Of course staff will wear PPE when having contact with the person, but how do you manage a person who might wander in areas with unaffected residents?
- Firstly, residents with COVID-19 should not be restrained chemically. As COVID-19 is a respiratory condition, restraining a person could lead to lung complications such as pneumonia.
- If the person is wandering and won’t stay in the allocated area, a risk assessment should be performed to ascertain what risk the person poses to others around them. Strategies aimed at harm minimisation should be implemented. Can residents who are infected be cohorted in the same area or wing of a facility?
- Has a behaviour support service been contacted to advise on management strategies?
- Dementia Support Australia (DSA) recommend that physical restraints are not used unless all other options are exhausted. If they are required, the least restrictive method should be chosen. They recommend that 1:1 support (a special) should be considered and if this isn’t possible confining a person to their own room would be the next option but appropriate consent and documentation will need to be in place to support this.
To learn more about restrictive practices and restraints you can view our FREE Altura now segment where Nicola Burton, Altura Learning, discusses with Ann Wunsch, Executive Director, Quality Assessment and Monitoring Operations and Dr Melanie Wroth, Chief Clinical Advisor, Aged Care Quality and Safety Commission how to minimise the use of restrictive practices and restraints, as well as discussing the medical and ethical issues around the use of restrictive practices.