On July 21, 2020 Global Ageing Network, Heritage Foundation and BDU Heritage Center for Gerontology co-hosted a webinar focused on dementia care in the midst of COVID. Four distinguished panelists each provided their perspectives based on their distinct roles and countries.
Dr Al Power, U.S.-based gerontologist, described the benefits to those living with dementia of the cohorting that has become necessary with COVID to contain the spread and, with it, consistent staff assignments. The latter allow staff to follow the rhythms of an individual resident better. With cohorting there is also less commotion and increased spacing for meals and activities which, he suggested, are important lessons for us to consider post-COVID.
Dr Power also referenced a study that is currently underway by Susan Ryan of The Green House Project and Dr. Cheryl Zimmerman looking at the experience of COVID in 254 Green House homes. Early findings suggest the cases and death rates are lower than in other nursing home settings. Preliminary conclusions: size matters (small is better), consistent staff assignment is essential; private rooms and easy access to the outdoors are critical and the ability to “better personalize the rhythms of residents” creates a healthy environment, particularly in a pandemic.
Pavithra Gangadharan runs a private assisted living community in Hyderbad, India. She reinforced Dr Powers’ push for private rooms and consistent assignment, allowing for one on one caregiving. The operational changes she has made as a result of COVID include reducing group activities and limiting the number of ancillary staff coming into her community. In contrast, the state funded homes in India have upwards of 7 people to a room, fewer caregivers and far more cases of COVID 19.
Vincenzo Paolino, CEO of Almacaza in Switzerland is trained as a psychiatric nurse. While COVID is, at present, under control in Switzerland, Vincenzo asserted that quality of care is the basis for quality of life. In his communities, the resident is at the center of all care and support and building trust with families and residents is critical. Fearing the effects of social isolation by the resident when COVID was at its peak, Almacaza resorted to postcard exchanges between residents and families, a seemingly old fashioned but successful solution to a present day challenge.
Emi Kiyota, architect and advocate for older adults and those living with dementia, noted that COVID didn’t create the problems of our system of supports for those living with dementia but it did expose them. In India, dementia is stigmatized and dismissed as an age-related illness. People don’t like to admit that they have a family member living with dementia and, as a result don’t ask for help and quickly get burned out. In Italy, there is a post-COVID response that favors institutionalizing older people and medicalizing their care. By doing this, Vincenzo suggested, we minimize the humanity of older adults. “There should be no difference in humanity across countries when it comes to the livelihood of older people.”
The panel spoke about the role of technology, especially in addressing social isolation. There was widespread agreement that whether a technology solution is effective is completely individualized. For some individuals it may be a solution but it will never replace caregiving.
Emi Kiyota concluded the webinar by noting that, based on her experience working in Nepal and the Philippines and listening to Pavithra talk about India, there is a sense of community that is very strong in the less developed world, particularly as it relates to the role of older adults in community. This is something that the rest of the world can learn from.
Participants included individuals involved in aged care and services from over 13 countries.
By Katie Smith Sloan
Executive Director, Global Ageing Network