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My 88-year-old mother has a difficult personality, and we have been through many, many caregivers during the three years she has received care at home. She is now finally tolerant of her present staff of caregivers, but some of these caregivers also work in nursing homes. I realize that the caregivers who work in nursing homes are more susceptible to contracting the coronavirus, since the elderly population they care for is more at risk of contracting it. Is it wiser to let the nursing home caregivers go, or to allow them to stay on given my mother's tolerance of them? Without my even raising the subject, the caregivers who also work in nursing homes have assured me that they will take precautions to prevent contracting the virus (hand sanitizing, repeatedly monitoring temperature, etc.). I appreciate their pro-active stance, but I feel I must do what is correct to protect my Mom. Does anyone have a similar situation, or have an opinion on this matter? Many, many thanks!

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Do whatever makes you more comfortable. This is your decision. What do you feel is best? As far as sanitizers go, all the reports I hear recommend soap and water first, sanitizer in between times if soap and water aren’t available.
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Where I live staff are being screened every day before they are allowed to enter the building, in my opinion they are safer than workers in the community who are not facing that level of scrutiny.
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momissues Mar 2020
Thank you for that!!
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The decision is certainly yours, but more difficult is resigning yourself to making peace with what you decide.

Your mom is 88. You have blessed her with the very best you could during the three years in which you’ve been responsible for her care.

The management techniques for contagion control in our residential care sites are likely to be among the highest our country has ever seen, especially since the elderly have been identified as a population that is particularly vulnerable to this disease.

Given the information you have, ie. the choice between dismissing a staff that was difficult for you to acquire or taking into account the quality of contagion control in the employment sites where your aides work when they are not with your mother, you are pretty much balanced in making either choice.

I’d probably choose to keep the aides you have, and feel comfortable doing so, since your mom could have some risk of exposure with either choice.

You’re a good daughter. Have confidence that you’ll make the best decision you can.
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needtowashhair Mar 2020
"The management techniques for contagion control in our residential care sites are likely to be among the highest our country has ever seen, especially since the elderly have been identified as a population that is particularly vulnerable to this disease."

I wouldn't count on that. There's only so much they can do. Unless they wear a different tyvek suit or change clothes between each patient after every single interaction, then they are spreading the virus. The can wash their hands raw. The microdroplets will be on their clothes. When they go to change someone or lift someone, those microdroplets will be transferred to the patient or their bedding.

You can bet that the NH in Kirkland is doing all that it can with the scrutiny it's getting. Yet the infection ran like wildfire throughout that facility.
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On what basis are you employing these people?

What do the caregivers who do not also work in nursing homes do when they are not on duty with your mother?

It is your decision, of course, and unfortunately a very difficult one in the absence of guarantees. But do beware unintended consequences.

Supposing you let them go, the disruption upsets your mother, your mother's behaviour becomes more challenging, and both that and the increased workload lead to your losing the remaining caregivers too (healthy ones are not going to be short of job opportunities if they want them)?

I think you might do better to set aside a washroom for them to use on arrival, if possible, and keep it well-stocked and clean.
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momissues Mar 2020
Thank you so much for pointing out the possible repercussions if I let the nursing home caregivers go -- I would actually term those repercussions more "probable" then possible. Having your objective opinion has been a great help to me!!
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Countrymouse is right. Not just the caregivers, but anyone coming into the house MUST wash their hand first. Then, take a disinfecting wipe and go back any wipe every surface they touched on the way in....including the faucet and basin.

but, I wonder what your plan is for when a lock down prevents anyone from leaving their home. Voluntary at first. Maybe you might consider a live-in for a short while till this passes. The risks are exposure while you are out, then bringing it in. It is nearly impossible to "screen" because before you have any symptoms...you are infectious.
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needtowashhair Mar 2020
It's more than their hands. If they were around someone infected, it's all over their clothes. They themselves could be infected and not know it yet. So at least have them wear a mask. A mask helps prevent spread.
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This virus has added an additional burden to all of us who are caregiving for elderly loved ones - as if we needed one more thing to have to stress over!

I would think that professionals who work in a nursing home are very vigilant about maintaining proper hygiene to stem the spread of illness - don't forget, these are people who deal with flu outbreaks every year!! - since they 1) don't want to spread any illness to the people in their care and 2) they don't want to bring home any illnesses to their own families.

That being said, you have to do what you feel is best for your mom's overall health. But I don't know, if at this stage of the virus, that non-nursing home employed people are at less risk to carry/spread the illness than those working in a nursing home. If it were my mom, I would likely stay with the help I've already hired, since she knows them, likes them (as much as she is able) and I know they're reliable, trustworthy people.

Again, make the decision that you can best live with. Unfortunately, as so many people have stated in the forum before today, many times care-taking involves not either a good/bad option, but the "best of 2 bad" options.
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momissues Mar 2020
Yes, it is the "best of 2 bad options"! Thank you so very much for your wisdom and support! I send love and support back to you!!
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If you let them go, can you manage your mom on your own? ANYONE who has any contact with the outside world has a chance of contracting this virus. Even if you order groceries online & have them delivered, the items could have been contaminated at the store. Pumping gas. You would have to find a person with NO one living in their house & never having contact with anyone/anything to remove all risk. That's just impossible. I'd trust the nursing home workers as much as anyone else.
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momissues Mar 2020
Thank you so very much for setting my somewhat scattered thoughts straight! I cannot manage my Mom on my own. I'm an hour away and I work. The caregivers I've hired are intelligent, pro-active and sincere. I'm going to let things be for the time being and keep a close eye on the situation... Many, many thanks!!
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I hear you, I've had to take the very same decision 2 weeks ago, and I have literally agonized over it. And my mom's (93yo) helpers weren't even working in a nursing home, they were just taking public transports.

I'm in Europe, in Italy.
2 weeks ago we weren't in a lockdown yet. I didn't sleep for a couple of nights about this decision. I really didn't know what to do, the helpers are payed per hour and I felt terrible leaving them without a job in a difficult moment for everybody. I also didn't feel the strenght to do everything by myself, from cooking, to therapies, to cleaning, foodshopping etc. I talked with a friend and she told me to write down a list with all the pros and cons.

My pros of them keeping coming were essentially about less stress for me, and a help for them in a difficult economical moment.
My cons were the risk of me or my mom dying.

The list made me decide instantly. I put all of them in payed holiday leave for 2 weeks and cancelled all appointments. Today, with our present situation, I can tell you that I feel very, very happy about my decision. We are in a lockdown now, so they wouldn't be able to come anyway, but I did my part, and I know my mom hasn't been in contact with anyone for 2 weeks already and this makes me sleep at night.

This is just my experience of course, perhaps your list will be different, but it was a very good tool for me.

Everything will be alright. :)
Warm wishes
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Beatty Mar 2020
Arwen, your answer I'm sure has helped the OP. It has helped me - I also have relatives relying on daily carers.

I have been watching the news & the only positive thing has been watching the Italians singing from the balconies. The community spirit was so touching & reminded many people what is important.

Wishing you & your Mother safety though this time.
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Social isolation means social isolation. People coming into the house is just as bad as you leaving the house. We have someone that comes by for bathing. I've put that on hold for the duration.
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cak2135 Mar 2020
If you think I'm going to sit in my home all day long and look at the four walls, you're crazy
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I feel your pain, I am struggling with the same decision. I do all my mom's cares, so aides are only coming in for respite twice a week. I canceled one, will probably end up canceling the other, it's just hard to think of zero visitors for months on end.
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Once again, thank you all so very, very much for your extremely helpful responses!! Being able to read your objective input has enabled me to see things from a logical perspective. In the end, of course, there are strong pros and cons to either decision, and we can only do the best we can in trying to arrive at the most prudent one. Many, many thanks again to each and every one of you who have taken time from your very busy schedules to respond to my dilemma!! XOXOXOXOX
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My caregivers and I are being careful and I am wearing gloves, because I work outside home.none of them work in nursing home all home health aides for people who don"t get out. No garrantees. I am there with her 16 hrs after work am I safe for mom, who knows I drive the handi cap and elderly so we sanitize our vehicles all the time. If they are standing by her and staying I wouldn't. We should have probably done it 2 weeks ago I am in NY and there are 3 aides I am hopeful we were careful enough. I am afraid any of us could bring it in and mom is 92. No one has answers use your gut feeling. Opening a door, pumping gas, using cash to pay all a risk, hang in there we are all trying to figure this out. My aides do not want to not work so all being as careful as possible. I want to get mom checked as soon as they allow to make me feel better
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dogparkmomma Mar 2020
You want to get her checked for what? Coronovirus? Does she have symptoms? Could you bring it in? Yes. Have you? Who knows? You are correct, anyone could bring it in. There is only so much you can do about it. Taking her temperature at the same time daily, or even twice a day is as good indication as any of her infectious status; people are not getting testing without symptoms at this point. Don't drive yourself crazy with this. We can only do the best we can and be careful.
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We have suspended all cargivers.
Althout our caregivers wash hands upon entry, change their clothes and shoes, bio-contamination is risky
As many as 20,000+ Coronavirus can rest on the head of a pin. As shown in the redult of a recent NIH/Princeton/UCal study released only last week the virus remains virulent for hours and sometimes days on various surfaces. On paper and cardboard for about 24 hours, and in plastic, stainless steel etc. for days.

Those who work at nursing homes and medical clinics are the greatest risk. The aides can bring the virus in your home on their face, hair, and back of hands.
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kbuser Mar 2020
i suspended my mom's caregivers as well. So true about the virus remaining on surfaces, my local library shut down and have to wait at least three days to process returned books because the virus might be on them.
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Mom lives with me and I’m working from home for the foreseeable future. I have given the two aides the time off w pay for the same amount of time. One also works in an AL and takes 2 buses & a subway to get to us; the other works in retail in Rite Aid/Walgreens type of store, in the hand sanitizer aisle! I don’t want to risk their exposure any more than it is, or ours.
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disgustedtoo Mar 2020
As with Arwen31, kudos for giving the time off with pay! It is likely a win-win situation for both sides - they get their usual pay (and a little break, possibly less exposure and it would make them more willing to come back when the time is right!
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Thank you for posting this question. I have been wrestling with the same question, except that none of my mother’s caregivers work in a nursing home. Two of my caregivers ONLY work with my mom. The other works for an agency and I received a letter saying that they were training their people on Coronavirus hygiene. I also work some days and nights. I don’t think that I could physically or mentally take care of her by myself. If it comes down to it, I will have to, but for now...after reading these posts, I will keep the caregivers I have hired. Thank you!
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My dad is in AL and we also hire outside caregivers. The company that employs them haselected not to send caregivers since all they would do is be cooped up in dad's room because they are on lockdown. My dad is suffering badly. He likes to be in the lobby. Insists I let him move home (he still owns a house). Not gonna happen. Just getting through this one day at a time.
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disgustedtoo Mar 2020
figures, just when he was adjusting somewhat, now he's cooped up and miserable. sigh, we can't win! hopefully it'll get better soon... hopefully...
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The workers are often underpaid and overworked, over stressed. They are often made to come to work even when feeling sick. Nursing homes should be shut down completely.
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cak2135 Mar 2020
That really makes a lot of sense. Where are you going to put those who can no longer take care of themselves, who have no family in the area where they live, and are on their way out? You need to think before you speak.
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I know I would feel more comfortable but Now probably wouldn't be a good time as you might not find someone new or might cause stress on your mom.

Just make sure they all wash their hands with soap and water for 29 seconds the second the walk thru the door.
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Contrary to many posts, Assisted living and nursing facilities are safer than most places from the virus. Seniors are "at risk" of the serious results like death, but are at less risk of contracting the virus. More concern should be directed at caregivers who go to the grocery store.
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"...since the elderly population they care for is more at risk of contracting it..." That is incorrect. The elderly population is more at risk of *dying* from it if they get it. The general population is more at risk of *contracting* the virus because we have more contact with the outside world e.g. grocery stores, shopping malls, schools, office buildings, etc.

They are coming to work in clean uniforms, right?
Does their work involve touching your mother's face?

In my opinion, you are better off making sure everyone washes their hands when they come to your mother's house. Washing your hands and not touching your face are the best ways to prevent getting sick.

Your mother is a "difficult personality" and I would not risk upsetting her when she finally is content with her caregivers.
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blueberrybelle Mar 2020
Perfect answer!
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I think you are doing what you can do to protect your mother but there is only so much that can be done realistically. If you let the staff go, how are you going to care for her? If you change staff, no guarantee those that don't work in NH also won't be exposed elsewhere. No aides at all? Then what, you are providing care yourself? And never going to shop for supplies? I don't have our LO's at home; my mother is in one facility and my FIL in another. I have no control over how their care is provided; I can only trust that both places are doing the best they can and if someone happens to get it, really not that much we can do. Someone here mentioned that the virus ran quickly thru the nursing home in Kirkland despite scrutiny. That shows a lack of understanding of the situation. They possibly had the virus in Washington state earlier than other states but it was no known and people were infected before anyone knew. And there was no testing available so many people were infected before anyone was aware. So Kirkland is hopefully an anomaly.
My FIL has his 95th birthday on Saturday. He cannot have visitors. I was planning to get a cake from a local bakery and drop it off for everyone to share. The facility was agreeable to that but now I think we will not do that either as I would be concerned possibly about contamination on the surface of the box. That is something I can control so I think we won't send anything over there. I think you have to do what you can do and make peace with what might happen if something happens. This is uncharted territory.
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dads1caregiver Mar 2020
What about dropping off some sealed "Little Debbie" cakes/cupcakes?
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Some times in Life We have no choice therefore We are compelled to take a risk. As your Mom likes these Caregivers I would keep them on, after all you can not manage your Mom's Care with out Them.
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Nursing homes have installed extensive measures to check health of staff before and after shifts. These are probably the safest folks you can employ.
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We had wrestled with this as well and after speaking to my agency we decided to keep the caregivers.
My main reasoning was in the event that we are all quarantined the only ones that will have access to the highways and be able to get to my mom are the caregivers.
So for example if we are all quarantined none of my family would be able to get to my mom only the caregivers would be able to be on the roads giving care.
The agency confirmed that they would be able to supply her with groceries medicine and anything else she may need.
The only restriction they have at this time is that they are not taking them out of their home.
Our agency has confirmed that they are taking every precaution every measure possible with her please.
They are all badged and able to perform care even if we are all quarantined.
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I think you should keep the caregivers that your mother finally likes. Because they work in precarious situations, they are probably taking more precautions than the average population.
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This is a difficult and nuanced decision that you have to make. The problem with nursing homes is that the residents there have conditions that require them to go to hospital, sometimes often. During my mother's last year of life, she required five hospitalizations (fractured hip, medication complications, aspiration pneumonia). Each time one requires hospitalization, one risks exposure to whatever is in the hospital. Sometimes it is an antibiotic resistant bacteria which my dad picked up after a surgery and required three hospitalizations over 2 years. My point is that a nursing home has a revolving door to the hospital so to speak. Your mom is at a very vulnerable age for the coronavirus. I believe that you would be able to travel to your mother's, especially if you contact your local senior council and obtain some sort of documentation that proves that you are needed for the care of your mom. You should do this no matter what you decide. If you can't take care of her on your own because her needs are too great, or if you are working in a job that you believe puts you at a greater risk of exposing the virus to her (er nurse, for example), then keep her caregivers. That being said, my mother had caregivers in the home. There was a rotten virus going around. I repeatedly instructed her caregivers not to come if they were sick....that I could step in for a few days. One person didn't heed my instructions. They were there all morning, sick. My mother caught it, and I believe that this illness is what caused her to fall and break her hip. Up until then, my mother had good balance and was very deliberate in her movement.
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I chose to suspend caregiver. It is going to be very hard on my mother because of her extreme anxiety and sundowning. I pray for all of you and your vulnerable loved ones.
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LET THEM GO!!!
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KaleyBug Mar 2020
Easier said then done in some cases.
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I would not let them go. But I would ask them to change clothes, if they have come from another client. As a family member, make sure supplies are available & convenient to use such as hand wipes in every room.
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I understand your problem. My husband is being cared for at home with Parkinson’s dementia AFIB and so on. I’ve worried about people coming into care for him for weeks now. However, it is a necessity for me to have help. He can’t stand or walk a few feet without help walker plus helper. The size difference alone (about a foot in height) requires more help than I physically can give. So I hope for the best everyday. Sanitizers , soap and water are available for frequent use and prayers for common sense. Wishing you all healthy days ahead.
rachel
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