Coronavirus cases continue to rise in Dallas-area nursing homes and other long-term care facilities, leaving some families wondering whether their loved ones would be safer at home.
When officials announced the first signs of clusters of COVID-19 patients at assisted-living facilities in Dallas County, Judge Clay Jenkins encouraged people with the means to take their loved ones home to do so.
“I want every family to really question: Could they take care of a person and maybe try to get them home?” Jenkins said late last month. “What I am saying is if you bring your loved one home, it’s safer than leaving them in the nursing home, if you can.”
But experts say there are key questions people should consider before they make the tough decision to bring anyone home. Here’s how the process works in Dallas County.
An aerial view of a Dallas Fire-Rescue ambulance at the Edgemere senior living facility on April 1.(Smiley N. Pool / Staff Photographer)Does my loved one have to undergo a COVID-19 test before I can bring them home?
Whether a resident of a long-term care facility has to have a COVID-19 test before being allowed to leave with a family member depends on whether a positive case has been identified at that facility.
If at least one positive case has been reported at the facility, anyone who wants to bring a loved one home has to arrange a COVID-19 test for the resident. That should be done by contacting the long-term care facility, said Lauren Trimble, Dallas County Judge Clay Jenkins’ chief of staff.
The staff at the facility will collect the test specimen, and it will be processed at Dallas County Health and Human Services’ lab, Trimble said in an email.
While tests through a medical provider can take several days to complete, Jenkins has said the county has a limited number of rapid-results tests that are being used if people want to remove someone from a nursing home. The rapid-results tests have a turnaround time of about a day.
As of Thursday, COVID-19 cases have been reported at nine facilities, according to Dallas County officials. These counts include residents and staff members who have tested positive for the virus.
Monticello West: 11 cases, including one deathSkyline Nursing Center: 39 casesEdgemere Luxury Living: 10 cases, including three deathsThe Reserve at Richardson: seven casesBrentwood Place One: 39 casesBrentwood Place Two: six casesSt. Joseph Village: one caseThe Villages of Dallas: one case
Westridge Nursing and Rehabilitation in Lancaster has also seen a positive case, the county’s health director said earlier this week. A county official said Thursday that person was not a resident of the nursing home. Family members do not have to arrange for a test to take a loved one home from Westridge.
What happens after the test results?
If a resident tests positive, he or she can’t leave the facility, Trimble said.
If the resident tests negative, he or she may leave. But once a family member is home from a long-term care facility, the entire household must quarantine for at least two weeks — so families should be prepared to stay at home for 14 days without trips to the grocery store or anywhere else.
If the family member develops symptoms of the coronavirus during the quarantine, the household has to stay under quarantine for 14 days after their loved one recovers. People are deemed to have recovered once they go at least three days without a fever (without the use of fever-reducing medications) and at least seven days from the onset of symptoms.
While a household is quarantined, people should check their temperature twice a day and look out for COVID-19 symptoms, which include fever, cough and shortness of breath. Those symptoms should be reported to a doctor; they don’t have to be reported to the Dallas County health department, Trimble said.
What should you consider before bringing a loved one home?
Bringing a loved one home can present many challenges, and the decision must be carefully considered by each family.
For one, it can be challenging to set up and order the needed equipment, like a hospital bed or a wheelchair, to make a home comfortable for a family member who requires a higher level of care.
Dr. Sarah Ross, assistant professor of geriatrics for the University of North Texas Health Science Center, said people should “take COVID out of the equation” when they’re considering whether to bring someone home.
“In nursing homes, the patients that are there are there because they need help with some of their basic activities of daily living — walking, bathing, dressing, eating,” Ross said. “If you really can’t do those care or tasks, it’s really not going to create a safe situation for them to move home.”
Families can also try at-home care. But that can be costly, hard to find, and take time to set up. Health experts say it’s important to remember an at-home provider may work with other at-risk patients or in other long-term care facilities, which could put a loved one at risk.
Families with young children have extra considerations to take into account before making the decision, Dr. Thomas Cornwell, executive chairman of the Home Centered Care Institute, told CNN.
“Kids, generally, even in the past few weeks, have been exposed to hundreds of others [at school],” he said. “They tend to be vectors of infection.”
And for people with memory problems, being removed from nursing homes can be difficult, Ross said.
“Individuals with dementia really rely on that routine and that familiarity, so if they’re removed from what they see as a safe place and what has been their home for a year or more, and then they’re thrown into a different environment, it could be traumatic for them,” he said.
When should you bring a loved one home?
Ross said families that have the capability to provide at-home care should pull their family members out of long-term care facilities.
“Once a case has hit the facility, it’s too late,” Ross said. “There may be public health initiatives put in place to restrict people from leaving to prevent spread. It kind of becomes complex if there is an actual case in the facility.”
Ross said the argument can be made that there’s a risk either way. Whether you leave family members in a facility or bring them home, they are being exposed to people who have left their homes for essential business or other errands and risk infecting your loved one with the virus.
But because they live in such close quarters, one infection can spread rapidly in a nursing home or other long-term care facility. That’s why it’s better to bring them home now, if possible, Ross said.
Aerial view of Skyline Nursing Center on Wednesday, April 1, 2020, in Dallas, Texas. (Smiley N. Pool/The Dallas Morning News)(Smiley N. Pool / Staff Photographer)Other resources to help you make a decision
When making the decision, people can also research and get in contact with a facility to learn what it is doing to prevent or prepare for an outbreak.
Charlene Harrington, a professor emeritus at the University of California, San Francisco, School of Nursing, told The New York Times that she recommends Medicare’s Nursing Home Compare tool, which lists information about every Medicare- and Medicaid-certified nursing home in the country. The site lists information about health ratings, staffing and quality measures.
People can also call the facility and speak with care providers about what they are doing to protect residents.
The U.S. Centers for Disease Control and Prevention has a tip sheet called the “Top 10 Infection Prevention Questions to Ask a Nursing Home’s Leaders.” The questionnaire was developed before the COVID-19 outbreak, but the questions are still applicable.