Assisted Living & Memory Care

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From CDC Considerations When Preparing for COVID-19 in Assisted Living Facilities (Accessed May 26, 2020)

Assisted living facility (ALF) owners and administrators should implement these recommendations:

  • Ensure staff know how to contact the health department for any of the following:
    • If COVID-19 is suspected or confirmed among residents or facility personnel
    • If a resident develops severe respiratory infection
    • If more than 2 residents or facility personnel develop fever or respiratory symptoms within 72 hours of each other.
  • Educate residents, family members, and personnel about COVID-19:
    • Describe actions residents and personnel can take to protect themselves in the facility, emphasizing the importance of social (physical) distancing, hand hygiene, respiratory hygiene and cough etiquette, and source control.
    • Remind residents and visitors that public health authorities have urged older adults to remain home and limit their interactions with others. 
    • Encourage residents to remain in their rooms as much as possible, practice social (physical) distancing, and not allow outside visitors to the facility. 
    • If residents leave their room or are around others, they should wear a cloth face covering (if tolerated), regardless of symptoms. If the resident does not have a cloth face cover, a facemask may be used for source control if supplies allow.
  • Encourage residents, personnel, and visitors to remain vigilant for and immediately report fever or symptoms consistent with COVID-19 (e.g., sore throat, new or worsening cough, shortness of breath, muscle aches).
    • Ask visitors to inform the facility if they develop fever or symptoms consistent with COVID-19 within 14 days of visiting the facility.

Keep COVID-19 from entering the facility:

  • Ask residents to not allow outside visitors until further notice. Visitor restrictions are to protect them and others in the facility who might have conditions making them more vulnerable to COVID-19. Facilitate alternative methods of communication (e.g., video conferencing).

  • Create or review an inventory of all volunteers and personnel who provide care in the facility. Use that inventory to determine which personnel are non-essential and whose services can be delayed. This inventory can also be used to notify personnel if COVID-19 is identified in the facility.

Implement recommended infection prevention and control practices

  • Ensure adequate cleaning and disinfection supplies are available. Provide EPA-registered disposable disinfectant wipes so that commonly used surfaces can be wiped down. Routinely (at least once per day, if possible) clean and disinfect surfaces and objects that are frequently touched in common areas.

  • Cancel all group activities. Instead of communal dining, consider delivering meals to rooms, creating a “grab n’ go” option for residents, or staggering meal times to accommodate social distancing while dining (e.g., a single person per table).

Rapidly identify and properly respond to residents with suspected or confirmed COVID-19

  • Designate one or more facility employees to ensure all residents have been asked at least daily about fever and symptoms of COVID-19 (e.g., sore throat, new or worsening cough, shortness of breath, muscle aches).

  • Implement a process or facility point of contact that residents can notify (e.g., call by phone) if they develop symptoms.

Resources for Older Adults at Higher Risk

From CDC “COVID-19 Guidance for Older Adults” (Accessed May 28, 2020)

Memory Care

From CDC “Considerations for Memory Care Units in Long-term Care Facilities” (Accessed May 25, 2020)

  • 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. 

  • Staff working in memory care units in LTCFs, and assisted living facilities should follow the IPC guidance for those specific settings, which are considered supplemental guidance to the Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings.

  • The first step in caring for people 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.

  • 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.

Infection Prevention and Control (IPC) Guidance for Memory Care Units

  • Routines are very important for residents with dementia. Try to keep their 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.

  • Dedicate personnel to work only on memory care units when possible and try to keep staffing consistent. Limit personnel on the unit to only those essential for care.

  • Continue 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.

  • Provide safe ways for residents to continue to be active, such as personnel walking with individual residents around the unit or outside.

  • Limit the number of residents or space residents at least 6 feet apart as much as feasible when in a common area, and gently redirect residents who are ambulatory and are in close proximity to other residents or personnel.

  • Frequently clean often-touched surfaces in the memory care unit, especially in hallways and common areas where residents and staff spend a lot of time.

  • Continue to ensure access to necessary medical care, and to emergency services if needed and if in alignment with resident goals of care.

When residents on a memory care unit are suspected or confirmed to have COVID-19

  • As it may be challenging to restrict residents to their rooms, implement universal use of eye protection and N95 or other respirators (or facemasks if respirators are not available) for all personnel when on the unit to address potential for encountering a wandering resident who might have COVID-19.

  • Consider potential risks and benefits of moving residents out of the memory care unit to a designated COVID-19 care unit.

    • Moving residents with confirmed COVID-19 to a designated COVID-19 care unit can help to decrease the exposure risk of residents and HCP; however,

    • Moving residents with cognitive impairment to new locations within the facility may cause disorientation, anger, and agitation as well as increase risks for other safety concerns such as falls or wandering.

    • Additionally, at the time a resident with COVID-19 or asymptomatic SARS-CoV-2 infection has been identified, other residents and personnel on the unit may have already been exposed or infected, and additional testing may be needed.

    • Facilities may determine that it is safer to maintain care of residents with COVID-19 on the memory unit with dedicated personnel.

  • If residents with COVID-19 will be moved from the memory care unit

    • Provide information about the move to residents and be prepared to repeat that information as appropriate.

    • Prepare personnel on the receiving unit about the habits and schedule of the person with dementia and try to duplicate it as much as possible.

    • Move familiar objects into the space before introducing the new space to the resident. Familiar objects such as favorite decorations or pictures can help make the person feel more comfortable; this applies to their new surroundings as well if residents are moved to new spaces.

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