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COVID-19 care planning for dementia in communal living

Key points

  • People with dementia in nursing homes have a higher risk of COVID-19 infection and death, so a proactive care plan is essential.
  • The care plan must be person-centered, based on the individual's preferences, routines, and triggers, and updated regularly.
  • Infection control measures (masking, hand hygiene, isolation) must be delivered with compassion and clear, simple explanations.
  • Virtual visits and consistent staffing help reduce the emotional toll of isolation and confusion.
  • Delirium is a common and serious complication of COVID-19 in older adults with dementia—report any sudden change in mental status immediately.
  • Family caregivers need support too: regular updates, a designated contact, and resources for their own well-being.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Conduct a person-centered assessment with the individual, family, and care team to document preferences, fears, routines, triggers, and communication cues for pain or distress.

  2. Assign a single named professional (e.g., nurse, social worker, care manager) to coordinate the care plan, ensure updates are shared with all staff, and serve as the family's primary contact.

  3. Create a daily routine with consistent meal, medication, care, and rest times; include at least two activities matching the person's abilities (e.g., listening to music, folding laundry, simple puzzles).

  4. Develop a communication plan for family visits and virtual connections, scheduling calls when the person is most alert; use simple, reassuring language.

  5. Train all staff on delivering dementia care under infection protocols—explain mask-wearing gently (e.g., 'This keeps us safe'), redirect room exit attempts, and recognize distress or delirium signs.

  6. Plan non-pharmacological strategies for behavioral changes: offer a favored snack, calming music, or a quiet walk; use validation ('I'm here with you') and avoid arguing or forcing compliance.

  7. Ensure equal access to medical care for other conditions; include symptom monitoring (fever, cough, confusion, falls), escalation steps, and advance care documentation.

  8. Review the care plan every two weeks or monthly; update immediately if the person develops delirium, a new health issue, or other condition changes.

  9. Document a one-page summary of the care plan for the family, including key phrases, triggers to avoid, and the person's preferred name and pronouns.

What not to do

  • Do not assume the person cannot understand safety guidelines; use concrete language and visual cues (e.g., 'We wash our hands before we eat'), not abstract explanations.

  • Do not isolate the person without explanation or alternative social contact; schedule frequent staff check-ins and virtual family visits if medical isolation is required.

  • Do not use restraints or force to keep the person in their room or to wear a mask; use redirection, offer choices (e.g., 'blue or green mask?'), and provide a calm environment.

  • Do not dismiss sudden confusion, agitation, or drowsiness as 'part of dementia'—delirium is a medical emergency requiring immediate reporting.

  • Do not neglect the family caregiver; offer regular updates, a designated contact person, and resources like support groups or counseling.

Practical tools

  • “Hello and Goodbye” Script for Virtual Visits

    Structure video calls: start with the person’s name and a familiar phrase (e.g., 'Hi Dad, it’s Jane, I’m thinking of you'), ask one simple question, share one piece of good news, and end with a reassuring closing. Keep calls to 5–10 minutes to avoid overstimulation.

  • Daily Mood and Activity Log

    A paper or digital log to record mood (happy, calm, sad, agitated), activities performed, and what helped or upset the person. Example: '9am: Listened to Frank Sinatra, smiled. 11am: Refused lunch, seemed tired.' Use patterns to adjust care.

  • Comfort Kit for Agitation

    A bag or box in the person’s room with soothing items: a soft blanket, familiar scented sweater, family photos, a fidget object (e.g., textured ball), calming music playlist, and a preferred snack or drink. Tailor to the individual's life history.

Discuss with your clinician

Ask the doctor: 'Given my loved one's dementia and other health conditions, what is their personal risk of severe COVID-19, and should they receive the vaccine or booster?'

Ask the doctor: 'If my loved one develops COVID-19, what treatment options are appropriate, and should we have a plan for hospitalization or comfort care?'

Ask the doctor: 'Are there any medications my loved one is taking that could interact with COVID-19 treatments or increase their risk of delirium?'

Ask the doctor: 'How should we monitor for delirium, and what should we do if we notice sudden confusion or agitation?'

Ask the doctor: 'What is the best way to manage my loved one's chronic conditions (like diabetes or heart disease) if they get COVID-19?'

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