Describe circumstances that may trigger potentially catastrophic
Planning for a Pandemic/Epidemic or Disaster: Caring for persons with cognitive impairment
American Association of Homes and Services for the Aging
American Health Care Association
American Health Quality Association
American Medical Directors Association
National Association of Directors of Nursing Administration
National Center for Assisted Living
Emergency situations such as a pandemic, epidemic or disaster present special circumstances for staff in long term care facilities. Residents in long term care facilities are particularly vulnerable to complications of influenza (the “flu”)
due to their age and other concurrent medical conditions.
Employees would also be affected by a serious flu outbreak.
Maintaining operations in a long term care setting with the
expected staffing shortages during a pandemic, epidemic or
disaster would be very challenging. During this time, non-
clinical staff may be needed to assist with patient care. This
document is designed as a guide for non-licensed staff and lay
people who may become involved in direct patient care during
a major disease outbreak or disaster. Note: these are suggestions
for care. It may be unrealistic to expect all items in this
document to be carried out in a pandemic or disaster situation.
This document is not a substitute for facility training. The
Alzheimer’s Association’s Campaign for Quality Residential
Care offers practice recommendations for long term care
facilities. The recommendations and information on training
can be found at: http://www.alz.org/qualitycare.
Approximately 50% of all nursing home residents have some
form of dementia with 26% experiencing mild cognitive
impairment. Among residents in assisted living programs 42% or
more have some form of dementia. Dementia is characterized
by a group of symptoms that include a decline in cognitive
abilities including loss of memory, poor judgment, changes in
personality, disorientation and problems with abstract thinking.
As the disease progresses, residents with dementia will need
additional assistance in conducting activities of daily living.
Due to their decreased cognitive ability, residents with dementia
may require additional assistance and consideration during the
implementation of an emergency plan.
Prevention Issues Residents with dementia may have an impaired ability to
follow or remember instructions regarding:
• Hand washing
• Wearing a mask
• Refraining from placing things in the mouth
• Staying in particular area
• Taking medications appropriately
• Following any other procedures that would require intact
memory and judgment
It is recommended that residents with dementia be placed
on a supervised “hand washing schedule” followed by the use
of moisturizer to avoid skin breakdown. Various approaches
may be needed to ensure that these individuals use masks and
remain in particular areas. This may require additional staff and
During Plan Implementation Residents with dementia may become more agitated, frustrated,
or even display “catastrophic” reactions during a crisis. They
are often less able to adapt to changes in their environment.
It is recommended to try to minimize any changes in routine,
environment and daily structure for the residents with
Below are some areas of concern for residents with dementia
that may require special attention during a major disease
outbreak or disaster along with some potential approaches:
1. Provide person-centered care One of the most important steps in providing quality dementia
care is to get to know the resident. In the event of a major
disease outbreak or disaster, this may be more difficult
for temporary staff members or those working in a new
department. It is recommended that a personal information
form, about each resident be completed and placed in an
easily accessible place, consistent with HIPAA guidelines.
For example, forms can be placed inside a closet door or in
a folder attached behind the door. This will allow temporary
or substitute staff members to quickly identify essential
information about the resident to help maintain a stable and
comforting environment. Information on the form can
• What the resident likes to be called
• Cultural background
• Names of family and friends
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