Aging Well

Differentiating between Nursing Homes, Congregate Care and Independent Living

Headlines regularly advertise that nearly half of all deaths due to COVID occur in nursing homes and congregate care. Is it safe to move mom or dad into senior communities during this pandemic?

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What to do?
Liisa Ogburn

“I don’t know why anyone would move into a senior community,” yet another person recently said to me, “with all the risk.”

Yes, it is true that COVID-19 affects older people disproportionately, and specifically, those over 65 with multiple health vulnerabilities (with the majority of cases occurring among those over 85).

Is this reason to avoid moving into a senior community or pulling a loved one out of one?

It may be useful to first understand what precisely is a nursing home, congregate care facility and independent living community. The NC Department of Health and Human Services reports cases and deaths of residents and staff in nursing homes and in congregate care facilities. Anyone can see the latest outbreaks here. Data is updated every Tuesday and Friday at 4 pm.

Residents in nursing homes are typically over 79, need significant help with their Activities of Daily Living (dressing, bathing, toileting, transferring, and eating), and also have care needs that require a registered nurse. People living in nursing homes are typically within the last year or two of life. Currently, of the 1,688 citizens who have died of COVID-19, 43 % of these have occurred in nursing homes.

Congregate care, which occurs in Assisted Living, Family Care Homes and Secure Memory Care Facilities, comprises those who need assistance with Activities of Daily Living, medication administration and check-ins every 1-to-2 hours, but not medical care overseen by a nurse 24/7. A nurse may be on site or on-call during the work week. Typically, Certified Nurse Assistants and Med Techs provide care and supervisions around the clock. The number of deaths from COVID-19 in congregate care is 136 in the state, or 8 %, of total deaths.

While every family can choose to remove a loved one from a nursing home or congregate care facility where there is an outbreak, they must carefully consider whether they are able to provide the care needed at home. They should also keep in mind that if they move their loved one home and then realize they are not able to manage all the needs, it may be difficult to get their loved one readmitted to the same facility.

A third type of senior community, Independent Living, is geared towards individuals and couples who are older, but relatively healthy and simply in need of conveniences that can enable them to live Independently for longer. Independent Living communities typically provide accessible design, weekly house cleaning, healthy meals, a wellness center, activities, a mobile physician service, on-site physical therapy, and other conveniences. There is also often a third-party home health agency on-site that residents can hire on an as-needed basis.

To-date, while I have read of a few cases of coronavirus in a handful of Independent Living communities in North Carolina, I have not seen evidence of any deaths in Independent Living. That is not to say there will not be any. However, one may find that because of the conveniences and infection prevention protocols, some families may find it safer to live in an Independent Living community than alone at home.

At Cambridge Village of Apex, for example, some policies they have put in place:

  • Residents returning from a hospital or skilled nursing rehab facility (SNF) or flying on an airplane must quarantine immediately upon return and then will be tested for Covid-19 on Day 5 and will continue the quarantine until the test returns as negative
  • Routine cleaning in common areas multiple times a day with commercial grade disinfectant
  • Masks are required for all residents, staff and visitors at this time
  • No housekeeping or maintenance at this time unless it’s an emergency to reduce possible exposure.
  • Any staff that has traveled on a plane will be required to self-quarantine and be tested for Co-vid (paid for by the company) and can return to work once the test comes back as negative.

There are no right answers. At the end of the day, each family must weigh the pros and cons and decide for themselves.


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