In 2016, when Lee and Jay Ferrette moved from a remote sheep farm in Pennington, NJ, to The Villages in central Florida, it seemed like they had found paradise. A group of retirement communities, The Villages has 50 golf courses, numerous recreation centers, three town squares, and more than 3,000 clubs and activities. The opportunity for socializing was the main reason the Ferrettes moved there: When Jay, now 78, was diagnosed with Alzheimer's disease in 2015, his doctor suggested they relocate to a less isolated place as a possible way to slow Jay's cognitive decline.

The couple thrived in their new home. Experienced ballroom dancers, they frequently danced at the town squares, and they became involved in churches and various groups. And when Jay completed another round of standard cognitive tests for Alzheimer's disease last year, his cognitive ability had improved, a result his neurologist attributed to social interactions as well as regular exercise on a stationary bicycle and a recumbent elliptical.

Since socializing has become limited because of the coronavirus, Lee, 76, has had to find new activities for Jay to keep him mentally and socially stimulated. For now, she's put him in charge of watering outside plants and weeding.

Many caregivers are facing similar challenges. Keeping your loved one engaged is key to successful caregiving, especially during the COVID-19 pandemic, says Carole White, PhD, RN, director of UT Health San Antonio's Caring for the Caregiver (CCG) program. And as always, caregiving during the pandemic requires resourcefulness and imagination. A person's interest can vary from day to day so it's important for the caregiver to remain flexible, says Beau M. Ances, MD, PhD, FAAN, endowed professor of neurology at Washington University in St. Louis.

The pandemic has also heightened the importance of safeguarding the health of loved ones. "If a caregiver keeps a care recipient from getting sick, that person is less likely to go to an emergency room and be put at risk for COVID-19 and a variety of other conditions," says Jennifer Olsen, DrPH, MPH, executive director of the Rosalynn Carter Institute for Caregiving in Americus, GA. "Caregivers are a critical part of flattening the curve and keeping the case count low."

Ask About Protocols

Those thinking about hiring outside help or respite care now should do some research, says Dr. Ances. "Ask prospective candidates what their pandemic-related policies and practices are and if they are taking care of one or more people," he says. "You've got to find someone that both you and the patient are comfortable with."

When the pandemic hit, Jim Cutler of Orange County, CA, was very concerned that his wife's health care aides might unwittingly bring the coronavirus into the house. He'd hired the aides a few years ago to supplement his caregiving after his wife, Barbara Milligan-Cutler, 86—who was diagnosed with Parkinson's disease in 2006—fell and broke her femur in 2015. They both have been pleased with the arrangement. Fortunately, Jim has been able to retain the aides because they have reassured him that they are taking ample precautions against COVID.
After returning from grocery shopping or any other activity outside the home, Cutler and the aides wipe down everything they touch—doorknobs, handles, chairs, sinks. And they're extra careful when they're out. "I wear a mask and carry hand sanitizer with me," says Jay, 85. "If I see people not wearing masks, I avoid them. I even told one person in line who was getting too close to back up and stand on the spot marking the distance."

Cutler also buys medication online, and he plans to maintain his vigilant behavior until the virus is under control. "I'm going to stay with this routine because it's working," he says, adding that he's adopted the motto "Caution is the new normal."

Keep Active

The Ferrettes' new routine includes watching old home movies that have been transferred to DVD. "It's fun to go back in time and see what Jay remembers. They're like a memory book," Lee says. During the day, the two walk, bike, and fish. Occasionally they play socially distanced golf with another couple—she met the wife in a support group for spouses of people with Alzheimer's. In the evening, Jay and Lee play Rummikub.

They also continue to dance, waltzing to music in their kitchen and, at least once a week, slow or swing dancing outside (with masks on) to bands that have set up in neighbors' driveways. "If we're lucky, we see some of our Alzheimer's friends doing the same thing," says Lee.

White, who runs the CCG program in San Antonio, recommends activities like walking, bird watching, gardening, taking drives, and picnicking for caregivers and patients to do together. She also encourages people to access support groups, social services, and social events online, as many groups (including CCG) have transitioned to virtual programming. "Although the CCG choir isn't the same online—when members sing, everyone except the choir director is muted—it still provides an opportunity for socialization and for people to see one another," says White.

Allen Rabinowitz, 69, who lives in Atlanta and was diagnosed with Parkinson's disease in 1999, participates in virtual boxing. "I think the boxing really helps because he sees other people and they talk at the beginning of the session, so it functions like a support group," says his wife, Jan, 66. Allen also sees a therapist online, she says.

White notes that support groups can arrange to make regular phone calls to members who don't use the internet, and there are nonprofit organizations that teach older adults to use smartphones and other technology.

Although Lee Ferrette is skeptical about virtual socializing, she plans to check out a memory cafe on Zoom with Jay. "We're willing to try anything," she says. The Villages residents can sign up for a jigsaw puzzle trading program and receive a guidebook detailing 200 activities for people in different stages of neurologic disorders. "So far, we have given away more than 750 books," says Janet Pandy, who helped create the guide. "We feel it's especially important during the pandemic, when many activities and support groups are unavailable," she says.

Consider Relocating

Some people have had to make new care arrangements for their loved ones because of the pandemic. When Debbie Nadolney visited her 85-year-old mother, who was living on her own in Palm Coast, FL, in March, it was clear the situation was precarious. "It was a perfect storm of anxiety meets mild dementia," says Nadolney, 62, an artist and gallery owner in Provincetown, MA. "She was hallucinating and extremely paranoid." Nadolney knew she had to find a better arrangement.

On the first night she was there, her mother barely slept and was hearing sirens and seeing bugs crawling on the ceiling. The next morning, "my mother was absolutely unreachable," her daughter recalls. "Her eyes were clamped shut. She was hysterical, crying. She curled up in a chair and pulled her sweatshirt over her head. I could not get through [to her]. Then she became quiet, almost catatonic. It was really scary."

Her mom was hospitalized for five days, then moved to a room in a memory care unit and later to an assisted living facility that she had visited a few years ago and liked. Nadolney, who feels "incredibly lucky" that the facility has had no COVID-19 cases, consulted with some of her mother's close friends before moving her there.

Although Nadolney hasn't seen her mother since March 27, she phones and FaceTimes with her regularly. "I miss her terribly, and I know it's mutual," says Nadolney, who wishes she'd urged her mother to move into senior living earlier.

No situation is perfect, says Susan Frick, who runs a support and education program for people with young-onset Alzheimer's disease and their family members through the Rush Alzheimer's Disease Center in Chicago. Those caring for relatives at home may not feel safe taking them out in public if they don't want to wear a mask or don't understand social distancing. On the other hand, Frick says, families who need to place their loved ones in a care facility despite visitor restrictions may not experience the day-to-day challenges of caregiving, but they have the stress and loneliness of not being able to see or touch their relatives.

Care for Yourself

For those who have continued to provide care for relatives, getting some time to themselves has become even more vital. After several months off, a companion from Seniors Helping Seniors has resumed visiting Jay Ferrette once a week. "This gives me a breather," his wife, Lee, says. "I get to go out and take a walk alone." Lee adds that exercise has been a great stress reliever. "I exercise just like my husband—he does his hour, I do my hour," she says. "If I don't exercise, I won't sleep. I lie awake all night, thinking about the future and how I'm going to handle the next problem. I try to exercise, eat right, and socialize as best I can—and lots of times that's just on the phone."

Nadolney had previously cared for her grandmother and aunt during their illnesses, so she knew that tending to herself while helping her mother in Florida was paramount. She made sure to eat healthy, get enough sleep, and go for a drive along the ocean when she needed to clear her head. Back home in Provincetown—where her partner tested positive for COVID-19, was hospitalized, and spent three days on a ventilator before recovering—Nadolney maintained her self-care routine. "Even though it was a really, really stressful and scary time, I tried to eat well and take time on the beach to just breathe—inhale deeply—and get some fresh air," she explains.

Jim Cutler takes care of himself by gardening, writing his life story, and reading to his wife. He also plays golf, where it's easy to social distance. Jan Rabinowitz, meanwhile, believes in the power of support for her self-care. "It's nice to talk to someone who's in the same boat," she says. Rabinowitz is the Atlanta group leader of the Well Spouse Association and participates in a Parkinson's caregiver group on Facebook. If she needs an extra boost, she calls the Parkinson's help line or the counseling center where her therapist works.

For Lee Ferrette, church has provided sustenance her whole life. Now that her church offers only drive-up communion, she and Jay attend other area churches where the congregation members practice social distancing and wear masks. At their favorite church, staff take their temperature when they arrive, pews are disinfected between services, and communion is held outside in a large garden. "Believing in something greater than myself is helping me get through this pandemic," Ferrette says.

Resources for Long-Term Care

If you are looking for a skilled nursing or assisted living facility, contact your state's long-term care ombudsman, who advocates for residents of such facilities and can provide information about how to choose one. Also, visit the National Center on Elder Abuse for a guide to taking family members out of facilities to care for them at home during COVID-19.

• Administration for Community Living: acl.gov; 202-401-4634
• Centers for Medicare and Medicaid Services: cms.gov; 800-633-4227
• National Center on Elder Abuse: ncea.acl.gov; 855-500-3537
• National Long-Term Care Ombudsman Resource Center: ltcombudsman.org; 202-332-2275
• Eldercare Locator: eldercare.acl.gov; 800-677-1116
• US Centers for Disease Control and Prevention: cdc.gov; 800-232-4636