Whether it's independent living, assisted living, or memory care, a senior residential facility may be the last place you want a family member with a neurologic disorder to be during the pandemic. At least one-third of coronavirus deaths in 26 states have occurred in long-term care facilities, and in 14 states more than half have, according to data from the Kaiser Family Foundation. Some families, however, have no choice, says Susan Frick, director of Without Warning, a program offered through the Rush Alzheimer's Disease Center in Chicago that helps families affected by young-onset Alzheimer's disease. "Sometimes the health of the caregiver is so impaired that he or she can no longer care for a loved one at home."

Or it may be unsafe for the person to remain at home. "If a person wanders and isn't sure where he is and isn't social distancing or wearing a mask, he is very much at risk," says Carole White, PhD, RN, director of the Caring for the Caregiver program at UT Health San Antonio in Texas.

Whatever the reason for moving a relative to a facility, it's important to understand how these places have responded to the pandemic. "Some are doing a fantastic job," says Beau M. Ances, MD, PhD, FAAN, endowed professor of neurology at Washington University in St. Louis. "Still, if there is a second wave, the number of infections and possibly deaths could spike again."

When researching facilities, families should find out if they have instituted an infection prevention and control plan and if trained personnel are on-site to manage the program, Dr. Ances recommends.

Ask about protocols to limit handling of residents' belongings and provide adequate sanitation of items touched by staff, says Jennifer Olsen, executive director of the Rosalynn Carter Institute for Caregiving in Americus, GA. She also suggests families find out what occurred during the first wave of COVID-19—for instance, did administrators prohibit visitors and perform temperature checks of staff as soon as local government guidelines were enacted? You might inquire if the facility notified family members when it had a case of COVID-19; what procedures were followed when a previously hospitalized resident returned to the facility; and what the policies were regarding COVID testing and residents who were infected with the virus. Find out how often rooms are cleaned and patients monitored, what type of personal protection equipment employees wear when interacting with residents, and if staff work at more than one facility.

"I think a lot of organizations have learned a great deal and have put procedures in place to protect the safety and well-being of their residents," says Olsen. Although the situation can vary by location, care facilities should adhere to public health advice and follow basic precautions like requiring everybody to wear masks and stay at least six feet apart, limiting guests and outside contractors, establishing appropriate contact tracing, increasing cleaning, and reducing contact on common surfaces. (For more, check out the guidance from the US Centers for Disease Control and Prevention.)

If you are thinking about moving your relative to a facility, it's important to know its visiting policies and how much access you can have to your loved one, says Olsen. People have been concerned that social isolation and lack of stimulation during the pandemic could lead to cognitive decline in their loved ones since facilities have discontinued in-person visits and group activities. Nursing homes may have resumed visits on a modified schedule, and some residences have come up with innovations such as plexiglass visiting cubicles or booths where family members don masks and shoulder-length plastic cattle gloves so they can safely hug. Certain facilities have taken bingo games and other activities out into the hallways so residents can participate without being crowded into a room.

Once you decide on a place for your relative to live, create a detailed plan of care that includes how you'll communicate with providers as well as your loved one, says Dr. Ances. Finally, request regular updates and ask staff to set up video calls so you can interact with your relative to see how he or she looks and sounds.