Describe circumstances that may trigger potentially catastrophic.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”)

Planning for a Pandemic/Epidemic or Disaster: Caring for persons with cognitive impairment

Prepared by:

Alzheimer’s Association

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:

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

volunteer training.

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