Dementia and mask wearing during COVID-19

With so many articles and posts on social media about masks during the pandemic, the great debate carries on: “Do I wear one or not? What about masks or face coverings involving persons living with dementia? Let’s take a closer look at mask wearing during COVID-19 by exploring the 3 different stages of dementia: early, middle, and late.

Early stage

It may be easier to explain to a person with early stage dementia the reasons for wearing a mask. In addition to modelling mask wearing yourself, consider the following pointers to encourage your family member to wear a mask.

  • Does the person simply forget why it’s needed? Post a sign in a location for them to see such as on the fridge door or front door.
  • Does the mask fit comfortably? Try different styles face coverings or looser fastenings if the mask is too tight.
  • Is the person unhappy with the feel of the fabric? Try some different materials, maybe one made from a familiar garment (check with them first before cutting the fabric).
  • Does the person pull the covering down? Try some distraction or positive statement like how wearing a face covering helps to stop the spread of coronavirus and keep people well.

Middle stage

People in the middle stage of dementia often need help with daily tasks. For many family caregivers, this is the stage where they reach out for extra support. If you currently receive or plan to receive home-based services from a provider, infection prevention and control is a joint effort and responsibility. As a caregiver you and your family member are not mandated to wear a mask. However, you can rely on the health care worker to wear a mask when in your home.

Caregivers lack support and respite services during pandemic

Unfortunately, a casualty of COVID has been the cancellation of several support and respite services previously available to family caregivers. With services on hold, many caregivers are on their own to fill these service gaps.  This is really taxing on the caregiver because a person in the middle stage of dementia  may not be able to be left at home alone or unattended.

As a result, caregivers are more likely to bring their family member along with them when out in the community. We know it’s safer for everyone if we all follow the public health guidance on masks/face coverings. Nonetheless, this can be a real challenge and, sometimes impossible, for caregivers to get people living with dementia (especially in middle to later stages) to wear a mask.

Medical exemptions

By-laws which make mask wearing or face coverings mandatory in places such as businesses, public transit and indoor spaces are spreading across Canada. Most of these by-laws also have medical exemptions. The City of Toronto, for example, has 2 exemptions relevant to someone with a dementia diagnosis: persons with an underlying medical condition which inhibits their ability to wear a Mask or Face Covering; persons who are unable to place or remove a Mask or Face Covering without assistance.

Proof of the medical exemption is not typically required. This means you don’t have to go to the doctor or a health professional to get this medical exemption. At the same time, uncomfortable and tense situations can arise when people see others without a mask on and it is mandatory to wear one.

One simple and effective tool that can assist caregivers are help cards. These are not to be confused with fake exemption cards being used by anti-maskers. Legitimate help cards read as follows-The person I am with has dementia. Your help and understanding are appreciated. Thank you”. These cards can be handy in situations where your loved one is not masked. A card shown to a store attendant, cashier or even to a fellow customer when shopping may avoid questions or comments.

Masks are only part of the COVID-19 prevention strategy

There is lots of attention on mask wearing these days. Other infection prevention practices, like physical distancing and proper hand hygiene continue to be of utmost importance.

Later stages and long-term care homes

Long term care homes have been hard hit by the coronavirus and have implemented strategies to further safeguard residents in their homes. Facilities are regulated to have all staff wear personal protective equipment (PPE) during COVID. Residents, particularly those living in memory or specialized care units, are often in the later stages of dementia. With advanced cognitive decline, they are probably less likely to wear a mask or face covering.

A resident living with dementia may have difficulty understanding or even be distressed as to why their health care worker wears PPE. Masks distort the ability to recognize faces or facial expressions and more time may be required for the residents to understand what is being said or asked.

If it is possible, let the residents see your face and hear your voice before putting on a mask so they can connect with you first. Using fun stickers, such as smiley faces, silly characters or animals like cats and dogs on the front of the masks (in such a way as to maintain the integrity of the mask) may bring a smile to their face. Avoid using stickers if residents find these decorated masks disturbing.

Dementia-friendly face coverings

Traditional masks block faces and we can’t see facial expressions and emotions or catch visual cues. A face can express emotions without saying a word. A smile, for example, can convey empathy. The loss of this wordless communication can make it harder for someone with dementia.

Manufactured masks with clear pieces over the mouth already exist but can be expensive or in short supply. Many have taken to sewing face coverings, so why not a do-it-yourself project for a transparent fabric mask.

Before wearing a see-through fabric mask to visit a loved one in a residential care facility, such as a retirement home or long-term care home, first ensure the facility accepts the wearing of such masks.

A note about face shields

Face shields will also provide protection and enhance communication. They may not be commonplace to public wearing just yet, but as the pandemic continues, more Canadians are considering this plastic protective face wear. Like masks, it is important to wear face shields correctly to maximize protection.

We would love to hear about your mask or face covering story. Please submit your experience in the comments below.



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