“Sometimes, they would sit and cry and say, ‘Why am I living if I can’t go outside?’ and things like that. And at that time, the depression comes on.”

Coral Dressekie has 20 years of experience with older adults. She is currently employed at Home Instead Senior Care in New York City as a caregiver. The role of caregivers working with seniors during the COVID-19 pandemic has become more essential. However, caregivers are not officially considered health care workers. They are grouped with the more than two million domestic workers in the United States. New York State’s Department of Labor defines a domestic worker as someone who works in another person’s home, which includes caring for the elderly at home. Caregivers of seniors face challenges similar to those health care workers employed in hospitals and nursing homes.

Dressekie shared her technique of dealing with seniors when they are experiencing depression.

“What I do most of the time is say, ‘Okay, let’s play some games.’ I bought a crossword puzzle book and try to work with the client and say, ‘You do that and I’ll do this one.’ You have to try do things like that to cheer them up.”

Caregivers have the task of sustaining the quality of life for seniors, including effective communication. The COVID-19 pandemic has led to increased usage of protective gear such as masks, gowns and hazmat suits. This presents more challenges for caregivers and other health workers to communicate with their patients. New York State 46th District Assemblymember Mathylde Frontus introduced a bill requiring employers to inform employees of environmental and health risks, as well as providing personal protective gear for all care workers. “As a practical matter, we know that care workers need personal protective equipment, and I have introduced a bill to require PPE for all workers who need it. But care workers are also struggling with the concern that close contact with seniors in their care can pose a risk. Best practices are evolving quickly, and support for care workers has to keep up with that.”

In March, Assemblymember Frontus met with representatives from home health care agencies to address the difficulties care workers have as they continue caring for their home-based patients. Additionally, caregivers are facing mental health challenges during this pandemic. Because of this major concern, Assemblymember Frontus is introducing a package of mental health bills to expand access for counseling and support to health care workers, which incorporates caregivers. “The unknowns around this disease have caused tremendous anxiety among patients and caregivers, and until we know more, the challenge is to communicate honestly and protect populations that are most vulnerable.”

New York State’s stay-home orders caused hardships for agencies to maintain their usual services. These hardships led to a number of home care workers staying home. The absence of usual caregivers increases the risk of a disrupted routine system for seniors at home. Dr. Jennifer Reckery, a Geriatrician who works with the Mount Sinai Visiting Doctors Program, is familiar with how a disrupted system is very hard on seniors. “I’ve had patients where their regular caregiver is out and the agencies can’t find somebody else to come in so they’ve been by themselves. That’s been very hard. I think it’s a big disruption.” Dr. Reckery has recently written a letter to her editor at Mount Sinai detailing how COVID-19 confirms paid caregivers as essential members of the healthcare world.

“For me, it helps make so clear that people who really rely on somebody there to help them day to day with their needs, when that person is gone, when that person is different, when that system gets interrupted, it’s a major deal.”

During this pandemic, caregivers must also pay close attention to any changes from their clients and patients. Geriatrics specialists have observed how other illnesses in seniors can diminish typical COVID symptoms, making it tougher to diagnosis immediately.

Dr. Bindu Thomas, a geriatrician who practices at Allen Hospital with affiliation to New York Presbyterian hospital, suggested we all change our perception of typical COVID symptoms in older adults. “We heard with COVID, a lot of patients complain of a dry cough and that might not be a presenting symptom for an older adult. We have to change our way of thinking and recognize that patients were not presenting the way that they were advertising on television.”