Create a Caregiver Action Plan for COVID-19

How to think about designing an action plan to care for your household and loved ones in the event that someone becomes sick.

This document last updated March 18, 2020. Continued updates will be provided.

Make a plan

You may get sick. Someone you live with may get sick. Being ill is stressful for the patient and caregiver alike. This guide was made to make it easier to care for the people we live with, while minimizing our risk of exposure to the coronavirus/COVID-19. It’s available as a resource for others, because when someone falls ill, having a plan can reduce mistakes and ease stress.

I tried to apply recommendations from credible sources (like the WHO and the CDC) to create a plan for what home isolation could look like for a case of COVID-19 in my own family situation. This article provides a description of how I thought about making a caregiver action plan in my personal situation, and ends with information for you to apply to your own.

Even if you believe it to be inevitable that you fall ill, there are actions that can help your household deal with the situation. Preventing everyone from being sick at the same time matters for your care, and the continuous goal of preventing further spread means that each action you take lessens the chances of your causing harm by infecting someone else.

Disclaimers

Unfortunately, this plan would be difficult to use for parents who have young children to care for while they are sick, or for parents with young children who are sick, but it may give you a place to start.

I am not a medical professional, but this document was reviewed by those with medical training. I have made the assumption that most folks will be caring for loved ones at home, or will at least start that way. I will do my best to update this document with appropriate recommendations as I learn about them — further critiques by medical professionals would be gratefully received.

I work in information security. I make checklists and processes to avoid forgetting a step, to allow us to operate consistently, and to avoid making decisions on the fly under stress. It is not the same as working in medicine, but the need to provide consistency of effort is the same. Please defer to medical experts for advice on how best to handle this disease.

Let’s get started

Though most people will recover from the coronavirus, not everyone will be able to do so without professional medical assistance. Show your loved ones how much you care by being ready for whatever comes.

Create a caregiver action plan:

1. A list of contacts for yourself and your family who may function as caregivers, or whom you will be providing care to
2. Information for caregivers about your medical information and who should want in the loop about a patient’s care
3. A plan for isolating yourself or someone in your household: how would you separate the sick from the well and avoid spreading the illness?
4. Create a personalized plan for checking in on loved ones, for communication between your support network, for isolating someone, and checklists for cleaning your household.

Pack go-bags

Cover each person in the household for

1. Hospital stays
2. For kids who can’t stay at home if you are in the hospital
3. For pets

Ensure gas is in your car

The last thing you want to think about is whether or not you have enough gas to drive to the hospital or care for a loved one.

Unpleasant but necessary: think about the worst

1. In the event of your death, ensure money you have saved (things like retirement accounts and insurance payouts) have designated beneficiaries.
2. If you have a will, ensure people can find it (keep a copy in your home). If you do not, but want one, know that you can make your own without a lawyer (though hiring a lawyer is strongly recommended).
3. Do you know the wishes of your family upon death? Have you told others yours?

What goes in your caregiver action plan?

Many, many lists.

Identify the Caregivers

Contact the caregivers and those you would be a caregiver for. Discuss the action plan with them. Provide copies to everyone involved. Print out the checklists and provide those.

Things to consider:

• Who can you count on to provide care for you and your family? Who will you provide care for?
• Who will care for the children?
• Who will care for the pets?
• Do you live alone? Who among your contacts can you check in with so they know your state of health? Could they get you to a hospital if needed? Can they drop groceries at your door if needed?
• If you do not have someone close by, do you have someone you can check in with anywhere? Can they help you coordinate a plan that would keep you fed, and monitored if ill? What if you require a driver for emergency care?

Information for care and folks to keep in the loop

It’s time to make some lists! The most important thing is that this information is easy to find for your caregiver. Paper lists are fine as long as your potential caregiver knows where to find it. Email or shared documents work. Think about the following categories:

Medical Information

• Share where to find your insurance information with those who could become caregivers.
• Note important health history and current medications for your potential caregiver.
• Make a list of the hospitals or medical centers nearby (note which accept your insurance), including their phone numbers. If possible, include more than one.
• Note the name of your primary care physician if you have one, include their phone number.
• Check into your telehealth options, and note how to access those options. Perhaps your insurance provides medical professionals to call?

Friends and Family, including Pets

• Write down friends and family who should be kept updated if you become severely ill, include their phone numbers or emails
• If you need to make arrangements for pet care, make sure you provide your preferred veterinarian’s name and phone number.

Care for the caregiver

• Did you think about who could emotionally support and check in with the caregivers? Who could be available to talk if you were caring for a sick loved one?

Someone in your household is feeling ill

This plan does not guarantee that in following it your household won’t become sick — the guide is intended to give the household a better chance of fending off the disease. Please use the CDC’s Preventing the Spread of Coronavirus Disease 2019 in Homes and Residential Communities as a reference.

The goal is to avoid as much contact with the infected person as possible. The more the sick person can isolate themselves for the duration of their illness, and for some days after, the better.

If symptoms are consistent with COVID-19 or flu symptoms, call their primary care provider or use telehealth options to be evaluated over the phone. Note if additional risk factors are present (>60 years old, diabetes, asthma, COPD, immunocompromised, other chronic disease). The individual may be instructed to report to the provider’s office or local health department for testing (testing to confirm infection is important for public health professionals to track the spread of the virus, and may render the need for quarantine unnecessary).

Time to quarantine and isolate?

This section describes a version of a quarantine plan that made sense for my household. Modify it to fit your own needs while taking similar precautions to limit exposure.

Definitions used:
— Caregiver: the currently healthy person providing care to the sick person (patient)
— Patient: the sick person receiving care from the healthy person (caregiver)

When?

The patient should choose to quarantine as soon as they believe themselves to even possibly be ill: fever, a dry cough, shortness of breath or difficulty breathing, aches, and fatigue are possible symptoms.

Where

Choose the room(s) the patient will stay in.

Choose the bedroom closest to the bathroom. If the patient has to leave the bedroom to use the bathroom, be ready to do a lot of disinfecting. Separate from the patient as much as possible within the home.

Other household members may have already been exposed to the virus, so along with caregiving for the currently sick, it is important that everyone in the household do their utmost to avoid exposing more people to the disease. Leaving the home to stay elsewhere could result in spreading the contagion. Consider the harm you may cause to others, and avoid exposing them. If feasible, the entire household should stay home and isolate from the outside.

How

1. The patient will go into the designated quarantine area and close the door.
2. The caregiver will no longer enter the quarantine area.
3. The caregiver will clean the household according to the wipe down checklists (wearing protective gloves, a mask, and eye protection as available).
4. The caregiver will ensure the items the patient requested for a “comfortable” quarantine are in the room (the patient will communicate deficiencies).

Getting items into the quarantine room

1. The caregiver should leave items needed that are not yet in the room outside of the door to the bedroom, and notify the patient.
2. The patient will open the door and retrieve the items once they believe the caregiver to be away.
3. For added assurance, the caregiver may confirm to the patient via text or call that they are away from the door.

Try to only allow items that you don’t require outside of the zone into the quarantine zone. Once something goes in, try to do without it.

Think about what items may be stored in the quarantine zone before anyone is ill to allow for immediate separation of the ill person.

What might the patient need?

Try to ensure what your household would need while isolated is previously consolidated where possible, and ready to go. Consider keeping a box of goods in the room that would become the quarantine area.

Comfort and necessities

What would a patient need to be well in a room for two weeks: food and drink, prescription medications, thermometer, clean clothes, trash can, sanitary items…? What would a patient want: books, electronic devices, stuffed animals…?

For patient self-service food/drink

Think about if you could set the quarantine room up like a hotel room with cooking necessities. Maybe you have a minifridge, microwave or hot water heater you could give the patient to lessen the number of times the door opens?

Communication

Does the patient have a phone and computer? Give them paper as well. Ensure they can contact you without being required to rely on an electronic device.

While isolated

1. The patient should place used tissues in a lined trash bin. All trash should remain in quarantine until 3 days after the quarantine is lifted.
2. The patient should continue to wash their hands and wipe down surfaces with disinfectant as health allows — especially high touch areas (door knobs, table tops, bathroom fixtures etc.). Checklists can help ensure the right things are cleaned, find an example below.
3. Patients should cover their coughs and sneezes by expectorating into their elbow, or covering their face with a tissue.

Communication during isolation

Establish check in times with the caregiver daily. The easiest is morning, afternoon, night (effectively, when the patient wakes up, some time in the middle, and before they go to sleep). Texting may be easiest.

Patient should provide:

• Temperature, if available
• If you have an oximeter, provide the blood oxygen saturation (SpO2) reading, and pulse rate
• Describe symptoms
• Feelings/sense of well being
• How much fluid and food consumed
• Default to overcommunication: try to communicate when one may be unavailable (napping, etc.)

Caregiver should

• Remind the patient they are cared for and loved
• Communicate the caregiver’s own wellbeing / symptoms
• Prompt the patient for their health readings
• Keep cell phone’s ringer on and cell phone charged
• Record the check in medical readings from the patient with times and dates for future reference (especially in the event of an emergency)
• Check for non-verbal “crisis index cards” described below

If the patient is unable to communicate

This is extremely concerning. Contact a medical provider immediately.

Utilize non-verbal communication: index cards

The caregiver should provide the patient with two index cards, one red (or with a red spot) and one yellow (or with a yellow spot). These index cards will allow the patient to slip one under the door to communicate non-verbally that they need assistance.

Using an index card indicates an emergency: the patient is in crisis and unable to verbally communicate sufficiently. Provide the patient with two index cards. The patient will slide the appropriate card under the door for the caregiver to see if they believe themselves to be in crisis.

• RED index card: indicates an emergency (the caregiver should expect to enter the room — wear protective gloves, mask, and eye protection as available — and get the patient to a doctor immediately)
• YELLOW index card indicates the patient requires communication and the other channels are somehow inadequate (indicates severe distress).

If patient is unresponsive/non-communicative

The caregiver should assume the patient is in crisis

1. If the patient misses a check in (with no previously communicated naps etc.) caregiver should call the patient’s phone.
2. If the patient does not respond, the caregiver should knock.
3. If there is no response, the caregiver should assume the patient is in crisis
4. The caregiver should prepare to enter the room (with the protective gear available: gloves, mask, and eye protection)

Ideas about preventing spread during care

Without an isolated bathroom

Are you unable to avoid the bathroom a sick person must access? All hope is not lost, but be ready for stringent disinfecting. The caregiver should treat the bathroom like a public restroom and avoid the area as much as possible. Have separate towels and disinfectant for the patient in the quarantine room for the patient to bring to and from the bathroom.

For the patient

1. The caregiver should provide the patient with towels and disinfectant they may use to clean the bathroom when they use it. These items should be taken to and from the quarantine room by the patient.
2. The caregiver may consider providing the patient an empty container, like an empty milk jug, to urinate into, allowing the patient to avoid leaving isolation except for BMs (bowel movements).
3. The patient should do their best not to touch anything they don’t need to in the bathroom as they use it — consider touching things with a clean tissue and disposing of it after use.
4. The patient should wash their hands with soap before using the bathroom, before switching on lights, before touching anything but the doorknob, if possible.
5. The patient should “do their business.”
6. The patient should wash their hands with soap.
7. The patient should wipe down with the disinfectant wipes (according to package instructions) anything they think they have touched (use a wipe down checklist if you made one).
8. The patient should return directly to the quarantine area, touching as little as possible.

For the caregiver

1. The caregiver should assume everything they touch in the bathroom was touched by the patient.
2. The caregiver should wipe down all surfaces they will be touching with disinfectant, especially light switches, door knobs, sink and shower handles (use the wipe down checklist).
3. The caregiver should wash their hands.
4. The caregiver uses the bathroom.
5. The caregiver should wash their hands in a different sink, like the kitchen avoiding touching anything in the bathroom they don’t have to.

A bathroom schedule might be useful (but infeasible for some households) to ensure the caregiver may avoid using the bathroom immediately after the patient when the danger will be highest.

To wash and remove dishes while a patient is in quarantine

If bedroom has an isolated bathroom:

1. Caregiver will provide patient with a dish towel, dish soap, and sponge/washing tool to patient
2. Patient scrapes leftovers into lined trash can
3. Patient washes hands
4. Patient uses dish soap etc. to wash dishes in sink or tub
5. Patient alerts the caregiver they’re ready and places dishes outside the door. Closes door.
6. Caregiver picks up dishes, directly moves to kitchen sink and washes them thoroughly with hot water and soap
7. Caregiver places dishes into the dishwasher (if available).
8. Caregiver washes hands with soap

Without an isolated bathroom:

1. Patient scrapes leftovers into lined trash can
2. Patient alerts the caregiver they’re ready and places dishes outside the door. Closes door.
3. Caregiver picks up dishes, directly moves to kitchen sink and washes them thoroughly with hot water and soap
4. Caregiver places dishes into the dishwasher (if available).
5. Caregiver washes hands with soap

To remove trash while quarantined: you should not

1. Caregiver provides the patient with many plastic bags and a sturdy container for this purpose.
2. The patient will keep trash inside the quarantine room for the duration of their quarantine.
3. Wait 3 days after the sick person fully recovers to remove the trash

Thinking about how to get the patient to a doctor

If it is necessary to go to the doctor, attempt to avoid coming into contact with the patient as much as possible.

Caregiver

1. Refer to the patient’s insurance information and available hospitals.
2. Call ahead to understand the hospital’s procedures and availability.
3. Provides clean clothes, and mask (as available) to the patient
4. Wear protective gloves, mask, and eyewear as available.
5. Provides tissues to patient and plastic bag for tissue disposal
6. Caregiver to bring hand sanitizer and disinfectant wipes as available (for disinfecting the car and the drive home)
7. Take the patient’s hospital go-bag
8. Proceeds to the car and drives to the hospital

Patient

1. Showers (if able) and puts on clean clothes (if able)
   If unable to shower, patient to wash hands (if possible)
2. Patient should put on protective equipment:
   1. Washes hands with soap
   2. Puts on mask, or anything available to cover the mouth
   3. Washes hands with soap
   4. Puts on gloves
3. Goes to car.
4. Should sit as far from the caregiver as possible.
5. Should try to face away, attempting to cough and breath away from caregiver (wearing a mask, if available)
6. Proceed to the hospital

The caregiver must remember the car is now contaminated, and disinfecting the surfaces inside is necessary to become safe again. If the car is not needed, wait three days before entering the vehicle again. The caregiver should wash their hands after returning home.

Hospitals may not allow visitors as guests may require already limited supplies. Caregivers should be prepared not to be able to stay with the sick person.

When to end the quarantine

1. A patient could remain ill for weeks, and the patient should stay in isolation until they feel completely well. Contacting a healthcare professional is the most appropriate way to understand if someone can end their quarantine.
2. The patient should use disinfectant to wipe down the quarantine room’s high touch surfaces as they feel better. Reference the wipe-down checklist, if you made one.
3. If possible, the patient could crack a window to improve airflow
4. When the patient is expecting to leave the room, the patient should bundle the bed clothes and laundry, and if possible let them sit for a few days out of the way where no well person will come into contact with them (the virus does not survive past that on porous substances), if possible the patient should be the one to launder the items, and dry them on highest heat available.

The current information suggests that this particular coronavirus, COVID-19 can live on non-porous surfaces for up to 3 days. My family’s plan recommends avoiding the quarantine zone entirely for four day, and then disinfecting everything upon entry.

Create your personalized plan

This section provides a list of items to write down, or to type into a document to create a plan for you to plan for household cleaning, the creation of contact lists, and other preferences.

Quarantine

Did the above quarantine outline work for you? Modify the ideas above to think about what your plan could look like.

Wipe down checklists

Use disinfectant wipes, bleach with water solution, or other strong disinfectant known to kill viruses and bacteria.

1. Make a list of each room in the house, including hallways.
2. List what you should wipe down in each room. Yes, every single thing you believe someone would touch.

Be sure to note “high touch items” like light switches, door knobs, sink handles, refrigerator door handles, bathroom fixtures, oven dials, keyboards, computer mice etc.

You can choose to post this checklist in the room it refers to for easy reference. Refer to it every time you must wipe down the room — you won’t forget a spot that way.

List items to have on hand for a quarantine situation

1. Ideally, you would make this list and purchase these items before quarantine is necessary. If you must isolate someone in your household, and you did not make these purchase beforehand, make do with what you have on hand, or order items for delivery. Do not leave your house as you may be infected as well.
2. Health monitoring tools: thermometers, protective thermometer covers, pulse oximeter etc.
3. What disinfectants would you need? Things like soap, diluted bleach, etc.
4. What protective gear, for yourself and the patient? Nitrile or latex gloves, masks, etc. No gear available? Make do with what you do have. Creating masks out of paper towels or cloth is preferable to using nothing to cover a patient’s mouth.

List what the patient needs to be “comfortable” during quarantine

Think about what someone might need to be comfortable during their quarantine. Ask members of your household.

1. For cleanliness, maybe add toiletries, plastic bags for trash, clean clothes, comfy pajamas, sanitary pads or tampons, etc.
2. For comfort, think about items like hot water bottles, a blanket, entertainment, stuffed animals or other comfort items
3. For communication, think about printed procedure documents so everyone knows the plan, knows the right contacts, and has the checklists they need to clean well
4. Are you able to make the bedroom like a little hotel room? If you can, maybe provide the quarantined person with food they can make themselves, eating utensils, and their own dish soap — if you’re very lucky you have an extra microwave, hot water kettle, and/or mini refrigerator, and they can almost entirely self-service.

List and purchase your household’s preferred sick foods

Different people prefer to eat different things when they’re feeling unwell. Make a list of your household’s preferences. Soup and other neutral foods are recommended. Remember that a person will likely remain sick for some time.

Reference Material

How to prepare go-bags

For a hospital visit

Packing isn’t something you want to think about while severely ill or caring for someone who is. Keep the bag by the door so whomever is helping you get medical attention can find it, and you do not expose them to more harm by requiring them to search your home. Think about

• Toiletries: hair brush, shampoo, toothbrush, toothpaste, deodorant, lip balm, hair ties, glasses if you wear contacts
• Comfortable loose clothing: cardigan or hoodie, pillow, pajamas, warm socks
• Flip flops or crocs
• Entertainment: books, e-readers, coloring books, etc.
• Electronics and their accessories: extra long charging cord for your cell phone, headphones, cell phone, laptop, related chargers
• Pen and paper — sometimes writing is easiest
• Current medications
• List: general medical history, medications currently used, primary care physician’s information, and emergency contacts.
• Ensure your caregiver knows where to find your insurance information and what hospitals and emergency care locations accept it.

For kids if you go to the hospital

Make your children a go-bag if they won’t be able to stay in your home during a hospital stay for you. Keep in mind your child may be a carrier, and could infect whomever is caring for them. Avoid an elderly caregiver and those with pre-existing conditions.

Your child’s go bag will not look substantially different from what you would pack for them to go on vacation. Have this near your hospital go-bag.

For pets

Make a pet supplies pile. Pets are not known to transmit the disease, but they could on their fur, and their supplies may have been contaminated. Make sure the caregiver disinfects the supplies.

Remember, requesting someone repeatedly come to your house to feed your pets exposes them to the illness on surfaces days after you have left. If you are able to, have someone ready to pick up your pet and care for them elsewhere.

Include all items your pet would need to live without you for a month (being hospitalized could have you away for weeks).

• Pet carrier or leash
• Food
• Waste collection bags
• Litter
• Toys and treats
• Vet name and phone number

How to use and remove protective equipment

The CDC recommends the sick use masks when around others to prevent spreading the illness and only for caregivers that are caring for someone sick.

How to put on a mask

Here is a helpful video: six steps to wearing an N95 mask.

Six steps to wearing the N95 mask from the Ministry of Health in Singapore

1. Wash your hands, 20+ seconds
2. Hold the mask in one hand and put it over your nose, mouth and chin
3. Stretch bottom band over your head with the other hand and position under your ears
4. Stretch the top band high and position at the back of your head
5. Press the thin metal wire along the upper edge of your mask on the bridge of your nose to fit snugly
6. Check for a snug fit by breathing in and out and note if there is air leakage around your face
7. Once adjustment of the mask if complete, do not touch it again unless hands are washed first. Dispose after use.

In what order to remove protective equipment:

1. Remove and dispose of gloves
2. Wash your hands with soap and water or hand sanitizer
3. Remove mask — do not touch the outside of the mask — dispose of mask
4. Wash your hands with soap and water or hand sanitizer

How to remove protective gloves

Be careful not to contaminate your hands when removing gloves.

1. Grasp the outside of one glove at the wrist. Do not touch your bare skin.
2. Peel the glove away from your body, pulling it inside out.
3. Hold the glove you just removed in your gloved hand.
4. Peel off the second glove by putting your fingers inside the glove at the top of your wrist.
5. Turn the second glove inside out while pulling it away from your body, leaving the first glove inside the second.
6. Dispose of the gloves safely, do not reuse the gloves.
7. Wash your hands with soap immediately after removing gloves.

This image is from the CDC.

How to wash your hands

Clean your hands with soap and water for 20 seconds, or about how long it takes to sing you ABCs, or “Happy Birthday” twice.

1. Wet hands with water, apply enough soap to cover all hand surfaces.
2. Rub hands palm to palm
3. Right palm over left back-of-the-hand (called the “dorsum”) with interlaced fingers and vice versa
4. Palm to palm with fingers interlaced
5. Backs of fingers to opposing palms with fingers interlocked
6. Rotational rubbing of left thumb clasped in right palm and vice versa
7. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa
8. Rinse hands with water
9. Dry thoroughly with a single use towel
10. Use towel to turn off the faucet
11. And your hands are safe

This image is from the World Health Organization.

Final Note

I intentionally did not describe specific stages of the illness, nor when to seek out medical advice. You should seek out the advice of a medical professional to decide the right course of action for you and your household. You may find the resources provided by the CDC useful for understanding more about this disease, and for making more complete plans for you and your family: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Be kind, be safe, be well. We’ll get through this if we help each other, and recognize that sometimes helping means staying home.