Older adults, their families and their caregivers often face difficult and complex housing decisions. The home, retirement home or nursing home may no longer be suitable for the evolving needs of older adults. There are probably multiple options to explore, but it's often difficult to identify which one would be best. And all this must be done while weighing many factors that can influence such a decision. Indeed, a recent systematic review identified no less than 88 factors influencing housing decisions for frail older adults (including factors related to age and health status, access to adequate care and services, or the comfort and safety of the living environment.(1)

Housing decisions can become even more complex and stressful in the context of the pandemic that we are currently experiencing. COVID-19 poses significant risks to the health of older adults and people with weakened immune systems. In recent weeks, we have seen several retirement homes and long-term care facilities being overrun by COVID-19 outbreaks.(2) This situation can raise a lot of concerns and questions among older adults, their families and their caregivers regarding the most appropriate and safe place to live during the pandemic. How could we support them in making these complex decisions?

Using decision aids

Researchers associated with the Ottawa Hospital Research Institute, the University of Ottawa and the National Institute on Ageing recently published two decision aids to help older adults, families and their caregivers who are grappling with two questions during the COVID-19 pandemic:
- Should I go to live elsewhere or stay in my retirement/assisted living home? (3)
- Should I or my family member go to live with family or stay in the long-term care or nursing home? (4)

These decision aids aim to help people become involved in the decision by making explicit the decision that needs to be made, providing information about the options (including the potential risks and benefits), and by clarifying your personal values.(5) The two tools present a series of structured questions to help you think about:
- who is legally responsible for making such a decision;
- the reasons why you are considering leaving your current residence;
- the exit and readmission rules of long-term care or nursing homes during the pandemic;
- the support available for daily activities and personal care at your new residence;
- other things you need to make your decision, and
next steps.

Reviews that examined the effectiveness of such decision aids found that they generally help :
- increase knowledge about options;
- encourage patient being engaged in decisions;
- support realistic perception of outcomes and risk;
- reduce decision-related conflict (and level of anxiety);
- increase patient-practitioner communication; and
- support professionals to provide information and counseling about available choices.(5)

If you are contemplating the idea of moving during the pandemic, use decision aids to help you make an informed decision.