Significant risk factors for Covid-19 infection include old age ,somatic illnesses as well as psychiatric and neurological illnesses such as dementia and schizophrenia .

This lecture reviews the specific case of measures and considerations that were used to protect elderly holocaust survivors with severe mental illness or dementia, in Israel. We had to protect our residents from the virus, yet preserve certain autonomy.

In addition this lecture reviews global aspects of nursing homes struggle during the pandemic as reflected in various periods (at beginning in march 2020, during various waves and after vaccinations). During the pandemic 100 holocaust survivors were monitored and protected in their long term residence at Lev-Hasharon mental health center, Israel with variety of measures such as recurrent PCR tests to inpatients and staff, isolation during fever and after emergency department visits etc. The features of caregivers visits changed in time. The safety measures that were taken in our nursing home and around the world is reviewed as well as the demand for preserving the autonomy and rights of the tenants.

At the beginning families could not visit at all and virtual contacts were maintained in patients that could communicate. After the first wave a "drive in" method was carried out, families communicated with their relatives from a car.

During the second wave of the virus in Israel (September 2020), an outbreak spread in our residence. 14 patients tested positive for COVID19, all suffering from dementia or schizophrenia. They were immediately placed in quarantine in Corona departments in other geriatric and general hospitals. All patients came back after recovering, small part of them regressed.

As the pandemic continued we allowed visits with social distance and masks that were monitored by the staff. After vaccinations we allowed families to be with the elderly patients in the open yard without staff inspection. Four patients were infected during the third wave, although they were immunized.

We had to consider every step of the way protection versus some autonomy to our patients and families and weigh creative ways to do this.