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She's healthy except for dementia.

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What were her end of life wishes before the SNF and the dementia? Were her wishes to Allow Natural Death/DNR or were they for CPR?

Not all COVID patients need hospital care. Can she get supplemental oxygen in the SNF? Can they give her Tylenol for a fever? Can she be kept comfortable at the SNF if she gets sick?
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My mother lives in Memory Care; the doctor called me a few weeks ago with questions about her care plan in case she comes down with COVID-19. Do I want her hospitalized or to stay in house with hospice? At 93, we're assuming the worst case scenario if she does contract the virus. I said I wanted her to stay in house & have hospice give her comfort care, but, and here's the big BUT: my mother can speak for herself. She's not THAT far into dementia to where she can't say what she wants to do herself. That said, my mother has an oxygen unit that she needs for sleep; it can be used at any time if the need arises, which it does from time to time.

So, unless your sister is very far advanced with her dementia in that she is non-verbal, then she herself can say whether or not she wants to be taken to the ER if she gets sick. If she's non verbal and you are her POA, then what are her final wishes? My feeling is that being kept alive on a ventilator with dementia is futile. The quality of life is already compromised greatly, and in my mother's case, she's 93 and saying daily (or at least several times a week) that she wants to die. So, if she does contract the virus, then I'll leave her fate in God's hands.

Do whatever you feel is right, and what you feel your sister would want. Good luck and Godspeed.
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When my husband had a fever and accompanying chills in his rehab facility, he was 911-Ed within 24 hours to the local hospital that is accepting possible Coronavirus patients in our area. Luckily, it wasn’t Coronavirus and he was back at the facility within 24 hours. A test was done at the facility, but by the time the test results came back, he was back at the facility. Chances are your sister, if she begins showing signs, will be sent to the hospital. Hospitals are better equipped to test and treat than facilities. Not all Coronavirus patients need hospitalization, that’s true. But facilities are leaving it up to the hospitals to make that decision, especially with a Senior Citizen.
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This is a big decision. How advanced is her Dementia? If she is hospitalized, would she understand what is go on. Would it be upsetting to be in a different place.

My decision would be to leave her where she is. Personally, I know what its like to watch a person decline and go to the bitter end. I prayed that Mom not be put thru the indignity of Dementia.
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I refused to hospitalize my LO because even if she were offered a ventilator, I would have been refusing THAT, based on HER DNR.

Also, the staff at her AL LOVE her, and she loves them.

Since I couldn’t be with her to comfort and encourage her, I wanted her with the next closest to me.

She was sick for almost 2 1/2 weeks, and is now recovering. It may or may not happen, but my fondest hope is to put my arms around her and whisper in her ear, as I always do, “STOP CUSSING. YOU’RE MAKING A SCENE”.

I love her to pieces, and I’m overjoyed that at least for now she’s doing so well.
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Does she have a DNR or POLST?
What would be the decision IF she needed to be intubated?
Would she understand what is going on? Chances are if she were intubated she would be sedated. People with dementia do not do well recovering from sedation. Whatever "stage" of dementia she is currently at she will decline after an illness, if hospitalized and certainly after sedation.
this is a very tough decision.
If it were my Husband I would elect to keep him home, or if he were in a Memory Care facility I would elect to keep him there.
If the facility is doing everything they can to follow protocol and isolating residents that are ill, providing proper protection for staff and making sure they follow CDC guidelines she is probably safer where she is than in the hospital.
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