It Is Time to Ease the Visitation Ban in Long Term Care Facilities

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Visitation is one of the most important and meaningful rights of long term care facility residents.  Both U.S. and California law guarantee very broad access for residents to visit with friends, families, and others who provide critical support.

With the arrival of COVID-19 into the United States, the visitation rights of residents were one of its first casualties. In March, the federal government and California both suspended residents’ rights to visitors in an effort to prevent introduction and spread of COVID-19 in long term care facilities. Most residents have now gone months without seeing their families and friends.

Loneliness has consequences. Under the visitation ban, residents lost the love, companionship, support, and care from their loved ones just when they needed it most.  The isolation has brought an immense emotional toll on residents and all who care about them.  Far too many residents are suffering and dying alone.

Emotional support is only one of many losses caused by the ban.  Family members and friends often act as advocates for residents, communicating their needs to the staff and monitoring their care.  Some serve as interpreters for residents who face communication barriers. Spouses and adult children of residents who have dementia often help them manage their days.  Families often provide routine, life-sustaining care to residents, such as helping them to eat and drink, change positions, maintain hygiene, get dressed, and exercise.  Residents who benefited from that loving support and care are harmed everyday by its loss.

Federal, state and county authorities imposed the visitation bans in March amidst the rush to keep COVID-19 out of long term care facilities.  However, circumstances have changed since then.

  • The visitation ban was not successful in protecting long term care residents from COVID-19.  Thousands of facilities have had outbreaks, many of them massive, and thousands of residents have died. With so many facilities experiencing an outbreak, the visitation ban has diminishing value.
  • Increasingly, COVID-19 does not appear to be a temporary problem for long term care facilities.  The facilities were among the first to isolate and are likely to be the last to integrate.  It may be years, not months, before full visitation can be restored to residents.
  • The complete absence of visitors has made facilities more susceptible to COVID-19 outbreaks, not less, because there is no one to sound the alarm about the staffing crises, poor infection control practices, and neglect that cause them.  Locking out visitors has left facilities with no oversight, including those with deplorable histories of abuse and neglect.
  • Warm weather has returned, opening the opportunity for outdoor visits on facility property, such as courtyards, patios, or parking lots.

Given the failure of the visitation ban to arrest COVID-19 and the growing concern that current policy may be condemning residents to never see their loved ones again, it is time to soften the visitation ban and use an approach that better balances the relevant concerns about residents’ welfare.

Other nations that imposed visitation bans have already recognized the need to change course, including France and Belgium.  New York and New Jersey now permit support person visitors and Florida is preparing to allow any visitors who have a negative COVID-19 test.

California has already begun restoring partial visitation rights for health care patients.  The Department of Public Health (DPH) All Facilities Letter 20-38.1 recommends that patients with disabilities be allowed a support person when “medically necessary.”  DPH needs to strengthen this guidance.  What is “medically necessary?”  Does that mean a physician’s order is needed?  Why send families after a physician’s order if a facility can nonetheless refuse to abide a DPH “recommendation?”

Assisted living facilities, on the other hand, have received no updated visitation guidance.  Residents in these facilities, many of whom have cognitive impairments, need and deserve support person visitors too.

The visitation bans issued in March were hasty responses to the uncertainty of the time.  Now that we have gained more experience and information about COVID-19 and its impact on long term care, it is time to update visitation restrictions and allow support person visitors to maximize the welfare of residents.  Broad visitation bans are doing more harm than good.

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