The COVID-19 pandemic has caused hardship to many in a variety of ways. Coping with the pandemic has been particularly difficult for families who, heeding the advice of experts, have minimized their in-person contact with elderly relatives who suffer from health conditions that make them particularly vulnerable to COVID-19.
The rollout of promising vaccines might bring the pandemic under control, although experts are uncertain about whether and when that could happen. Dr. Anthony Fauci predicts that the United States can reach a state of “normality” by the end of the year, but only if 75% to 80% of Americans agree to be vaccinated.
The CDC has recommended that residents of long-term care facilities be among the first in line to receive vaccinations. That process has started, although facilities that seek consent from patients to administer the vaccine have encountered unexpected roadblocks. Explaining the benefits and risks of a vaccination can be challenging when health impairments limit a patient’s ability to communicate or make an informed decision.
The pace of vaccinations in nursing homes and other long-term care facilities has been slower than state governors expected. Employees of CVS and Walgreens are administering vaccinations to facility residents in many states. The two vaccines approved in the United States require a second shot to become effective. Patients won’t be fully protected until a few weeks after they receive the second dose.
The Risks and Benefits of Patient Visits
During the early months of the pandemic, long-term care facilities generally followed CDC guidance that restricted or prohibited in-person visits with patients. Families kept in touch with their loved ones by telephone or video conferencing.
Nursing homes were hit hard by COVID-19. As one healthcare professional observed, the “virus entered long-term care facilities insidiously. It came in via visitors, staff, and new residents who were asymptomatic and unaware of their infectivity.” Restricting patient visits was a logical response to the spread of a highly contagious disease within vulnerable populations.
Yet protecting patients in long-term care facilities has a cost. Social isolation imposed by quarantines can exacerbate depression and feelings of loneliness, potentially causing mental and physical health consequences. Remote visits only partially offset the harm of social isolation. Public health authorities have therefore balanced the risks of worsening the infection rate in long-term care facilities against the need for patients to visit their loved ones in person.
New Guidelines for Visits
Restrictions on visits with seniors are generally imposed by the facilities in which the seniors reside. States have also regulated patient visits during the pandemic.
Following the revised guidance recently established by the Centers for Medicare & Medicaid Services, most facilities now allow outdoor visits with visitors who are likely to be uninfected. Facilities that have been free from COVID-19 infections for 14 days are generally permitting indoor visits.
Facilities are expected to follow routine procedures to assure that visits can be performed safely, including:
- Screening visitors for symptoms of COVID-19
- Requiring visitors to wash their hands, preferably with an alcohol-based hand rub
- Requiring visitors to wear face masks
- Enforcing social distancing of six feet between visitors and residents
- Regularly cleaning and disinfecting designated visitation areas
The CMMS has not differentiated between facilities whose residents have or have not been vaccinated. In fact, the guidelines were created before vaccines had been approved for distribution.
Visiting Vaccinated Seniors
As the Times reports, allowing visits before residents and staff are vaccinated is controversial. Even after vaccines reach a family member’s facility, it is important to remember that the vaccine won’t be fully effective until two weeks have passed after the second shot is administered.
While residents of long-term care facilities are being prioritized for vaccinations, it isn’t clear how long it will take before vaccines are available to younger people. Dr. Sabine von Preyss-Friedman, chief medical officer of Avalon Health Care Group, told the Times that it may be best to wait until all visitors have been vaccinated before making an in-person visit to a family member who resides in a long-term care facility.
Whether or not they have been vaccinated, family members who do decide to visit should follow the CDC guidelines by wearing a mask and practicing social distancing. Until the pandemic is under control, we still can’t regard hugs as safe — as much as we might miss giving and receiving them.