Care homes and COVID-19: the hidden impact of visiting restrictions

Without steps to allow families access, the psychological and emotional consequences of lockdowns will be immense

Much of the debate around COVID-19 and nursing and care homes has focused on personal protective equipment (PPE), yet comparatively little attention has been given to the huge impact of a ‘no visiting’ policy on residents and relatives.

Sadly, this is something of which my family and I have firsthand knowledge.

Some social interactions continued for residents

For the past year, my dad, who was 90 and had metatastic prostate terminal cancer, lived in a home in Wales.

As COVID-19 escalated, the home responded quickly. They were exceptionally well-organised and swiftly enforced a rigorous process for any goods delivered and excluded all visitors, in line with government guidance.

With face-to-face visits prohibited, they established opportunities for positive social interactions, setting up video calls from relatives directly into residents’ rooms.

Mum did not see the point in sitting outside dad’s window

Staff were always reassuring whenever we phoned to check on dad, and to date there have been no COVID-19 cases reported within the home. This is a testament to all of their hard work to protect residents.

While this is of course to be commended, policymakers need to realise there is a much bigger, silent social impact of visiting restrictions on residents and their families.

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In June, the Welsh Government updated its guidance and the home set up a chair for visitors outside the window of dad’s room.

My mom completely disengaged with socially distanced visiting – she did not see the point in sitting outside dad’s window. She was also struggling with her own health issues and could not get comfortable on the plastic chair outdoors in the baking heat.

Dad shouted at us to come in, even beckoning for us to climb through the window

Dad could not hear or see her, being understandably disoriented by this new COVID-19 world.

He shouted at us to come in, he even beckoned for us to climb through the window and, exasperated when he believed we were ignoring him, he shouted out: ‘This is bloody ridiculous.’ He told us to ‘shut the window and go away’.

On one of my last visits, I stood outside in the pouring rain and silently witnessed his anguish through his window. He couldn’t see or hear me. He was fidgeting, presumably in pain, plucking earwax from his ears and thoroughly agitated.

I got attention for him by ringing the home’s front door bell. Carers were immediately deployed to his room.

Where were his hearing aids, I asked. Where were his glasses? After a lot of searching, his hearing aids were located under his bedclothes. The batteries were dead, and his ears were full of wax. For the first time, I welled up with tears.

Relatives are denied the chance to do the simple things they always do for loved ones

Although everything was dealt with swiftly, the bigger issue here is that by not being able to enter the home even in full PPE, relatives are denied the opportunity to do the simple things they always do for loved ones, and to be able to look out for them.

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The home has reassured us that dad would not die alone, but even though he was dying, he was still living.

Earlier this month, leading charities called for the relatives of people with dementia to be treated as key workers and allowed access to homes to visit their loved ones, and I believe the same access should be granted to all families.

Charities such as Dementia UK and the Alzheimer's Society argue that the care given by family members is essential to the overall well-being of people with dementia and the current social distancing restrictions have contributed to a 'hidden catastrophe' in care homes.

What a quality caring model needs

Studies show a quality caring model comprises three things:

• Structure – taking account of the context of care provision.
• Process – the technical and interpersonal aspects of care delivery.
• Outcomes – based on the consequences of the process.

We may be emerging from the peak of the pandemic, but if a second wave comes we need to rethink the entire visiting policy.

• RELATED: Effective communication with older people

Precious opportunities to visit and advocate for relatives are relatively shortlived, with the average lifespan of a resident in care being about one year. Almost four months have now passed since lockdown began. For my dad, human contact played a huge part in his quality of life.

Measures to protect residents need not mean completely excluding all visitors. Time-sensitive, innovative and bespoke strategies are needed to involve families.

Without these, the psychological and emotional consequences of lockdown on residents and relatives will be immense.

Liz Lees-Deutsch is a National Institute for Health Research (NIHR) senior nurse research leader

The views expressed in this article are those of the author and not necessarily those of the NIHR, or the Department of Health and Social Care