Update: Subsequent to publication, the Centers for Disease Control and Prevention’s recommendations, the Centers for Medicaid and Medicare Services’ guidance, and the nursing facility industry’s standards have changed.
This week the United States Department of Veterans Affairs (VA) announced a “no visitors” policy at its 134 nursing homes in response to the spread of the coronavirus, a decision that cuts off its annual 40,000-plus residents from families and friends.
The risk to older people who get COVID-19 is serious and there is still much uncertainty about the disease. But this blanket policy flies in the face of public health guidance, which doesn’t call on nursing facilities to close themselves off entirely.
Without a doubt, some limits on visitors are reasonable, given that the virus has disproportionate effects on older people. Eighty percent of those who have died of COVID-19 in China were over the age of 60.
But the VA’s sweeping visitor ban fails to take into account the serious risks that can come from social isolation.
It means an older person with dementia cannot see a loved one, possibly the only person they remember. A 2018 Human Rights Watch report documenting abuses in nursing homes found that people who are on their own, without family or friends visiting or communicating with the facility staff, and who have language barriers or disabilities that make communication between them and others difficult, are some of the most at risk for worse treatment. Visitors help to point out when things are wrong.
Instead of imposing a blanket ban with no foreseeable end, the VA could take less extreme measures to keep residents safe from COVID-19. The Centers for Disease Control and Prevention’s recommendations, the Centers for Medicaid and Medicare Services’ guidance, and even the nursing facility industry’s standards appear to better balance the risks of the disease and the problems of social isolation. They each call for bans on visitors who are sick or who have been or likely have been exposed to COVID-19.
The VA could even go further, for example supervising visitors’ handwashing and limiting numbers of visitors per day, conducting heightened screenings of visitors for symptoms, or requiring visitors to keep distances or even wear gloves and masks.
The VA should repeal its visitor ban and replace it with a policy that balances the protection of older and at-risk residents with their need for family and connection.
