Last week, in response to the spread of the coronavirus, the United States Centers for Medicare and Medicaid Services (CMS), the regulator for over 15,000 nursing homes in the US, announced a “no visitors” policy for all facilities across the country. The blanket ban cuts off over 1.5 million older residents from family and friends, with limited exceptions for end-of-life visits.
Having limits on visitors to nursing homes is reasonable, given that the virus has disproportionate effects on older people and those with underlying conditions, and the guidance properly reinforces the importance of proper infection control.
But a broad visitor ban doesn’t take into account the serious risks that can come from social isolation. Instead of imposing a blanket ban with no foreseeable end, CMS could put in place measures being used in other settings to keep residents and nursing facility staff safe. For example, it could restrict visitors who are sick, as many facilities already do, limit the number of visitors per day, strictly supervise visitors’ handwashing and masking, have a dedicated room for visiting, and ensure visitors maintain a safe distance from others.
Beyond the possibility of health risks from social isolation, a 2018 Human Rights Watch report documenting abuses in nursing homes across the US 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. With visiting restrictions equally applying to ombudsman programs, adult protective services, and individuals’ doctors, there will be far less contact with residents, limiting the ability to identify when things go wrong.
Human Rights Watch also documented routine denial of older people’s rights to make decisions for themselves. This ban amplifies that harm. If an older person were receiving services and support at home rather than in a nursing facility, they could choose whether to have visitors. For those in institutions, CMS is making the choice to cut them off.
CMS should amend the current policy recognizing the risk of social isolation and identify how nursing homes can balance the protection of older and at-risk residents with their needs for family and connection.
