A study at 26 nursing homes in the Netherlands, proving that families can visit without causing a new Covid infection, encouraged advocates. They argue that, in areas with low rates of infection in the community, when facilities have adequate protective equipment and testing capacity, family caregivers can be cautiously reintroduced.
But many long-term care facilities still cannot meet those conditions. Dr Bergman, with whom the team is expected to release its recommendations next month, points out that some are still reporting shortages of protective equipment, especially the N95 masks of the right size. In many regions, check-in bottlenecks are so late that they are useless for screening visitors.
What’s more, Dr. Karlawish said, “one thing that haunts long-term care is the fear of litigation.”
Last month, Medicare announced it would send a set of rapid tests to each of the nation’s 15,000 nursing homes, preferring those with outbreaks or Covid hotspots; so far it has allocated around 2,400. But these antigen tests produce more false negatives than the slower but more reliable PCR tests, experts say; The facility manager is also concerned about the cost of supplies that the kit requires.
“Providers are eager but cautious to welcome visitors and volunteers back to their buildings,” the American Health Care Association / National Living Support Center said in an email. “That’s why we need public health officials to direct resources – tests, PPE and funding – for long-term care on an ongoing basis.”
There is always a reason for delay, and facilities where residents and employees have suffered and died from Covid-19 can understand fear of recurrence. But they can execute the verdict, Dr. Karlawish says, and at least allowing visitors to residents who are clearly struggling with isolation. “Nursing homes care for a group of people where profitable ethical decisions are part of life,” he said.
Almost by definition, long-term care residents have a limited life expectancy; Nursing home residents are especially fragile. Do they value safety over quality of life that they want to spend their final months or years apart from their loved ones? Did anyone ask them?
Ms. Baum constantly visits her mother and mother-in-law from afar, but she is haunted by “the idea that either of you can get through without us by your side,” she said. “I don’t know what I’m going to do.”
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