Adelina Comas-Herrera¹, Maximilian Salcher-Konrad¹, Jennifer Baumbusch², Nicolas Farina³, Claire Goodman⁴, Klara Lorenz-Dant¹, Lee-Fay Low⁵

¹Care Policy and Evaluation Centre (CPEC), Department of Health Policy, London School of Economics and Political Science, ²School of Nursing, University of British Columbia, ³Centre for Dementia Studies, Brighton and Sussex Medical School, ⁴NIHR Applied Research Collaboration (ARC) East of England, Centre for Research in Public health and Community Care (CRIPACC) University of Hertfordshire, ⁵Faculty of Medicine and Health, University of Sydney.

The full pre-print article (not yet peer-reviewed) can be found here:

Abstract:

Most countries have restricted visits to care homes to prevent COVID-19 infections, however, concern is increasing about the negative impact of these restrictions on the health and wellbeing of care home residents and their families.

We carried out a rapid review of evidence to address three questions:

1. What is the evidence on the impact of visitors in terms of infections in care homes?
   • We found no scientific evidence that visitors to care homes introduced COVID-19 infections, however during the peak of the pandemic most countries did not allow visiting and there are some anecdotal reports attributing infections to visitors before restrictions.
2. What is the evidence on the impact of closing care homes to visitors on the wellbeing of residents?
   • There is increasing evidence that care home residents experienced greater depression and loneliness and demonstrated more behavioural disturbance during the period that included visitor bans.
3. What has been the impact of restricting visits on quality of care?
   • There is evidence of substantial care provision by unpaid carers and volunteers in care homes prior to the pandemic, hence visiting restrictions may have resulted in reductions in quality of care or additional tasks for care home staff.

Conclusions:

Given that there were already low rates of social interactions among residents and loneliness before the COVID-19 pandemic, the evidence reviewed suggests that visiting restrictions are likely to have exacerbated this further. While there is no scientific evidence identifying visitors as the source of infections this is likely to reflect that most care homes did not allow visitors during the initial peaks of the pandemic. A pilot re-opening homes to visits under strict guidelines did not result in any infections.

Allowing visitors in facilities where there are no COVID-19 cases is important to support resident wellbeing. Safeguards to reduce risk of COVID-19 infection have been described, including visits through windows/glass, outdoor visits, and well-ventilated indoor spaces, screening of visitors, use of masks and other PPE and hand hygiene and cleaning.

In addition, it is important to recognize and support the provision of unpaid care, particularly for people who pre-COVID had a history of regular visiting to provide care (e.g. feeding, grooming, emotional support). They should be classified as essential workers, provided training and PPE, and be allowed to visit regularly and provide care, interacting as closely with residents as staff.

Citation:

Comas-Herrera A, Salcher-Konrad M, Baumbusch J, Farina N, Goodman C, Lorenz-Dant K, Low L-F (2020) Rapid review of the evidence on impacts of visiting policies in care homes during the COVID-19 pandemic. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE.