When Will Long-Term Care Facilities Reopen to Visitors?


A study in 26 nursing homes in the Netherlands, demonstrating that families can visit without causing new Covid infections, has encouraged advocates. Perhaps, they say, in areas with low community infection rates, when facilities have sufficient protective equipment and testing capacity, family caregivers can be cautiously reintroduced.

But many long-term-care facilities still can’t meet those conditions. Dr. Bergman, whose group expects to publish its recommendations next month, pointed out that some still report shortages of protective equipment, particularly N95 masks in appropriate sizes. In many regions, bottlenecks in testing have so delayed results that they are useless for screening visitors.

Moreover, Dr. Karlawish said, “one thing that haunts long-term care is fear of litigation.”

Medicare vowed last month to send a rapid testing kit to each of the nation’s 15,000 nursing homes, prioritizing those with outbreaks or in Covid hot spots; so far it has allocated about 2,400. But these antigen tests produce more false negative than the slower but more reliable P.C.R. tests, experts said; facility administrators also worry about the cost of supplies the kits require.

“Providers are eager but cautious to welcome visitors and volunteers back into their buildings,” the American Health Care Association/National Center for Assisted Living said in an email. “That is why we need public health officials to direct resources — testing, PPE and funding — to long-term care on an ongoing basis.”

There’s always a reason to delay, and facilities where residents and staff members have already suffered and died from Covid-19 understandably fear a recurrence. But they could exercise judgment, Dr. Karlawish said, and at least allow visitors for residents who clearly struggling with the isolation. “Nursing homes care for a group of people for whom high-stakes ethical decisions are part of life,” he said.

Almost by definition, long-term care residents have limited life spans; nursing home residents are particularly fragile. Do they so value safety over quality of life that they want to spend their last months or years separated from their loved ones? Has anyone asked them?

Ms. Baum keeps visiting her mother and mother-in-law from a distance, but she is haunted by “the idea that one of them might pass, without one of us next to them,” she said. “I don’t know what I would do.”

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