A study in 26 nursing homes in the Netherlands, demonstrating that families can visit without causing new Covid infections, has encouraged lawyers. Perhaps, they say, in areas with low rates of infection in the community, when facilities have adequate protective equipment and testing capabilities, family caregivers can return safely.
But many long-term facilities cannot meet those conditions. Dr. Bergman, whose group expects to publish its recommendations next month, noted that some still report shortages of protective equipment, particularly N95 masks in appropriate sizes. In many regions, barriers to testing have delayed results so much that they are useless to screening visitors.
Furthermore, Dr. Karlawish said, “one thing that follows long-term care is the fear of litigation.”
Medicare pledged last month to send a quick test kit to each of the country’s 15,000 nursing homes, giving preference to those with outbreaks or at Covid hotspots; so far it has tuned about 2,400. But these antigen tests produce more false negatives than slower but more reliable PCR tests, experts said; facility administrators are also concerned about the cost of supplies required by the kits.
“Providers are eager but careful to welcome visitors and volunteers back into their buildings,” the American Health Care Association / National Assisted Living Center said in an email. “That’s why we need public health officials to direct the resources – testing, PPE and funding – to long-term care on an ongoing basis.”
There is always a reason to delay, and the facilities where residents and staff members have already suffered and died from Covid-19 are understood for fear of a recurrence. But they can exercise judgment, said Dr. Karlawish, and at least allow visitors to residents who clearly struggle with isolation. “Nursing homes care for a group of people for whom ethical decisions of high interest are part of life,” he said.
Almost by definition, long-term care residents have limited lives; Residents of nursing homes are particularly fragile. Do they value quality of life so much that they want to spend the last months or years apart from their loved ones? Has anyone asked them?
Ms. Baum continues to visit her mother and mother-in-law from a distance, but she is haunted by “the idea that one of them could pass, without one of us near them,” she said. “I do not know what I would do.”
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