The variability of COVID-19 vaccination by nursing home staff and family caregivers has been the biggest obstacle to resuming home visits during the pandemic, research from the University of Liverpool suggests.
This was exacerbated by a lack of help and guidance on implementing government guidelines, meaning individual care homes were left to their own devices to interpret the limited guidelines, where they existed, and make decisions about how and when visits should resume.
In March 2021, the government made two announcements and first allowed one essential visitor to nursing homes, followed by a second essential visitor. As the sector did not receive any communication from the government on the changes in advance, the nursing homes implemented the directions in the way they saw best, with some homes allowing visits and others remaining reluctant to do so. do it.
Funded by the National Institute for Health Research (NIHR), the research partner of the NHS, public health and social services, this is the first study to explore the concerns and issues surrounding immunization and increasing testing on home visits while making recommendations to manage home visits in future pandemics. 62 interviews were held with family caregivers and nursing home staff across the country.
The researchers, whose work has been published in Age and Aging, have broken down their findings into five themes as the main factors influencing the restart of home visits during the pandemic:
Delayed and inconsistent offers of face-to-face visits: This left some family caregivers seeing their loved ones via alternative face-to-face visits, pod and window-only visits, delays, varied visiting rights and general uncertainty as to when care homes would resume normal face-to-face visits. For many, that meant they had not been able to visit their loved one for almost a year, as restrictions had not increased significantly in some homes since the lockdown began.
Visiting procedures and facilitation: Care homes implemented strict testing, PPE, and distancing procedures, and family caregivers faced lengthy logistical challenges for visiting loved ones, involving testing before visit and having to wait outside until the test comes back negative.
Variable adoption of the COVID-19 vaccine: despite the priority given to residents of nursing homes and to health and social personnel to access the COVID-19 vaccine, as well as to family caregivers, there has been variable use according to the figures of the study. All family caregivers participating in the research had been vaccinated, while not all staff or colleagues were in the same care home, which directly contributes to delays in restarting visits.
Dissemination of false information: Nursing home staff have reported various issues regarding information about the COVID-19 vaccination, with some of their colleagues being misinformed about the vaccine. There appeared to be a lack of credible information and sufficient education to fully inform staff about vaccination, with side effects on fertility as well as being microchipped being mentioned as reasons for not getting the vaccine. Disinformation appears to have spread via social media and the internet more widely
Family caregiver frustration and anger: Family caregivers were angry and frustrated that they had not been able to enter care homes and have face-to-face visits with their loved one despite having been tested, vaccinated and cautious about adherence to restrictions. This was made worse by the fact that family caregivers saw the care home staff sitting next to their parent behind a nearby screen or cradle window, not quite sure whether the staff had been vaccinated or not. Additionally, on each alternate visit, different staff members could facilitate the visit sitting close to the resident, again increasing the potential risk of infection when family caregivers often had little or no knowledge of staff vaccination.
The authors of the report make five specific recommendations for the nursing home sector, for the benefit of staff, family caregivers and residents during future pandemics:
In-person visits are a human right and the right to see loved ones should only be removed as a last resort, regularly reviewed in consultation with residents and caregivers, and reinstated as a high priority as soon as possible
Support to nursing homes for the effective implementation of infection control measures and access to personal protective equipment alongside healthcare staff, to avoid taking staff time to care for residents and lead to stopping visits by default, at lower cost, protective response
Need for better immunization information and advice support for all involved and improved logistics processes for vaccine delivery
General need for better guidance and communication to support nursing home staff in their work delivery and communication between nursing homes and families
In accordance with current government policy, vaccination of social service personnel should be mandatory
Lead researcher Dr Clarissa Giebel, from the University of Liverpool-based NIHR Applied Research Collaboration North West Coast, said the findings will be shared with the care home sector, family caregivers and government.
She added, “We have made clear recommendations for the management of nursing homes in the future and in the event of a new pandemic.
While more research is needed on the precise impacts of residents from their perspective, there is a clear message that government guidelines must be backed up by law to protect the rights of nursing home residents to life. of family.
The study was conducted with the advice of family caregivers and input from the Lewy Body Society.
Jacqui Cannon, Executive Director of the Lewy Body Society, said: “As a charitable research organization, the Lewy Body Society is very keen to support studies that help advance understanding of the lives of people with dementia. to Lewy bodies, their families and caregivers, in addition to funding research through our grants program. We have been particularly keen throughout the Covid-19 pandemic to understand the main barriers to care home visits and to support this vital research. “
Paul Marlow, an ARC NWC public adviser and his mother’s caregiver at a care home in Liverpool, participated in the study. He made a video of his frustrations with navigating the visiting rules to access the nursing home during the pandemic.