“The ban on visitors really had a negative impact on the well-being of nursing home residents”

Jan Hamers (professor of Care of Older People): “Soon after the COVID-19 pandemic broke out last March, Minister De Jonge of the Ministry of Health announced a ban on visitors to nursing homes. Shortly afterwards, I received a phone call from the ministry. Their first question was whether the Living Labs in Ageing and Long-Term Care could help them collect data: how many people in nursing homes were infected with coronavirus? How many residents, how many employees? They had no insight into those figures. And then there was the question of how to proceed, of course. I passed their request on to SANO, the network of Academic Collaborative Centres for Care of Older People. Amsterdam started working on those figures, Leiden and Groningen set out to analyse the meeting notes of nursing home crisis teams, and our own Living Lab in Ageing and Long-Term Care Limburg (AWO-L) teamed up with the Nijmegen University Knowledge Network for Care of Older People (UKON) to study the ban on visitors.

Overestimated

“The ban was having a very significant impact, as we quickly learnt from both residents and their loved ones. After all, what is worse: not seeing your partner in person for three months, a mother with dementia no longer recognising her child after that amount of time – or the risk of getting infected with coronavirus? It was quite possible that people were willing to take that risk. Moreover, the number of cases in nursing homes had been overestimated; only half of all suspected cases were confirmed, and three or four out of every ten patients died. You might say that’s a lot, but we shouldn’t forget that this is the most vulnerable group of people. The average life expectancy in a nursing home is eighteen months. I’d prefer to look at it the other way around: 60 to 70 per cent of those patients survived the virus.”

“We wanted to do a small-scale pilot study into allowing one visitor at a time, under strict conditions. We would monitor the visits. People were increasingly calling for the restrictions to be eased, so the minister decided that one nursing home in each Dutch safety region could participate – that’s 25 in total. At the end of May 2020, the general ban on visitors was lifted, under certain conditions. By that time, we were monitoring 76 nursing homes using questionnaires – the general monitor – and conducting in-depth monitoring at five homes, interviewing the people affected by the ban. These interviews were very emotional at times, particularly the ones with family members who were finally allowed to visit their loved ones again. They had been suffering terribly and were so relieved that the ban had been lifted, just like the residents themselves. The ban really had a negative impact on people’s well-being. Importantly, the study didn’t lead to any additional cases. Zero. We also found that visitors were quite capable of following the instructions. The only thing they struggled with was avoiding physical contact. The situation remained stressful for employees, though: they continued to experience high levels of work pressure and were still worried that people would get infected with coronavirus.”

Never again

“In June, the ministry asked us to report on the lessons learnt. We passed this request on to nursing home administrators and our older adult advisory council at AWO-L, which includes representatives of client councils as well as representatives of the older adult advisory council of the Ministry of Health. They all said: never impose a general ban on visitors again, and let the homes develop their own visitation policies. So that’s what happened in September and October 2020. We were on our third round of collecting data when the second wave hit, with outbreaks in 25 per cent of Dutch nursing homes. This time, the minister didn’t impose a general ban on visitors; he left it up to the homes, as we’d advised. We checked with nursing home administrators, who said they weren’t planning to close their doors to visitors again. You never know, though – in the spring of 2021, some of them did so anyway.

But the government didn’t impose a general ban on visitors again, and I think our research contributed to that. Internationally as well: we published our findings in an American journal, JAMDA, which even gave us an award because the article got so many hits in the US and the UK. It said: see, nursing homes don’t have to close their doors to visitors.”

In the spring of 2021, when about 80% of nursing home residents and 60 to 70% of nursing home employees had been vaccinated, the researchers went back to collect more data. They found that most nursing homes hadn’t further eased their visitation restrictions, despite these high vaccination rates. Nursing home residents also reported that they felt lonely due to the COVID restrictions. Says Jan Hamers, “This was reason for us to urge the care home sector to take the initiative and ease the restrictions after discussing it with residents, their loved ones, and employees. We knew that reopening the doors to visitors was the only way to improve the well-being of the residents.”

• Science network elderly care Nijmegen (UKON), Radboudumc

• University Network Elderly Care - University Medical Center Groningen

• Academic Collaborative Centers on Care for Older People (SANO)

• Tranzo, Tilburg University

• UNO Amsterdam, Amsterdam UMC

• Presentation ‘Impact of COVID-19 vaccinations in Dutch nursing homes. Back to normal?’, Judith Urlings. International workshop on Covid-19 and Long-Term Care Systems, December 2021.
•  Presentation 'What we learned from a year of corona', researcher Bram de Boer, nurse Ellen Hermans and family caregiver Fon Kistermann. Online conference ' Figure it out' by Vilans (national centre of expertise for long-term care in the Netherlands), February 2021.  
• Presentation 'Monitor study easing of visitation restrictions in nursing homes', researchers Hilde Verbeek and Judith Urlings, nurse Melissa Bettink, Debby Gerritsen (UKON). Day of Geriatrics 2021 (online)