Protecting long-term care facilities in the next pandemic: Lessons regarding visitation and activity restrictions during COVID-19

AIMS: To examine nursing home restrictions in the US during COVID-19 in light of staff and resident/family attitudes and of bioethical principles. DESIGN: Online survey of nursing home leaders (e.g., facility administrators, medical directors, directors of nursing, and other managerial staff). DATA SOURCES: Nursing home leaders from 48 states and the District of Columbia were surveyed between October 2022 and May 2023. RESULTS: Federal, state, and local regulations were the key factors in the policies facilities implemented (92% of facilities rated them "very important."). "Non-maleficence" and "beneficence" were the primary ethical considerations in initial and revised restrictions, although over time "autonomy" and "justice" became more significant. Staff and residents/caregivers generally regarded strict restrictions on visitation and contact unfavorably. CONCLUSION: Nursing homes reported challenges in implementing standardized restrictions due to a lack of facility-level discretion and the ethical dilemmas these directives created. When promulgating restrictions on long-term care, public health officials should balance safety with psychosocial well-being, permit greater local flexibility in policies, and conduct follow-up studies on the restrictions' enduring effects. IMPLICATIONS: This study highlights the ethical dilemmas staff faced in balancing infection control with residents' well-being. Greater discretion in policy implementation and expanded psychosocial support for residents and caregivers should be integral to pandemic preparedness.