Howell-Spooner, B; Dalidowicz, M; Boden, C. How is "compassionate visit" defined and operationalized in the context of an infectious outbreak or pandemic? 2020 Apr 28; Document no.: LTC042402-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 7 p. (CEST evidence search report)
Visitor restrictions in long-term care (LTC) during an outbreak or pandemic are implemented due to the perceived risk of transmission between residents or staff and visitors.
· Social isolation and possible loss of care resulting from visitor restrictions in LTC may place residents at risk of poorer outcomes in terms of both physical and mental health, as well as distress to families and staff (see Saskatchewan LTC Network Family Perspective).
· Visitor restriction policies typically allow visits for compassionate reasons that include end of life, critical care, and support of persons who require assistance beyond that provided by healthcare e.g. support for feeding, mobility, or behaviors, but specific detail on these is not consistent or clear.
· Recent changes to visitation policies in Australia are less restrictive and allow brief visitations (end of table 1, noted in red font).
· Although the majority of policies describe a need for flexibility and case-by-case assessment of visits deemed “essential”, the majority of policies are not clear in who is to conduct this analysis or the criteria that should be used to make these decisions.
Visitation policies differ in detail regarding the number of visitors allowed at one time, total number of visitors allowed, visit duration, mobility within the home and location of the visit.
· Remote and technology assisted visits are to be facilitated by LTC staff.
· Infection control practices are enforced for visitors, and may include screening (e.g. temperature, symptoms, travel and contact history), prohibiting ill visitors, use of personal protective equipment (PPE), hand and cough hygiene.
· Education of visitors and support for proper infection control practices is encouraged in the majority of policies.
Tupper, S; Ward, H; Howell-Spooner, B; Dalidowicz, M; Boden, C. How is "compassionate visit" defined and operationalized in the context of an infectious outbreak or pandemic in long-term care? 2020 May 1; Document no.: LTC042402
RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
Boden, C; Ellsworth, C. What are best practices for engaging family care providers during a pandemic? 2020 Apr 30; Document no.: LTC042401-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 32 p. (CEST evidence search report)
Core concepts of family engagement include dignity and respect, information sharing, participation in care and decision making, and collaboration (Hart 2020).
A careful balance needs to be maintained between attending to patients’ physical and psychological needs and adhering to infection control guidelines, while offering psychological support to family members (Chan 2006).
The word ‘visitation’ does not adequately describe family members’ involvement. Family presence is a more suitable term as it redefines families as partners in care (Hart 2020). However, it is important to recognize that family presence is not a substitute for adequate staffing levels.
Very little guidance is provided in the literature on innovative or specific approaches engage family care providers during a pandemic. The literature mainly focuses on supporting alternate forms of communication such as telephone calls, or technology assisted communication through social media or video/voice calls.
Enhanced communication strategies that provide regular information to a primary family contact on the patient/resident condition and allow chosen care partners to contribute to decision making as much as possible are recommended (Koller 2006).
The negative impact of visitation restrictions places increased stress on patients/residents and families who are unable to provide or receive non-healthcare specific supportive care. Those with neurocognitive disorders or communication barriers are more significantly impacted.
Staff also report increased stress during family visitation restrictions due to the additional time required to take on a “familial role” for the patient/resident. These roles may include providing a supportive environment, social interaction, information sharing, and opportunities for play (Koller 2006a – pediatric hospital setting).
The search question did not specifically look at impact of visitation on infection rates; therefore, there is insufficient information to determine if visitation policies affect infection rates. However, a systematic review in pediatric hospital setting in Ontario found no connection between liberal visiting hours and increased SARS infection rates (Smith 2009).
When facilitating sibling visitation in the NICU, a pre-visit education process is recommended. Maternity settings may wish to consider a 'combination' policy, where the women's partners and/or significant other would have open visiting (all day), with restricted visiting for others. In other general hospital ward settings, open visiting with a 'quiet hour' is suggested (Smith 2009).
Tupper, S; Ward, H; Dalidowicz, M; Boden, C; Ellsworth, C; What are best practices for engaging family care providers during a pandemic? 2020 Apr 16; Document no.: LTC042401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 22 p. (CEST rapid review report)
Dalidowicz, M; Howell-Spooner, B. What are the impacts on the family unit from visitation restrictions during an infectious disease outbreak and how can we support the families? 2020 May 1; Document no.: LTC042403-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 24 p. (CEST evidence search report)
Tupper, S; Ward, H; Howell-Spooner, B; Dalidowicz, M; What are the impacts on the family unit from visitation restrictions during an infectious disease outbreak and how can we support the families? 2020 May 14; Document no.: LTC042403 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 38 p. (CEST rapid review report)
As essential partners in care, family caregivers support feeding, mobility, personal hygiene, cognitive stimulation, communication, meaningful connection, relational continuity, and assistance in decision-making. 1,2,13,14,15,16,17 Prior to the pandemic, research indicates that on average, 37.4 hours of informal care was provided in LTC per resident each month by informal caregivers, most often described as family. 3 Visitor restrictions inclusive of family caregivers reduced available resources for resident care, intensifying staff shortages.1,2,3,5,13 Designation of essential caregivers, distinct from general visitors, in policy and legislation was in part recognition of these roles and contribution to resident care.1,2,13
Prior to the pandemic, the role family caregivers in providing care for other residents was described as evolving over time as family members and friends become familiar with the needs of other residents. Roles described by family members in their care of other residents include providing companionship, assisting with meals, bring additional food or supplies when brought for their own family member, and assisting with leisure activities. 17
LTC volunteers roles during the pandemic reduced their activities to maintaining (limited) activities for residents, assisting residents with use of technology to communicate with family/physicians, and providing emotional support.4
A commentary article describes an example of family caregivers who were hired on short (90 day) contracts to care for residents during acute staffing shortages (Kensington Health 2021).5 Personal communication intended as an environmental scan (AB and ON) spoke to the variability of staffing needs and the individualized response by LTC homes to address these staffing shortages. If family caregivers were to be invited to provide additional resources in the context of staff shortages, this decision was made by individual homes, in communication with residents and families and aligned with provincial visitation policy.
During the pandemic, a new paid role of comfort care aide was also created by Alberta Health Services The job involved providing comfort, support and assistance to residents, portering residents, mealtime assistance, ensuring PPE was always available, refilling equipment and care supplies as needed, cleaning and disinfecting high touch surfaces, supporting reception duties, supporting screening of staff and visitors, receiving deliveries and stocking supplies, and performing other duties as assigned.6
Myge, I; Ward, H; Tupper, S; Fox, L; Howell-Spooner, B. What are the roles or function of family caregivers in providing care to other residents in LTC? 2022 Jan 27, Document no.: LTC220101 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 13 p. (CEST rapid review report).
Provincial and state policies tend towards disincentivizing removal of residents from LTC during the pandemic due to perceived increased risks in the community.
Planning, risk and resource evaluation, clear communication, and follow-up arerequired to successfully transition a well-selected resident from LTC to the community.
Several tools exist to support communication and decision making around leaving LTC.
Family/informal caregiver fears are heightened by media reports describing abandonmentand lack of proper PPE use.
Fears can be mitigated by frequent, transparent communication that is both push and pull in nature.
Increased oversight of LTC homes by provincial oversight committees during the pandemic can ensure that provision of routine care, infection prevention measures, and effective communicationare in place.
If a resident leaves to community and has to return,appropriate isolation and screening measures would be required.
Tupper, S; Ward, H; Groot, G; Ellsworth, C; Dalidowicz, M; Boden, C. What decision support or communication materials are available for helping LTC directors discuss care options with residents' family members? 2020 Apr 14; Document no.: LTC040801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 23 p. (CEST rapid review report)
Ellsworth, C. What decision support or communication materials are available for helping LTC directors discuss care options with resdients' family members? 2020 Apr 10; Document no.: LTC040801-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 6 p. (CEST evidence search report)
