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.