“You Admit a Resident, You Admit a Family” The Impact of COVID-19 Restrictions on Family Time in Long-Term Care

Abstract

Social connection is associated with wellbeing and better health. However, the public health restrictions that were put in place due to COVID-19 disproportionately affected the older adult population, particularly those living in long-term care (LTC). Due to this unprecedent situation, the researchers aimed to understand the perceived impact of pandemic restrictions on families of residents in LTC facilities, and to shed light on how families perceive the strategies put in place helped families stay connected. Reporting on the interview data of a larger mixed-methods study, findings focused on themes of quality of life, quality of care, mental health concerns, communication, and the rules. The rules was an overarching theme and each of the inter-related themes describe the experiences of families feeling dismissed by the health system, stressed about not being able to support their loved one, and helpless during the various lockdowns when staffing was additional strained. These findings highlight how being excluded from decision-making processes, family members and their loved ones were severely impacted by the COVID-19 restrictions and calls for policy changes to be inclusive of families as part of the care team in decision-making for LTC.

Keywords

• COVID-19
• Restrictions
• Policy
• Long-Term Care
• Family Caregivers
• Social Connections
• Canada
• British Columbia

References

1. Bethell, J., Aelick, K., Babineau, J., Bretzlaff, M., Edwards, C., Gibson, J., Hewitt Bolborne, D., Iaboni, A., Lender, D., Schon, D., McGilton, K. (2020). Social connection in long-term care homes: A scoping review of published research on the mental health impacts and potential strategies during COVID-19. JAMDA, 22, 228e237 https://doi.org/10.1016/j.jamda.2020.11.025
2. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. www.doi.org.10.1191/1478088706qp063oa
3. Canadian Institute for Health Information [CIHI]. (2020). Pandemic experience in the long-term care sector: How does it compare with other countries? www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf
4. Chamberlain, S.A., M. Hoben, J.E. Squires, and C.A. Estabrooks. 2016. Individual and Organizational Predictors of Health Care Aide job satisfaction in long term care. BMC Health Services Research, 16(1):577. https://doi.org/10.1186/s12913-016-1815-6
5. Chu, C.H., Yee, A.V., & Stamatopoulos, V. (2022). “It’s the worst thing I’ve ever been put through in my life”: The trauma experienced by essential family caregivers of loved ones in long-term care during the COVID-19 pandemic in Canada. International Journal of Qualitative Studies on Health and Well-being, 17(1), 2075532, DOI: 10.1080/17482631.2022.2075532
6. Daley, S., Akarsu, N., Armsby E., Farina, N., Feeney, Y., Fine, B., Hughes, L., Pooley, J., Tabet, N., Towson, G., Banerjee, S. (2022). What factors have influenced quality of life in people with dementia and their family carers during the COVID-19 pandemic: a qualitative study. BMJ Open 2022;12:e053563. doi:10.1136/bmjopen-2021-053563
7. Dupuis-Blanchard, S., Maillet, D., Theriault, D., LeBlanc, F., & Bigonnesse, C. (2021). "Be Their Advocate": Families' Experience with a Relative in LTC during the COVID-19 Pandemic. Canadian Journal on Aging / La Revue canadienne du vieillissement, 40(4), 628–638. https://doi.org/10.1017/S0714980821000398
8. Fisman, D., Bogoch, I., Lapointe-Shaw, L., McCready, J., Tuite, A. (2020). Risk factors associated with mortality among residents with coronavirus disease 2019 (COVID-19) in long-term care facilities in Ontario, Canada. JAMA Network Open, 3(7):e2015957. doi:10.1001/jamanetworkopen.2020.15957

9. Gallant, N., Hardy, M-S., Beogo, I., Conklin, J., Connelly, D., Kaasalainen, S., Keefe, J., Roitaille, A., Yous, M-L., Fanaki, C., & Cameron, C. (2022). Improving family presence in long-term care during the COVID-19 pandemic. Healthcare Quarterly, 25 (Special Issue), 40-46.
10. Hugelius, K., Harada, N., & Marutani, M. (2021). Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review. International Journal of Nursing Studies, 121, 1-10. https://doi.org/10.1016/j.ijnurstu.2021.104000
11. Kallio, H., Pietila, A.-M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing, 72(12), 2954–2965. https://doi-org.ezproxy.tru.ca/10.1111/jan.13031
12. Kemp, C. (2020). #MoreThanAVisitor: Families as “essential” care partners during COVID-19. The Gerontologist, XX(XX), 1-7. https://doi.org/10.1093/geront/gnaa161
13. Lincoln, Y., & Guba, E. (1986). But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Program Evaluation, 30; 73-84. https://doi.org/10.1002/ev.1427
14. McGrath, C., Palmgren, P., & Liljedahl, M. (2019). Twelve tips for conducting qualitative research interviews. Medical Teacher, 41(9), 1002–1006. https://doi-org.ezproxy.tru.ca/10.1080/0142159X.2018.1497149
15. Mitchell, L., Albers, E., Birkeland, R., Peterson, C., Stabler, H., Horn, B., Cha, J., Drake, A., & Gaugler, J. (2021). Caring for a relative with dementia in long-term care during COVID-19. JAMDA, 23, 428-433. https://doi.org/10.1016/j.jamda.2021.11.026
16. Nash, W., Harris, L., Heller, K., Mitchell, B. (2021) “We Are Saving Their Bodies and Destroying Their Souls.”: Family Caregivers’ Experiences of Formal Care Setting Visitation Restrictions during the COVID-19 Pandemic. Journal of Aging & Social Policy. Journal of Aging and Social Policy, 4-5, 398-413. https://doi.org/10.1080/08959420.2021.1962164
17. Ontario Ministry of Health and Long-Term Care. (2008). People Caring for People: A Report of the Independent Review of Staffing and Care Standards for Long-Term Care Homes in Ontario. Toronto: Queen’s Printer for Ontario. https://www.health.gov.on.ca/en/common/ministry/publications/reports/staff_care_standards/staff_care_standards.aspx
18. Romanow, R. (2002). Building on Values: The Future of Health Care in Canada – Final Report. Ottawa: National Library of Canada. At https://publications.gc.ca/collections/Collection/CP32-85-2002E.pdf
19. Ryan, F., Coughlan, M., & Cronin, P. (2009). Interviewing in qualitative research: the one-to-one interview. International Journal of Therapy & Rehabilitation, 16(6), 309–314.
20. Tupper, S., Ward, H., & Parmar, J. (2020). Family presence in long-term care during the COVID-19 pandemic: Call to action for policy, practice, and research. Canadian Geriatric Journal, 1(23), 335-339. https://doi.org/10.5770/cgj.23.476
21. Wolf, D. A., & Jenkins, C. (2008). Family care and assisted living. In S. M. Golant & J. Hyde (Eds.), The assisted living residence: A vision for the future (pp. 198–222). Johns Hopkins University Press.