COVID-19’s Non-visitor Policy and Its Impact on Social Isolation of Older Adults in Ontario Long-Term Care Homes: A Scoping Review

Year 2025, Volume: 8 Issue: 3, 119 - 145, 31.12.2025

Angelina Falconi , Christina Saliba Raza Mirza Christopher Klinger

https://doi.org/10.51819/jaltc.2025.1826908

Abstract

In the early months of the COVID-19 pandemic, governments worldwide implemented strict non-visitor policies in long-term care (LTC) homes. As a result, older adults were often confined to their rooms and only “essential visitors” were allowed. Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, the goal was to examine the impact visitor restrictions had on social isolation of older adults in LTC homes in Ontario (Canada) as well as to make recommendations for further research, policy, and practice. Twenty-five articles that met inclusion criteria were reviewed. Themes identified included the impact visitor restrictions had on older adults residing in LTC as well as their ethical and legal implications. Pandemic policies should be assessed at the individual level with family members essential to resident’s care. Information and communication technology (ICT) was seen as crucial to support social connectedness in later life. While written from a Canadian perspective, implications reach globally.

Keywords

Canada , COVID-19 , Information and Communication Technology , Long-Term Care , Older Adults , Scoping Review , Social Isolation and Loneliness

Ethical Statement

This knowledge synthesis was written in partial fulfillment of the requirements for the HST450Y1 Health Studies Independent Research Course at University College within the University of Toronto (AF). Preliminary results from this scoping review were presented as a research poster at the University College Research and Practice Day in April 2024 (AF). The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supporting Institution

The University of Toronto, University College

Thanks

The authors gratefully acknowledge the support of Elena Springall, MLIS, Liaison and Education Librarian, Gerstein Science Information Centre, University of Toronto with refining the search strings.

References

• Anderson, R. (2007). Thematic content analysis (TCA) descriptive presentation of qualitative data. Retrieved from http://rosemarieanderson.com/wp-content/uploads/2014/08/ThematicContentAnalysis.pdf
• Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. doi:10.1080/1364557032000119616
• Baumann, A., & Crea-Arsenio, M. (2022). Rights versus Risks: The Impact of Isolation on Residents and Families in Long-Term Care. Healthcare Policy, 17(SP), 133–144. https://doi.org/10.12927/hcpol.2022.26849
• Benzinger, P., Kuru, S., Keilhauer, A., Hoch, J., Prestel, P., Bauer, J. M., & Wahl, H.-W. (2021). Psychosocial effects of the pandemic on staff and residents of nursing homes as well as their relatives-A systematic review. Zeitschrift für Gerontologie und Geriatrie, 54(2), 141–145. https://doi.org/10.1007/s00391-021-01859-x
• Benzinger, P., Wahl, H.-W., Bauer, J. M., Keilhauer, A., Dutzi, I., Maier, S., Hölzer, N., Achterberg, W. P., & Denninger, N.-E. (2023). Consequences of contact restrictions for long-term care residents during the first months of COVID-19 pandemic: a scoping review. European Journal of Ageing, 20(1), 39–39. https://doi.org/10.1007/s10433-023-00787-6
• Bergman, C., Stall, N. M., Haimowitz, D., Aronson, L., Lynn, J., Steinberg, K., & Wasserman, M. (2020). Recommendations for Welcoming Back Nursing Home Visitors During the COVID-19 Pandemic: Results of a Delphi Panel. Journal of the American Medical Directors Association, 21(12), 1759–1766. https://doi.org/10.1016/j.jamda.2020.09.036
• Chirico, I., Pappadà, A., Giebel, C., Ottoboni, G., Valente, M., Gabbay, M., & Chattat, R. (2023). The impact of COVID-19 restrictions and care home strategies on residents with dementia as experienced by family carers in Italy. Aging & Mental Health, 27(3), 512–520. https://doi.org/10.1080/13607863.2022.2056137
• Dementia Care Central. (n.d.). Stages of dementia: The 7 stages, progression & end-of-life signs. Retrieved from https://www.dementiacarecentral.com/aboutdementia/facts/stages/
• Dupuis-Blanchard, S., Maillet, D., Thériault, 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, 40(4), 628–638. https://doi.org/10.1017/S0714980821000398
• El Haj, M., Boutoleau-Bretonnière, C., Allain, P., Kapogiannis, D., Chapelet, G., & Gallouj, K. (2022). On Covid-19 and mental health: An observational study on depression, anxiety, and loneliness during the second lockdown in patients with Alzheimer disease. Medicine (Baltimore), 101(18), e29145–e29145. https://doi.org/10.1097/MD.0000000000029145
• Emergency Management and Civil Protection Act, RSO 1990, c E9 at s. 7.0.1(1). Retrieved from https://www.ontario.ca/laws/statute/90e09
• Estabrooks, C. A., Ewa, V., Keefe, J., & Straus, S. E. (2023). The predictable crisis of Covid-19 in Canada’s long term care homes. BMJ (Online), 382, e075148–e075148. https://doi.org/10.1136/bmj-2023-075148
• Fisman, D. N., Bogoch, I., Lapointe-Shaw, L., McCready, J., & Tuite, A. R. (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. https://doi.org/10.1001/jamanetworkopen.2020.15957
• Government of Canada. (2022). Social Isolation among Older Adults During the Pandemic. Federal/Provincial/Territorial Ministers Response for Seniors Forum. Retrieved from https://www.canada.ca/en/employment-social-development/corporate/seniors/forum/reports/covid19-social-isolation.html
• Government of Ontario. (2020a). New COVID-19 Precautions at Long-Term Care Homes. Ontario Newsroom. Retrieved from https://news.ontario.ca/en/release/58680/new-covid-19-precautions-at-long-term-care-homes
• Government of Ontario. (2020b). Ontario to Resume Family Visits in Long-Term Care Homes, Retirement Homes, and Other Residential Care Settings. Retrieved from https://news.ontario.ca/en/release/57177/ontario-to-resume-family-visits-in-long-term- care-homes-retirement-homes-and-other-residential-care-settings
• Hariton, E., & Locascio, J. J. (2018). Randomised controlled trials - the gold standard for effectiveness research: Study design: randomised controlled trials. BJOG: An International Journal of Obstetrics and Gynaecology, 125(13), 1716. https://doi.org/10.1111/1471-0528.15199
• Health Protection and Promotion Act, R.S.O. 1990, c. H.7. Retrieved from https://www.ontario.ca/laws/statute/90h07
• Hess, A. S., & Abd-Elsayed, A. (n.d.). Observational Studies: Uses and Limitations. In Pain (pp. 123–125). Springer International Publishing. https://doi.org/10.1007/978-3-319-99124-5_31
• Hua, C. L., & Thomas, K. S. (2021). Coronavirus Disease 19 (COVID-19) Restrictions and Loneliness Among Residents in Long-Term Care Communities: Data From the National Health and Aging Trends Study. Journal of the American Medical Directors Association, 22(9), 1860–1861. https://doi.org/10.1016/j.jamda.2021.06.029
• Leontowitsch, M., Oswald, F., Schall, A., & Pantel, J. (2023). Doing time in care homes: insights into the experiences of care home residents in Germany during the early phase of the COVID-19 pandemic. Ageing and Society, 43(5), 1184–1202. https://doi.org/10.1017/S0144686X21001161
• Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5, 69. doi:10.1186/1748-5908-5-69
• LeVasseur, A. L. (2021). Effects of social isolation on a long-term care resident with dementia and depression during the COVID-19 pandemic. Geriatric Nursing (New York), 42(3), 780–781. https://doi.org/10.1016/j.gerinurse.2021.04.007
• Levere, M., Rowan, P., & Wysocki, A. (2021). The Adverse Effects of the COVID-19 Pandemic on Nursing Home Resident Well-Being. Journal of the American Medical Directors Association, 22(5), 948–954.e2. https://doi.org/10.1016/j.jamda.2021.03.010
• Long-Term Care Homes Act, 2007. S.O. 2007, c. 8. Retrieved from https://www.ontario.ca/laws/statute/07l08
• Munshi L., Odutayo A., Evans G., et al. (2021). Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic. Science Briefs of the Ontario COVID-19 Science Advisory Table, 2(31). https://doi.org/10.47326/ocsat.2021.02.31.1.0
• National Institute on Ageing. (2022). Understanding Social Isolation and Loneliness Among Older Canadians and How to Address It. Toronto, ON: National Institute on Ageing, Toronto Metropolitan University.
• Nash, W. A., Harris, L. M., Heller, K. E., & Mitchell, B. D. (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, 33(4–5), 398–413. https://doi.org/10.1080/08959420.2021.1962164
• Noten, S., Stoop, A., De Witte, J., Landeweer, E., Vinckers, F., Hovenga, N., van Boekel, L. C., & Luijkx, K. G. (2022). “Precious Time Together Was Taken Away”: Impact of COVID-19 Restrictive Measures on Social Needs and Loneliness from the Perspective of Residents of Nursing Homes, Close Relatives, and Volunteers. International Journal of Environmental Research and Public Health, 19(6), 3468. https://doi.org/10.3390/ijerph19063468
• O’Caoimh, R., O’Donovan, M. R., Monahan, M. P., Dalton O’Connor, C., Buckley, C., Kilty, C., Fitzgerald, S., Hartigan, I., & Cornally, N. (2020). Psychosocial Impact of COVID-19 Nursing Home Restrictions on Visitors of Residents With Cognitive Impairment: A Cross-Sectional Study as Part of the Engaging Remotely in Care (ERiC) Project. Frontiers in Psychiatry, 11, 585373–585373. https://doi.org/10.3389/fpsyt.2020.585373
• Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., … & Moher, D. (2020). The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. PLoS Medicine, 18(3), e1003583. PMID: 33780438
• Parekh de Campos, A., & Daniels, S. (2021). Ethical Implications of COVID-19: Palliative Care, Public Health, and Long-Term Care Facilities. Journal of Hospice and Palliative Nursing, 23(2), 120–127. https://doi.org/10.1097/NJH.0000000000000735
• Reid, J. C., Carbone, S., Shaw, J. F., Gallibois, M., & Hawkins, S. A. (2023). “My Biggest Fear Is She’ll Die Alone”: Care Partner Perspectives of Institutional COVID-19 Visitor Restrictions in Ontario, Canada. Canadian Journal on Aging, 42(4), 710–718. https://doi.org/10.1017/S071498082300017X
• Resnick, B., Galik, E., Holmes, S., & McPherson, R. (2021). The impact of COVID-19 in an assisted living community. Geriatric Nursing (New York), 42(5), 1151–1155. https://doi.org/10.1016/j.gerinurse.2021.08.005
• Shaw, S., & Csikai, E. (2021). No Visitors Allowed! The Impact of Covid-19 Restrictions on the Psychosocial Well-being of Nursing Home Residents. Innovation in Aging, 5(Supplement 1), 731–732. https://doi.org/10.1093/geroni/igab046.2723
• Smith, C. B., Wong, K. L. Y., To‐Miles, F., Dunn, S., Gregorio, M., Wong, L., Tam, S., Huynh, P., & Hung, L. (2023). Exploring experiences of loneliness among Canadian long‐term care residents during the COVID‐19 pandemic: A qualitative study. International Journal of Older People Nursing, 18(1), e12509. https://doi.org/10.1111/opn.12509
• Sprague v. Her Majesty the Queen in right of Ontario, 2020 ONSC 2335. Retrieved from https://www.oha.com/Bulletins/Sprague%20v.%20HMQ(Ontario)%20corrected.pdf
• Stall, N. M., Johnstone, J., McGeer, A. J., Dhuper, M., Dunning, J., & Sinha, S. K. (2020). Finding the Right Balance: An Evidence-Informed Guidance Document to Support the Re-Opening of Canadian Nursing Homes to Family Caregivers and Visitors during the Coronavirus Disease 2019 Pandemic. Journal of the American Medical Directors Association, 21(10), 1365–1370.e7. https://doi.org/10.1016/j.jamda.2020.07.038
• Stall, N. M., Brown K. A, Maltsev A, et al. (2021). COVID-19 and Ontario’s long-term care homes. Science Briefs of the Ontario COVID19 Science Advisory Table. Retrieved from https://doi.org/10.47326/ocsat.2021.02.07.1.0
• Sutter, A., Vaswani, M., Denice, P., Choi, K. H., Bouchard, J., & Esses, V. M. (2022). Ageism toward older adults during the COVID-19 pandemic: Intergenerational conflict and support. The Journal of Social Issues, 10.1111/josi.12554. Advance online publication. https://doi.org/10.1111/josi.12554
• Thirsk, L. M., Stahlke, S., Perry, B., & Gordon, B. (2022). More than a visitor: Experiences of COVID‐19 visitor restrictions in Canadian long‐term care facilities. Family Relations, 71(4), 1408–1427. https://doi.org/10.1111/fare.12712
• Tupper, Susan. M., 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 Geriatrics Journal, 23(4), 335–339. https://doi.org/10.5770/cgj.23.476
• Veiga-Seijo, R., Miranda-Duro, M. del C., & Veiga-Seijo, S. (2022). Strategies and actions to enable meaningful family connections in nursing homes during the COVID-19: A Scoping Review. Clinical Gerontologist, 45(1), 20–30. https://doi.org/10.1080/07317115.2021.1937424
• Verbeek, H., Gerritsen, D. L., Backhaus, R., de Boer, B. S., Koopmans, R. T. C. M., & Hamers, J. P. H. (2020). Allowing Visitors Back in the Nursing Home During the COVID-19 Crisis: A Dutch National Study Into First Experiences and Impact on Well-Being. Journal of the American Medical Directors Association, 21(7), 900–904. https://doi.org/10.1016/j.jamda.2020.06.020
• Wirth, C., & Chadha, S. (2020, June 23). Ontario Divisional Court finds Hospital’s policy to deny visitors during pandemic not subject to judicial review and does not breach charter. The Canadian Bar Association. Retrieved from https://www.cba.org/Sections/Administrative-Law/Articles/2020/Ontario-Divisional-Court-finds-hospitals-policy