Caregiver Lizzie Putman, who is staying with six colleagues, speaks to Fremantle Trust-based Barbara Mannerings at the Fremantle Trust Nursing Home during the Coronavirus Disease (COVID-19) outbreak in Princes Risborough, UK.

The coronavirus rules for nursing homes are too strict and not scientifically based

The rules for nursing homes to prevent the spread of coronavirus are too strict and not based on science – it could cost lives, says June Andrews

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4th November 2020

By June Andrews

A carer speaks to a nursing home in Princes Risborough, UK

REUTERS / Eddie Keogh

Restrictions to curb the spread of coronavirus are tightening across the UK, including a four-week lockdown in England. Nursing homes, however, need to go the other way. The current rules do not make scientific sense and will harm many vulnerable people. That is why I and more than 60 experts and organizations launched a call to action this week calling for restrictions on visits to nursing homes in the UK to be lifted.

Nearly 14,000 fatalities in nursing and nursing homes in the UK were traced back to covid-19 between April and July 2020, imposing strict visiting restrictions on home residents. Many have been almost completely isolated from normal family contact for months.

For example, in Scotland, visiting a nursing home is only allowed if the entire home has been free of Covid-19 symptoms for 28 days and even then requires approval from the local health director. In Leeds, England, it’s not illegal to visit, but local government guidance says you must have a very good reason, and the example given is when someone dies. The problem is that most people in nursing homes are in their last two years of life. The average length of stay for people admitted to care beds is less than a year.

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Most people in nursing homes have dementia and for them the end of life can be weeks, months, or even years, according to the Alzheimer’s Society, although visiting rules often prevent family contact into the last few days. It is well documented that social isolation accelerates the deterioration of people with dementia. So these restrictions kill people.

Government policy for England is that “the first priority is preventing infections in nursing homes”. Death in someone who tested positive for covid-19 could be due to another cause. Infections are tirelessly measured and many cases have been registered as covid-19 without testing. This may mean that the case numbers in nursing homes have been overstated. The risk that people’s conditions will deteriorate and die because they are cut off from family and friends is not measured.

Nursing home operators and public health officials who make the final decision on local visiting rules face a real dilemma. Because of the reputational damage and legal risks that would result from an outbreak, they feel compelled to apply maximum visiting restrictions, even if it means separating families for months.

This is not just a problem in the UK. International concern about the negative impact of visiting restrictions on the health and well-being of nursing home residents and their families, as well as a review of covid-19 in nursing homes conducted by the London School of Economics, which included researchers in Australia and Canada found no evidence of visitor impact on infections.

There is no scientific evidence to suggest that visitors were the cause of a nursing home outbreak. Some research is meant to suggest that the risk of nursing homes is related to the size of the nursing home. However, before this can be proven, more research is needed, including rigorous diagnostic definitions of Covid-19 deaths. Governments have denied that this is related to the discharge of large numbers of untested or Covid-19 positive patients to nursing homes, although it seems intuitively likely. In truth, all of the data is in error and it’s too early to tell.

Current rules provide blanket prohibitions for anyone living in a nursing home and for anyone who wishes to visit it. However, with the right precautionary measures such as individual risk assessments and ensuring good ventilation of meeting places, the restrictions on nursing homes could be meaningfully relaxed. And that could save lives.

June Andrews is the author of Care Homes: The One-Stop Guide

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