A study in 26 nursing homes in the Netherlands, showing that families can try without causing new Covid infections, has encouraged lawyers. Perhaps, they say, in areas with low rates of community infection, if facilities have sufficient protective equipment and testing capacity, family caregivers can be cautiously reintroduced.
But many long-term facilities may not meet these conditions. Dr Bergman, whose group expects to publish its recommendations next month, pointed out that some still report shortages of protective equipment, in particular N95 masks in appropriate sizes. In many regions, testing bottlenecks are so delayed that they are useless to visitors.
In addition, Dr. Karlawish, “one thing that pursues long-term care is fear of litigation.”
Medicare promised last month to send a rapid test kit to each of the nation’s 15,000 nursing homes, prioritizing those with outbreaks or hot spots in Covid; so far it has allocated about 2,400. But these antigen tests produce more false negatives than the slower but more reliable PCR tests, experts said; supply managers also worry about the cost of supplies that the kits require.
“Providers are envious but cautious about welcoming visitors and volunteers back into their buildings,” the American Health Care Association / National Center for Assisted Living said in an email. “That’s why we need public health officials to continue to focus resources – testing, PPE and funding – on long-term care.”
There is always a reason to delay, and facilities where residents and staff have already suffered and died from Covid-19 are understandably afraid of a return. But they were able to exercise judgment, said Dr. Karlawish, and at least allow visitors for residents who clearly struggle with the isolation. “Nursing homes cater to a group of people for whom ethical decisions with high stakes are part of life,” he said.
Almost by definition, residents with long-term lives have limited life spans; residents of nursing homes are particularly fragile. Do they value security so much that they want to separate their last months or years from their loved ones? Did anyone ask them?
Ms. Baum continues to visit her mother and mother-in-law at a distance, but she is haunted by “the idea that one of them could pass without one of us next to her,” she said. “I do not know what I would do.”
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