#Morethanavisitor: Experiences of COVID‐19 visitor restrictions in Canadian long‐term care facilities

• Published date: 01 October 2022
• Author: Lorraine M. Thirsk,Sarah Stahlke,Beth Perry,Brogan Gordon
• Date: 01 October 2022
• DOI: http://doi.org/10.1111/fare.12712

RESEARCH

#Morethanavisitor: Experiences of COVID-19 visitor

restrictions in Canadian long-term care facilities

Lorraine M. Thirsk

1

|Sarah Stahlke

2

|Beth Perry

1

|

Brogan Gordon

1

1

Faculty of Health Disciplines, Athabasca

University, Athabasca, Alberta, Canada

2

Department of Sociology, University of

Alberta, Edmonton, Alberta, Canada

Correspondence

Lorraine M. Thirsk, Faculty of Health

Disciplines, Athabasca University,

1 University Drive, Athabasca, Alberta T9S

3A3, Canada.

Email: lthirsk@athabascau.ca

Funding information

Athabsaca University, Grant/Award Number:

Academic Research Fund 2020-2021

Abstract

Objective: The purpose of this study was to understand the

experiences of families, residents, and staff around visitor

restriction policies in long-term care during the COVID-19

pandemic in Canada.

Background: Beginning in March 2020, publichealth orders

across Canada restricted visitors to long-term care facilities

to curb the spread of the infection. This included family

caregivers who provide significant support to residents to

meet their physical, psychological, social, and safety needs.

Method: We collected data from publicly available news

and social media. News articles, blogs, and tweets from

Canada were collected from March 2020 to April 2021. In

total, 40 news articles, eight blogs, and 23 tweets were ana-

lyzed using generic qualitative description.

Results: Reports from family members indicate that some

residents may have died from malnutrition, dehydration,

and isolation, rather than from COVID-19, because of the

sudden and prolonged absence of family caregivers. There

are long-term impacts on family suffering and long-term care

worker burnout. Policy and structural issues were identified.

Conclusion: Experiences in long-term care reflected not

only impacts of pandemic-related visitor restrictions, but

also long-standing funding and workforce issues.

Implications: Involvement of family, and specifically fam-

ily caregivers, is crucial in policy decisions, even in unusual

circumstances, such as the pandemic.

KEYWORDS

COVID-19 pandemic, family nursing, long-term care, visitor restrictions

Received: 14 September 2021Revised: 9 December 2021Accepted: 5 March 2022

DOI: 10.1111/fare.12712

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits

use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or

adaptations are made.

© 2022 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

1408 Family Relations. 2022;71:1408–1427.

wileyonlinelibrary.com/journal/fare

The COVID-19 pandemic required public health orders that limited social interactions to

reduce spread of the virus. Although decades of policy have informed a movement toward

family-centered care in healthcare and recognition of family caregivers, the pandemic-induced

limitations meant severe restrictions of visitors to long-term care (LTC) facilities, including fam-

ily members. The limitations on visitation ultimately had negative consequences for the physical

and psychosocial health and well-being of both residents and family members (O’Caoimh

et al., 2020). As well, LTC workers experienced hardship because of how their work changed

with reduced family access and involvement, staffing issues, and the effects of social isolation

on residents and families. Although issues in LTC, interest in family-centered care, and

responses to the pandemic have been highly unified globally, this article reports the findings of

qualitative media analysis research that investigated experiences of residents of LTC facilities in

Canada and their family members, as well as exploring LTC workers’perspectives, during this

time. Documenting these perspectives and sharing this analysis will contribute knowledge on

the role and importance of family involvement and support, not only in the pandemic, but as

we recover and look toward improving LTC in the future.

BACKGROUND AND LITERATURE REVIEW

For several decades, the patient- and family centered-care movement has been expanding from

its initial start in pediatrics into adult populations, across all sectors of healthcare (Barken&

Lowndes, 2018; Institute for Patient- and Family-Centered Care [IPFCC], 2022). It is widely

recognized that families are not only important to the health and well-being of patients but also

should be considered part of the focus of care, including them in decision-making and promot-

ing their health and well-being (IPFCC, 2022; Shamon, 2021; Tupper et al., 2020).

Long-term care facilities are institutions that provide accommodation, healthcare, and personal

care assistance for people with moderate to severe long-term dependency; other common names

include residential care facilities, aged care facilities, or nursing homes (OECD, 2021). Canadian

LTC homes are also called continuing care facilities; LTC residents receive 24-hour nursing care,

personal care, and other services (Canadian Institute for Health Information, 2021). In Canada,

2.64% of people over the age of 65 live in an LTC facility (Statistics Canada, 2017a; Statistics

Canada, 2017b). Long-term care residents in Canada tend to be older than in other OECD coun-

tries; 91% are over the age of 65 and 74% are over 80 years of age (Canadian Institute for Health

Information, 2020). This study, therefore, focuses mostly on these older adults.

The family caregiver role in LTC is considered by the Canadian Geriatric Society to be an

essential service, and prior to COVID-19 was part of standard care (Tupper et al., 2020). The

diverse role of family in LTC settings has been found to include up to 10 hours per week of per-

sonal care such as grooming, feeding, hygiene, social and emotional support, mobilization, and

advocacy (Barken & Lowndes, 2018; Tupper et al., 2020). Family members act as surrogate

decision-makers, care coordinators, advocates, care providers, and an important source of

social and emotional support (Hado & Feinberg, 2020). As a specific example, malnutrition

affects many LTC residents (Trinca et al., 2020) and family support for feeding in LTC has

been shown in research to increase macro- and micronutrient intake at mealtimes (Wu

et al., 2020). Social and emotional support from family members mitigates loneliness in LTC

residents and helps promote maintenance of baseline cognition (Crooks et al., 2008). Family

involvement in care in LTC reduces mortality for residents (Tupper et al., 2020). Current

research finds that family members experience grief and guilt when a loved one is transferred to

LTC (Barken & Lowndes, 2018, and that there is insufficient psychosocial support provided to

family members during this transition (Shamon, 2021). This grief may be further complicated

when a family is disabled from attending to the needs of their relative in LTC, particularly if

death of the resident occurs during times of limited or restricted contact (Tupper et al., 2020).

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