Nursing homes' visitation bans during the COVID-19 pandemic: Effectiveness and consequences.
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PROJECT SUMMARY/ABSTRACT As of May 2022, there have been over 1 million COVID-19 cases and over 150,000 COVID-19 deaths among U.S. nursing home residents. One of the most widespread mitigation measures implemented by nursing homes was a visitation ban. In March and April 2020, 31 states issued state-wide visitation bans, affecting at least 66% of facilities and 70% of residents in the U.S. Visitation bans may prevent transmission between facilities and the community. Yet, any ban is incomplete because of staff who travel between the facility and the community. To our knowledge, there is no empirical study examining the effectiveness of visitation bans on preventing COVID- 19 infection rates, hospitalizations, and deaths. What also matters are the adverse effects of visitation bans on residents. Visitation bans can substantially reduce informal care, increase social isolation, and disrupt routine care, resulting in adverse events such as decreased function and increases in depression, falls, and hospitalization. Residents with Alzheimer's Disease & Related Dementias (ADRD), who rely more on caregivers, may have a greater risk of adverse events than those without ADRD. Our team has collected visitation data at both the state and facility levels, which document the dates when states initiated and lifted bans, as well as weekly bans data at the facility level in Ohio. We also collect open-ended comments from family members from a state-wide family satisfaction survey in Ohio. By linking data on visitation bans with national Medicare claims and assessment data, we propose a convergent parallel mixed methods study to examine the effectiveness and adverse consequences of visitation bans in nursing homes. We will study the 9,876 nursing homes in the 31 states that banned indoor visitation in March 2020, then lifted those bans between June and November 2020. We will also study the 701 nursing homes in Ohio, where we have weekly data on the presence of bans for each facility. Matched case-control design on prior infection rates and Hierarchical Generalized Linear Mixed Models will examine the association of lifting visitation bans with COVID-19 and health outcomes. Focus group interviews with direct care staff and analyses of family comments will be conducted to examine the effects of visitation bans on daily care practices and resident health outcomes. Understanding both the benefits and harms of visitation bans can inform future pandemic responses in nursing homes. The specific aims of this project are: 1) To assess the effectiveness of visitation bans on preventing COVID-19 infection (primary), hospitalization, and deaths among nursing home residents; 2) To evaluate the association of visitation bans with changes in function (primary), mood/behaviors, and adverse events among long-stay residents with or without ADRD; and 3) To understand how visitation bans affected daily care practices within nursing homes and resident health outcomes.
