Visitation After Vaccination: Ethics, Risks, and Benefits Must Be Considered

Decisions about welcoming more visitors into post-acute and long-term care facilities will require ongoing analysis of risk versus benefit, continued vigilance creativity, ethical considerations, empathetic, honest communication with family members, according to PALTC leaders who have been advising or formulating guidance on the issue. “Visitation” after vaccination emerged as a contentious issue early this year. Families advocates expected doors open residents were vaccinated. Meanwhile, LTC awaited from federal state officials data whether vaccines prevent significantly decrease transmission SARS-CoV-2 virus. Across country, in believe risk–benefit equation for opening has changing, said Mike Wasserman, MD, CMD, immediate past-president California Association Long Term Care Medicine. “The reason we did what [with restrictions mid-March 2020] is that risks so great. The benefits locking down clearly outweighed even social isolation,” he said. “But now appear reduce mortality severity virus, we’re new phase where balance not only impact isolation but year isolation. All us are recognizing it.” Almost 90% experts participated consensus-generating survey conducted earlier by Dr. Wasserman agreed statement “with abundant PPE, frequent testing, highly efficacious vaccines, shifted [and] may outweigh protective restriction in-facility visitation.” 27-question 19 respondents was an informal continuation modified Delphi panel-driven consensus generation resulted report last JAMDA recommendations back nursing home (J Am Med Dir Assoc 2020;21:1759–1766). These findings shared Centers Disease Control Prevention CMS. Nursing included vaccine trials, “which one great tragedies pandemic,” “We’re going make best actually looking at happening real-time” respect vaccination. Swati Gaur, MBA, chair Society’s Infection Advisory Committee leader developing its COVID-19 guidance, she looking, moreover, extent protection her older, frailer compared community-dwelling older adults trials. Kara M. Jacobs Slifka, MPH, acting lead team Response Branch within CDC’s Division Healthcare Quality Promotion, told Caring understanding effect among homes other settings “top priority.” This come information uptake, studies estimating efficacy, research using mathematical models assess relaxing restrictions, It also entail identification assessment breakthrough infections well “field deployments rapidly evaluate potential outbreaks include fully vaccinated individuals,” Slifka Gaur advised moving toward visitation low-risk communal activities. “Open building [...]very cautiously, mitigating, making sure you’re doing infection control processes, course bounds CMS your regs allow ... monitor outcomes,” medical director New Horizons Facilities Northeast Georgia Health System. In mid-February, planning hallway bingo ward time — mingling two wards next step along de-densified dining, sitting per table. Leslie Eber, geriatrician practicing Colorado, advises state’s team, individual states’ development “sound plans be essential safer.” So facility-level visitation, regardless visitors’ immunization status, rights unvaccinated they should given same opportunities necessary part discussions forward, “Ethics front center.” Overall, ensure much person-centered possible, said, policy-makers “need recognize living unprecedented times. standard needs take account nature pandemic.”Updated Guidance Opens DoorsBy publication late March 2021, had updated homes, removing restirictions responsible indoor visitation. Although status does limit under some scenarios unvacinated find themselves limited their ability visit friends family. Such would play once county rate exceeds 10% if facility below 70%. Additional criteria details avaialble http://go.cms.gov/3tfZX59. By