Dilemmas with restrictive visiting policies in Dutch nursing homes during the COVID-19 pandemic: a qualitative analysis of an open-ended questionnaire with elderly care physicians

Abstract

Objectives

To mitigate the spread of COVID-19, a nationwide restriction for all visitors of residents of long-term care facilities including nursing homes (NHs) was established in the Netherlands. The aim of this study was an exploration of dilemmas experienced by Elderly Care Physicians (ECPs) as a result of the COVID-19 driven restrictive visiting policy.

Setting and Participants

ECPs working in Dutch NHs.

Methods

A qualitative exploratory study was performed using an open-ended questionnaire. A thematic analysis was applied. Data was collected between April 17 and May 10, 2020.

Results

Seventy-six ECPs answered the questionnaire describing a total of 114 cases in which they experienced a dilemma. Thematic analysis revealed four major themes:

(1) The need for balancing safety for all through infection prevention measures versus quality of life of the individual residents and their loved ones;

(2) The challenge of assessing the dying phase and how the allowed exception to the strict visitor restriction in the dying phase could be implemented;

(3) The profound emotional impact on ECPs;

(4) Many alternatives for visits highlight the wish to compensate for the absence of face to face contact opportunities. However, given the diversity of NH residents, alternatives were often only suitable for some of them.

Conclusions and Implications

ECPs reported that the restrictive visitor policy deeply impacts NHs residents, their loved ones and care professionals. The dilemmas encountered as a result of the policy highlight the wish by ECPs to offer solutions tailored to the individual residents. We identified an overview of aspects to consider when drafting future visiting policies for NHs during the COVID-19 pandemic.