Sarah Christison, 2021
Since the first cases of Covid-19 were confirmed in the UK, the care home sector has been in the spotlight. Policies regarding the shielding of residents from the virus have come under particular scrutiny. Since March 2020, all care homes in Scotland have had some degree of visiting restrictions in place, from a complete ban on visitors (with an exception for end-of-life care and emergencies), to some limited re-opening for socially-distanced, outdoor visits. However, easing of restrictions outlined in guidance issued by the Scottish Government were limited and did not apply nationally. Physical contact remained restricted, with local lockdowns and the discretion of private care home providers both impacted the extent to which restrictions were eased. As a result, there has now been an extended period of many months where care home residents have been separated from their families and friends.
Covid-19 Impact on Families Study
In response to the Covid-19 pandemic, the Covid-19 Impact on Families Study was launched. This aimed to examine the impact that these visiting restrictions have had on the mental wellbeing of the families and friends of care home residents in Scotland. Funded by the Chief Scientist’s Office and led by the University of Edinburgh alongside researchers from the University of Strathclyde, the University of the West of Scotland, the University of Edinburgh’s Usher Institute and the Institute for Research & Innovation in Social Services; this project aimed to gauge how lockdown restrictions have affected the families of care home residents. As part of this study, researchers worked with care homes, charities and campaign groups, recruiting participants to complete an online survey. Collecting 444 responses between August and September 2020, this survey covered a range of issues regarding the participants’ experiences during the pandemic and included questions which gauged their support of government restrictions.
Throughout the pandemic, there has been much debate surrounding the issue of mental health, and whether the benefits of restrictions related to Covid-19 outweigh any negative psychological effects. These psychological effects and ‘pandemic fatigue’ have been identified by the WHO (2020) as the primary causes of a fall in compliance and support in Covid-19 rules. As part of this research into the wellbeing of the families of care home residents, the support for visiting restrictions was also explored, in particular how support for these restrictions has evolved over the course of the pandemic.
Who Opposes Visiting Restrictions?
When respondents were asked to what extent they supported restricting visitors to care homes, 51.4% of respondents agreed to some extent with the policy, while 37.9% disagreed to some extent, with the remaining 10.7% neither agreeing nor disagreeing.
Further analysis was carried out to explore the factors which influenced respondents’ support for visiting restrictions. A binomial logistic regression revealed that individuals whose partner was in a care home were more likely to oppose the restrictions compared to those with other relatives in care, including parents, grandparents, and siblings. Whether or not participants felt they were kept well informed by the care home regarding the wellbeing of their relative was also found to act as a predictor of support for this policy, with those who felt they were kept well informed less likely to disagree with restrictions. This may suggest that it is possible to bolster support for visiting restrictions by promoting contact between care homes and the families of residents to keep them informed of their relative’s wellbeing and provide reassurance that they are healthy and well cared for.
Results from this model found that the week participants completed the survey was the strongest predictor of whether participants disagreed with the policy, with those who completed the survey later in the eight-week period during which the survey was active, more likely to oppose visiting restrictions. This may suggest that support for the policy waned over the course of the pandemic and the longer the restrictions were in place.
A Shift in Support
This potential shift in support for visiting restrictions is also supported by the qualitative data collected in the survey.
Several respondents discussed how their attitudes to the restrictions had changed over time, with some describing how their views of the policy had changed the longer the restrictions were in place. Respondents felt the psychological damage caused by the lack of visitors and the social isolation experienced by residents outweighed the risk of infection.
“We are living through this all the time and it is getting worse and more difficult to accept. An element of risk is now justified or our loved ones are all going to die from mental neglect anyway.”
– Respondent from Aberdeenshire with a parent in care
A turning point in the support for this policy appeared to take place in early summer 2020, as the Scottish Government began its eased re-opening plan. In addition to the length of time they had been separated from their relatives, the re-opening of some sectors such as hospitality and retail appears to have compounded the distress felt by participants and eroded their support for visiting restrictions.
“I think that reintroducing visiting to care homes should have been the first priority for the government – when numbers and risk were low. It’s a disgrace that a whole generation are being left to slowly deteriorate in care homes without their loved ones whilst life on the outside is returning to normal.”
– Respondent from Fife with a grandparent in care
A number of respondents left similar comments, with many feeling that the length of time the restrictions had been in place had changed their support for the policy. This was further impacted by the lifting of restrictions in other sectors which participants perceived as a sign that the risk of the virus was low and that visiting restrictions were unfair and arbitrary. Many respondents expressed that they could not understand the decision-making process behind the easing of some restrictions and not others, resulting in increased frustration that they were unable to visit their loved ones and growing demands that the restrictions should be lifted or eased further.
This may suggest that greater transparency may be needed by policy makers to clearly outline why restrictions can be eased at different rates and highlight that the benefits and risks of resuming care home visits have been fully considered.
Have Restrictions Damaged Social Trust?
As well as considering how attitudes to these visiting restrictions have evolved in the short term, the potential ongoing impact of opposition this policy was explored.
Analysis of responses in this survey found a relationship between attitudes towards the visiting restrictions and a change in feelings of trust experienced by respondents. Overall, results indicated that those who felt that the restrictions were wrong were more likely to report that they had lost trust in others than those who were neutral or agreed with the policy. More respondents who opposed the visiting restriction reported a loss of trust in others, than would be expected by chance.
These results may highlight some concerning issues for the future, as they may suggest that those most opposed to the policy of restricting visits to care homes are becoming less trustful of others. This lack of trust may lead to greater opposition to public health policies and increase conflict between care homes and families.
While this research indicates that over the course of the Covid-19 pandemic, support for care home visiting restrictions has decreased among family members and friends of residents, responses were gathered before the increase in cases and the retightening of lockdown measures introduced in late 2020/early 2021. Further research is needed to understand how the new national lockdown, along with the apparent success of the vaccine roll out programme, and announced reintroduction of some limited reopening, have again shifted attitudes to care home visiting restrictions. With many respondents feeling a lack of hope that visits would ever be able to resume; the vaccine programme may offer a light at the end of the tunnel to reassure both residents and families that there may be an end in sight.
However, while care home visiting restrictions continue to be in place, more co-operation and communication between the families of care home residents, care providers and policy makers may be needed to ensure that all involved in the care process have an understanding of each other’s point of view. This includes the families who know their loved ones best, the care home providers who have a duty of care for all their residents and policy makers who must ensure that the health measures they implement strike the best balance between reducing the risk of infection and quality of care. Results from this research suggest that if care homes keep families well informed and policy makers provide evidence to support their health policies this may reduce opposition to visiting restrictions. It is important that all interested parties can co-operate to ensure that the most appropriate infection reduction policies are implemented effectively, while maintaining trust and support from residents and their families.
WHO (2020) Pandemic fatigue Reinvigorating the public to prevent COVID-19, Copenhagen: The World Health Organisation.