Reopening the doors of Dutch nursing homes during the COVID-19 crisis: results of an in-depth monitoring

Abstract

Objectives: On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff. Design: Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes. Participants: Visitors and healthcare professionals. Intervention: Allowing visitors using local regulations based on national guidelines. Measurements: Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations. Results: National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects. Conclusion: The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are sometimes still struggling to find the right balance between infection control and well-being.

From wave to wave: a Dutch national study on the long-term impact of COVID-19 on well-being and family visitation in nursing homes

“…We saw a great variety in how nursing homes dealt with COVID-19 infections. While the Dutch government recommended that no more national visiting bans in nursing homes should be implemented [9], nearly half of the respondents indicated that they would close whole nursing home wards for visitors in case of an infection. A minority of the nursing homes would close the whole nursing home for visitors if there was an infection.…”

“…Already early in the pandemic (spring/summer 2020), nursing homes were at the "end of the line" [4] with regard to national allocation of COVID-19 tests and personal protective equipment. For personal protective equipment, the shortage appears to have resolved compared to the period May-June 2020 [9]. Respondents were most concerned about the impact of this second wave on staff.…”

“…At the moment of data collection, it was unknown when residents and staff members of Dutch nursing homes could get vaccinated against COVID-19. On January 18, 2021, the first residents of Dutch nursing homes were vaccinated [9], which might have a great impact on well-being, family visitation, and workload of staff in nursing homes.…”

“…As nursing homes are the homes of people that were -in the absence of effective vaccinations -"most at-risk" for severe or deadly effects of the virus in the year 2020, returning to normal in nursing homes was seen as challenging [6]. While, right after the visiting bans, the re-opening of nursing homes was welcomed by all stakeholders [9], little is known on the long-term consequences and effects of visiting bans and re-opening of nursing homes.…”

“…The Netherlands was one of the first countries where, under very strict conditions set by the government, the visiting ban in nursing homes was lifted and the (long-term) impact was assessed scientifically in a national pilot [5]. The first findings of this pilot have already been published [5,9]. In this follow-up study, the aim was to assess the long-term effects of the pandemic on residents, family members, and staff, and their preparedness for the next coronavirus wave.…”