While most public health rules on social interaction are steadily disappearing as COVID-19 cases drop, many hospital patients and their potential visitors remain under some of the tightest restrictions in the country.
Some hospitals, including many in Ontario and across Western Canada, still only allow visits from one or two people who are officially deemed essential, such as close family.
Kirsten Fiest, an epidemiologist at the University of Calgary, is researching widespread hospital visit restrictions in Canada. She says many remain in place because of administrative inertia rather than medical science, and it is time for most of them to go.
Dr. Fiest and her team have gathered feedback from dozens of patients, family members and hospital employees, and found restrictions are having ripple effects beyond social deprivation.
“Isolation harms patients. Family members play a crucial care role, being advocates, making sure patients get what they need,” Dr. Fiest said. “Restrictions also contribute to the burnout of medical personnel who are suffering through extra workload acting as surrogates and having to carry emotional burdens families would usually carry. It’s hard for everyone.”
The epidemiologist said scant evidence exists that visitors bring COVID-19 into hospitals, given most are required to wear masks and often other protective equipment such as eye shields and gowns. Such measures could continue, she said. Proof of visitor vaccination could be another tool going forward.
“I understand when this started 18 months ago, there was much we didn’t know. But now with low case counts and high vaccination rates, it’s time to change thinking on those policies,” she said.
“It’s inertia. It’s time to rip off the Band-Aid. We have to get back to that human level of care.”
Canada has a patchwork of inconsistent policies that vary not only between provinces, but also between hospitals and often even individual wards.
Quebec appears to have among the most liberal and consistent hospital visitor policies. A provincial directive says regions at the lowest level of pandemic alert – the entire province right now – must allow hospital patients to receive two visitors at a time with no limit on how many may drop in during the day. Exceptions exist to allow more visitors for end-of-life and fewer visitors for immunocompromised people such as some cancer patients.
Ontario is more restrictive and unpredictable, as the provincial government has left hospitals and unit managers to decide what visits are allowed. Most allow one or two designated, essential caregivers.
Lori Marshall, the CEO of the Chatham-Kent Health Alliance in Ontario, said restrictions may be in place for a while as hospitals try to ensure patients are not at risk of COVID-19 infections. Visiting rules may never go back to their wide-open status as they were before the pandemic, she said.
When patient-centred care became the trend in medical care and visiting hours were all but eliminated in many hospitals, the system may have lost sight of patient choice, Ms. Marshall said. Hospital patients are sicker than they were in the past and spend far less time convalescing in hospital.
She said patients may be better off seeing only the people most important to them, whom they choose. “Casual visits from the neighbour down the street may be helpful, or they may not be who patients want to see in the hospital,” she said.
Sarah Robertson’s 93-year-old grandmother, Dorothy Robertson, has been in Etobicoke General Hospital since she had surgery in May to replace a broken hip. In the 10 weeks she has spent in the Toronto hospital, the rules have bounced around.
For the first three weeks, Ms. Robertson was not allowed any visitors. “We got a lot of mixed messaging about needing to be deemed a care provider, but basically we were told we couldn’t go in,” Sarah Robertson said.
Her grandmother takes good care of herself, the granddaughter said, but little things went neglected. Hearing aid batteries died and clothing went unchanged, she said. After three weeks, a doctor was in touch to say he was worried Ms. Robertson was experiencing cognitive decline. “You can’t base a diagnosis like this based on the situation she was in,” Sarah Robertson said.
The doctor agreed and allowed the family to send in Ms. Robertson’s daughter to give her a pep talk. The doctor and other hospital staff immediately noticed improvement, the granddaughter recounted.
A series of meetings among the family, the therapy team and floor management finally allowed two family caregivers at Ms. Robertson’s side, after nearly five weeks. Her daughter and son are now allowed to visit. But Sarah Robertson, 35, still can’t visit her grandmother, despite her complete vaccination status and eagerness to help.
A hospital social worker, Sarah Robertson says she thinks a lot about how her skills as a health care advocate were required to push for limited visits. “I’m not afraid to be loud and passionate. What happens with the people who don’t know they can push?” she said.
She emphasized the staff have given her grandmother excellent care, but they are handcuffed by hospital policies. “In the last 10 years, the health system has done so much to put mental health and humanity a bigger component. I feel like we’ve gone back years,” she said.
Michael Warner, an intensive care physician at Michael Garron Hospital in Toronto, has advocated to loosen patient visiting rules. He says patients are delaying going to the hospital because they are afraid of being alone.
“In my view, these are not evidence-based restrictions, and they harm patients and contribute to the moral distress of physicians and nurses having to tell loved ones they can’t visit,” Dr. Warner said. “At my hospital before COVID there were no visiting hours, they were 24 hours, seven days a week because we recognized the benefit of visitors at the bedside.
“Patients get better care if there’s someone there with them.”
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