Roger Wong is the vice-dean of education in the faculty of medicine and clinical professor of geriatric medicine at the University of British Columbia.
As we enter year three of the pandemic, we’ve learned a lot about what works, what doesn’t and what we should prioritize in the days and months ahead. Which is why a recent decision by the British Columbia government seems so confusing.
Effective Jan. 1, according to the B.C. government, “only essential visitors are allowed at long-term care facilities.” In other words, if you live in a long-term care home in B.C., your friends and family can’t visit you unless they’re deemed “essential” – a status determined by each facility.
Government officials say these policies are necessary to prevent the spread of the Omicron variant and save lives in long-term care.
Of course, the concern is understandable. According to the latest data, between March 1, 2020, and Aug. 15, 2021, more than 56,000 long-term care and retirement home residents (and 22,000 staff) across Canada were infected with COVID-19, resulting in more than 14,000 deaths. And the federal government says Canadians 65 and older accounted for about 80 per cent of all COVID-19 deaths in 2020. Clearly, older adults living in these homes are the hardest-hit segment of the population.
So what to do? In the early days of the pandemic, closing long-term care homes to visitors seemed like a reasonable policy. But in 2022, it feels short-sighted and misguided, an outdated approach from a darker time when we didn’t fully understand the COVID-19 threat or how to cope with it. Simply put, it’s not March, 2020, any more. We’ve learned a lot about the virus, its variants and the many ways we can protect ourselves and others, especially the most vulnerable in our society.
Many long-term care residents live with multiple health conditions, including dementia and other disabilities that affect their ability to perform basic tasks. These circumstances demand a holistic approach to care, which includes personal contact and external support from the community. Far from a perk, human companionship remains vital to health and well-being. For older people with health conditions or disabilities, social isolation can be devastating and result in further loss of cognitive ability and independence that may never be regained.
While coronaviruses are (and always will be) a threat to residents of long-term care, we must guard against any policy that, while potentially effective against viral transmission in the short-run, threatens to do more harm than good. From a geriatric doctor’s perspective, it makes no sense to increase social isolation and loneliness – with all their potential negative effects – solely in the name of COVID-19 safety.
One of the challenges, of course, is that COVID-19 cases and mortality rates are tracked and published, while the harmful effects of social isolation and loneliness are much harder to distinguish and communicate. If policy makers can draw a straight line from a virus to someone’s death in a long-term care home, they may focus too narrowly on transmission prevention, to the detriment of overall health. Family and friends may also feel more distress and guilt for not being there in person, especially when facing different interpretations of visitor restrictions by different long-term care homes.
Instead, government policies should help maintain an environment that accounts for all threats and conditions while striking a proper balance between caution and compassion. While well meaning, the new general visitation restrictions in B.C. miss the mark, and should be reversed immediately. To ensure compassionate care, we must allow loved ones to visit seniors in long-term care. It’s essential for their mental and physical health, and a basic human right.
At the same time, we must remain vigilant in the face of COVID-19. We should prioritize third-dose vaccinations for all seniors in long-term care and their caregivers. We should accelerate rapid antigen testing for all visitors – something the province has promised to do – and continue handwashing and mask mandates in these homes.
But we shouldn’t build a wall between long-term care residents and their family, friends and community of caregivers. Social isolation begets illness. Anxiety and despair can exacerbate health conditions and disabilities, and needlessly shorten lives. The virus can be deadly, especially for seniors with pre-existing conditions. But forced isolation, especially after nearly two years of anguish and uncertainty, can be just as lethal to the health and well-being of the most vulnerable members of our society. Our seniors in long-term care deserve much better.
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