How do we return to normal?

Although the regime differs per facility, in general elderly in facilities are in social isolation for almost 4 months already. Unfortunately, in California, we are not flattening the Covid curve yet. However, in Europe they are a few weeks ahead of us and there we see the first normalization also for the elderly in facilities.

In the Netherlands, at the end of on May 11, more than seven weeks after nursing homes were hermetically closed due to Covid19, as a test, the doors of the first 25 elderly facilities were opened. This was only possible in facilities without any Covid contamination and under strict conditions including allowing only one visitor per resident. The effects were closely monitored by regional common health services.


One of my best friends is a caregiver for the elderly. When I asked her about her experiences, she said it definitely took some getting used to. The first visitor in her facility happened to celebrate her birthday. It was the wife of an 82 year old resident, who wanted to treat the entire floor. This could not be done with the cake she brought, but only with cake from the nursing home, because bringing your own food is not allowed. And it is not the only rule that visitors must follow. The distance rule of 6 foot must still be observed in nursing homes, and visitors must also wash their hands, be free of complaints and follow certain walking routes.

“She really enjoyed the visit, my friend said about the birthday woman who was able to sit next to her husband for the first time in almost two months. An hour is reserved for each visitor. The actual visit lasts half an hour. Fifteen minutes are scheduled for preparation and information and 15 minutes for leaving the nursing home. Every visitor gets a personal guide, who ensures that the correct regulations are observed. The visit is in the room of the resident and in principal nobody is there during the visit. However, we have to check regularly whether the visitor respects the 6 foot distance. We all feel that for residents and their family members this situation of social isolation has taken far too long, so it’s a good thing that it is possible to really connect again.”


From May 25, visitors were again allowed under these strict conditions at 50 more nursing home locations in the Netherlands. Researchers intensively followed the pilot nursing homes that opened on May 11 as well as the consequent 50 other locations.

The evaluation shows that family members generally adhere well to the protocol agreed on the location. However, there are a few points of attention:

  • The follow-up of the hand hygiene instruction seems to decrease over the weeks
  • Face masks are regularly misused by visitors
  • After all the weeks of social isolation, there is a great need for physical contact. Avoiding that remains difficult
  • Many employees find it difficult to address loved ones when they do not follow the protocol.

Positive effects on well-being

The evaluation also shows that for residents reuniting with their loved ones after the visit ban is very emotional, especially in the first week. Social isolation was hard. The perceived effects on the well-being of nursing home residents are also positive. Many facilities report that their residents are brightening up, have more appetite and are more active, for example.

Therefore, there is a great need for next steps. Especially in terms of admitting multiple visitors and more flexibility regarding the time and frequency of the visit.

Workload on staff

It is very difficult for staff to ensure that visiting family members comply with the guidelines. It takes a lot of manpower and is difficult to manage under the current time pressure. The evaluation clearly shows that the further roll-out of the visitors’ scheme will go too fast without a bit more flexibility of the guidelines.


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