In-person visitation must be part of the national COVID-19 response

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When Xavier Becerra was introduced as President Joe Biden’s nominee for HHS secretary in January, he said “No one should ever have to die alone in a hospital bed, loved ones forced to stay away.” He’s absolutely right.

Sadly, isolation is still a reality for many people who are facing their final moments alone due to visitation restrictions put in place early in the COVID-19 pandemic.

Federal leadership is critical to guide healthcare providers as they struggle to balance the need for in-person visitation with important safety concerns for visitors and staff, especially amid vaccine rollouts and new variants of the virus emerging. Addressing these challenges to strike the right balance should be a formal part of the Biden administration’s COVID-19 response strategy.

I serve as president and CEO of Capital Caring Health, which has supported nearly 120,000 patients and families through life-limiting illness. At our four inpatient centers, every day of the year regardless of the pathogen situation, we allow two family visitors at a time plus pets—pets are very important to our terminal patients as well as family.

We have had zero cases of COVID-19 transmission since the beginning of the pandemic at any of these centers. We have strict safety protocols as well as air filtration purification systems in each room. We even let a family member spend the night with their loved one.

I’m also co-chair of the Coalition to Transform Advanced Care, where we leverage advocacy to improve the lives of people with serious illness, who are especially vulnerable to complications and death due to COVID-19. C-TAC has heard from healthcare providers, patients and families about the heartbreak and suffering from restrictions on visitation.

Navigating in-person visitation during the COVID-19 pandemic has been immensely stressful for all involved, from upset family members to overwhelmed staff to healthcare facilities that must find a balance between supporting patients and protecting workers.

Many facilities have used technology to help bridge the gap between patients and families. This effort should be applauded, but virtual visits are not a universal solution. Families from low-income communities often lack the resources needed for these virtual visits, like broadband internet, smartphones or tablets. The inherent limitations of virtual visits can also make it difficult for families to make fully informed treatment decisions for their seriously-ill loved one.

CMS released visitation guidance for nursing homes in September, expanding the definition of a “compassionate care” visit beyond those near death. Unfortunately, many nursing homes have not been educated on this update and still restrict visits to limited end-of-life scenarios. There has been no guidance to hospitals or other health facilities on this topic. Lack of visitation leads to suffering for patients, families and staff as a result of depression, anxiety and moral distress.

Since September, there have been major developments in the pandemic, such as the increasing availability of vaccines, the emergence of new COVID-19 variants, and a growing body of knowledge about how to better protect ourselves and treat those who are sick–all of which have serious implications for in-person visitation and should be addressed in the Biden administration’s COVID-19 response. Healthcare facilities have developed new safety protocols over the course of the pandemic to adjust and facilitate more meaningful visits, but they would benefit greatly from federal expertise and the dissemination of best practices.

President Biden’s national COVID-19 response strategy supports “the accelerated distribution of vaccines to residential care settings,” but does not specifically mention in-person visitation. While early data suggests that the COVID-19 vaccine reduces transmission and hospitalizations, the fact remains that we owe it to our patients and their families to think deeply and come up with safe ways for them to connect.

The circumstances surrounding COVID-19 are constantly changing and it’s critical to remember the emotional toll that restrictions on visitation are having across the country. As the administration continues to tackle this unprecedented crisis, we call on leaders to give healthcare organizations the guidance needed to do right by patients, families and front-line workers.



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