COVID-19 Restrictions in Long-Term Care Facilities in the United States

Abstract The high rates of coronavirus infection and death among residents of long-term care (LTC) facilities in the early days of the COVID-19 pandemic in the United States in 2020 led to strict public health limitations being imposed on visits by relatives and others from outside those facilities and on contacts among residents. This chapter describes and analyzes the risks involved and the role played by the restrictions along with other factors, such as changes in the virus and the availability of vaccines, in reducing harm to nursing home residents. To what extent were the benefits of such restrictions—which were imposed rapidly during the first, devastating surge of coronavirus infections in LTC facilities and later modified or rescinded to varying degrees—proportionate to the harms caused to residents’ well-being, and what considerations beyond physical and psychological harm should be included when weighing benefits and harms? For example, can and should decision-makers also consider the effects on residents’ self-agency imposed by such restrictions, and if so, how might those be incorporated into the policymaking calculus?