"Nursing Home Prison" includes Prison-Like Visitation Policies, including "window visits"
More detail on my nursing home's visitation policies under COVID for the last going-on-three-years.
In my first post on Substack, I ranted and went into some detail about visitation policies at nursing homes, mostly from the perspective of current Centers for Medicare and Medicaid Services (CMS) rules.
It’s possible for some of you that it may sound hyperbolic that nursing homes have become prisons. They have though - complete with our version of prison-like “window visits.”
Yes, that’s right. For good portions of the last almost-three-years now (when we haven’t completely banned in-person visits completely), our nursing home along with nursing homes across the United States have at times partially or completely replaced previous policies of mostly or entirely open-ended, in-person visits with family and friends with these so-called “window visits.”
Window Visits and the Story of Bob
Take the story of 88 year old Bob. He’s got moderate to severe dementia due to (let’s say) Alzheimer’s disease. He’s also wheelchair bound due to other issues, visually impaired, and he’s been married to his doting wife Doris for the last 55 years.
Prior to COVID she came to visit him at least a couple of times per week, hung out in his room with him, puttered around and fussed over him, fed him, went to bingo games with him, smooched him, held his hand. Mr. Jones has a tendency of getting anxious and having behavioral issues on our unit - but when his wife visits he’s almost like normal and it seems pretty clear the close physical contact with his wife (and his kids and grandkids, when they visit) make all the difference. He’s usually a bit calmer after she leaves too.
Then COVID happened, and we converted our nursing home into an impenetrable fortress. In 2020, we had no visitors at all for the first few months - which was horrible, but seemed temporary and more tolerable because at the time everything seemed time-limited. We were just “flattening the curve,” that kind of thing.
Then in 2021 we started allowing visitors again, but only under this idea of “window visits” - which we still offer today as an alternative when in-person visitations are not an option.
Window Visits? WTF is that?
So now imagine Bob - It’s 2021 and he hasn’t seen his wife for months. Nursing staff are exhausted because it’s become a daily, grueling task dealing with his behavioral issues and combativeness just changing his briefs and keeping him clean (like many residents with dementia, he’s incontinent).
Bob is lonely and even more confused than ever - because he has dementia, he doesn’t really understand why he isn’t seeing his wife and family much anymore. Also he hasn’t seen the faces of nursing staff anymore either, and he has much more trouble understanding them (remember, this all he has seen now when nurses come to visit him):
Finally we call Doris and say “guess what Doris! We know Bob misses you and really benefits from you coming to visit him. We have finally allowed visits to happen again! You just have to see him at a window.”
Doris really misses Bob. She’s called him a few times (we also offered “video visits” using iPads - but neither her nor Bob is comfortable with technology and so they’ve refused that) - but the phone calls were always brief and never seemed to go well - Bob just seemed confused and yelled over the phone and didn’t seem to understand that she was on the other end.
So, Doris makes the hour-long drive down to the nursing home, which, at 75, she’s still OK with doing, fortunately. When she gets there, she’s instructed to go around to the back of the building and sit in a chair that’s been set up for her.
Nurses bring Bob over to her from behind the glass in his reclining wheelchair. Nursing tries to give him a phone, but as usual, he’s not very good at holding on to it - fortunately it has a speaker phone function so they stick it on his lap.
So this is how the visit goes. Bob and Doris talk to each other (or try to) - behind glass, using telephones. It’s not actually very dissimilar from this, which is commonly seen in prison or jail meeting areas:
But Bob is different than your average prisoner.
He has dementia, so his memory is poor and he doesn’t understand why he can’t touch his wife. He’s confused why he sees her behind glass and only can hear her somewhat distorted voice over the phone. He probably can’t even understand her properly, given he’s also hard of hearing too.
For Doris’ part - she is happy to at least be laying eyes on Bob - but after her first window visit she is more depressed and bereft than ever. The visit clearly didn’t help Bob much, he seemed frustrated and kept asking “where are you? Why aren’t you here with me?” and she didn’t have much of a good idea what to tell him.
How Window Visits fit in with Current “Post-COVID” Visitation Policies at my Nursing Home
Interesting thing is window visits are still an option at my nursing home, “if in person visits are not available.” Perhaps unsurprisingly, many of the residents and family members don’t take the option anymore - they simply don’t visit and just wait until the nursing home opens up again in the hopes they can schedule an in-person visit.
I’ve already spoken about the limitations on in-person visits that still are the case. To review:
In person visits are limited to two hours
Masks need to be on at all times and need to be properly socially distanced
Need to be pre-scheduled (limited number can be scheduled at the nursing home per day) due to need of nursing to “monitor” visits for mask compliance and social distancing, and to screen visitors at the door
Limits on total number of visitors. Outdoors the max is 10 (including the resident). Much less for indoor spaces.
Those unable to comply with mask / social distancing requirements are not allowed (meaning small children can’t come).
Window Visits at my Nursing Home Today (2022)
It’s worth noting that window visits are still an option at my nursing home, even today. To be fair, visitation rules have slightly liberalized over the last almost-three-years. Biggest change is how we’ve treated “outbreak status” at our nursing home: previously if anyone tested positive, even if the staffmember was asymptomatic - visitations were stopped and we reverted back to our “no visits” policy… with the exception of window visits.
Now, when in “outbreak status” we still allow in-person visits, but they are limited to one at a time, and with only one visitor at a time.
What’s worth noting is that now that in-person visits are back, almost none of our family / residents choose window visits anymore.
That’s how ridiculous they were.
When taken together - What does this mean for the Future of Long Term Care?
These oppressive, prison-like visitation policies, the inability of residents to see the outside world (ever), the insistence on illogical and cruel, “universal masking” rules for asymptomatic staff and residents (using procedure masks no less - not actual, filtering masks like N95s)… and with no end in sight to any of this… are you now more likely or less likely to plan for use of LTC services in the future?
I’m a geriatrician. I’ve worked in geriatrics and long-term care for almost the last 20 years. I’ve always liked to say “if I ever end up in a nursing home I’ll be much more OK with it than the average person because I know what to expect.”
The problem is now it’s really the opposite - because I know exceedingly well what it’s like now - I’m going to do everything I possibly can to avoid the possibility of long term care in my future.
Wouldn’t you try to avoid eventual imprisonment, at all costs?