Ban on hospital visitors has profound effect on patients, families

Russ Morgan has some dementia, and often forgets both that he's had a stroke and the reasons why his loved ones can't visit. 

"It can be very heartbreaking on the phone when … we have to explain to him why we're not there," his daughter, Donna Morgan, told White Coat, Black Art's Dr. Brian Goldman.

The 87-year-old suffered a stroke in February and was admitted to a hospital in B.C.'s Lower Mainland, which began restricting visitors March 21 amid the COVID-19 pandemic. 

The ban on most hospital visitors is having a profound effect on patients and their families, caregivers and advocates say.

"It's just been terrible because the worry that we have about both his physical health and his mental health — being so isolated — is very overwhelming," Donna said.

"And it's been very difficult for my mother; she's coping with being on her own for the first time in 64 years and then worrying about her husband so much." 

Administrators have had little choice but to put what's been called "an iron ring" around their hospitals, keeping most family members away, regardless of whether the patient is hospitalized for COVID-19 or another condition.

The idea is that by limiting the number of asymptomatic people who could be carrying the virus, the hospital can protect front-line health workers and the most vulnerable patients from contracting the coronavirus. 

Before physical distancing measures were implemented, Donna and other family members would plan their visits around mealtimes to help Russ with eating.

"He has some use of his right arm," she said. "But his left side is paralyzed, and so we would help him open the packages and containers for his lunch and get him the things he needed."

But Donna said she thinks their most important role is cheerleading.

"I really think he needs the encouragement that family gives him to work on his healing." 

Families play crucial role in care

Patient advocate Julie Drury of the Canadian Foundation for Healthcare Improvement said families provide essential services to people in hospital. That's been the case well before COVID-19 put a strain on already stretched hospital resources.

"Nursing isn't what it was back in the 1950s when nurses were doing every little part of a personal care for a person in hospital," said Drury, who lives in Ottawa. "Families do personal hygiene for their loved one. They change beds. They monitor wounds. Maybe [provide] medication oversight."

They also play an important role as care co-ordinators and advocates for patients, she said, adding that there's compelling evidence having a family member present reduces things like medication errors and falls.

"Not only does the experience of the patient change, but the emotional well-being of the patient changes."

She said policy-makers could look to pediatric units for examples of how infection control is managed even with parent caregivers in the mix. 

Parents of minor patients are one of a few notable exceptions to no-visitor policies, along with labour partners in maternity wards and family members of those who are dying.

"I would say that many families who are long-term caregivers at bedside in hospitals understand infection control really, really well. You want to see good handwashing? Those families take this very seriously," Drury said.

Even referring to them as visitors is a bit of a misnomer, she said. It's not idle visits from friends or neighbours that's really in question during the pandemic.

"We cannot have visitors in hospital, but we can have one to two designated family members who are essential partners in care," Drury said.  

That partnership from family members has been shown to be key for staff satisfaction as well, said Drury.

"Staff feel more engaged and they feel more connected to their patients. And they recognize the families as allies in care."  

Disappointment, worry and fear

That's certainly the case for Bryan Regehr, an emergency and cardiac nurse at St. Boniface Hospital in Winnipeg. 

"I believe family is best at bedside with patients. I think it helps patients with outcomes. I think it helps with decision-making and in recovery," said Regehr. 

He's had to deliver the news that family members can't stay because of COVID-19 precautions, and that's been upsetting, he said. 

"You can tell there's disappointment. There is worry. There's fear [from] not knowing … what's going to happen, how you're going to get information." 

While Regehr said he understands the rationale, the no-visitor policy also makes his job harder.

"When we're missing this really vital resource, it makes things that much more difficult," he said.

His hospital is trying to help patients connect remotely with family by doing things like making bedside phones available for free. 

Donna Morgan said that staying in the loop with her father's care, and getting through to speak with him, has been one of the most frustrating fallouts from the COVID-19 visiting restrictions. The family set Russ up with a simple cellphone, but he finds it hard to operate, leaving them reliant on calls to the nurses' station.

"I'm sure they're busy but you feel they could do more to be in touch with you to let you know how he's doing," she said. "I know they're doing the best they can to care for him. But I think there wasn't a plan in place for this situation where families wouldn't actually be there and able to see what's going on."

"I think my biggest fear is that he's feeling quite lonely and sad, and that he'll become depressed and lose his motivation, lose his will to see us again."