{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:11:28Z","timestamp":1789665088746,"version":"4.0.1"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health Research Health and Social Care Delivery Research Programme","award":["132541"],"award-info":[{"award-number":["132541"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nDuring the COVID-19 pandemic, care homes for older adults in England implemented isolation, social distancing and other restriction measures to help protect residents from contracting the virus. Little was known about the physical and psychological impacts that these measures would have upon residents and their relatives.<\/jats:p>\n<\/jats:sec>\n\nAim<\/jats:title>\nTo explore the experiences of residents and their relatives of living restricted lives during the pandemic.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nThis qualitative study was conducted as part of a 12-month, mixed-methods, phased design. From six purposively sampled care homes in England, 17 purposively sampled residents (all older adults) and 17 purposively sampled relatives participated in an individual, on-line interview, where they discussed their experiences of the restrictive measures implemented within their care home. Interviews were audio- and video-recorded with participants\u2019 permission and analysed using an inductive orientation to thematic analysis, with coding and theme development driven by the data content.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nParticipants\u2019 experiences of care home restrictions varied; their impact was influenced by the existing pattern of relationships that residents and their relatives maintained within and beyond the care home. It was further influenced by the fact that many residents and relatives were still learning how to manage their relationships in the new context of living in a care home. Social distancing measures made care homes feel less homely and denied residents, staff and relatives physical touch and other forms of non-verbal communication. Many residents expressed a broad sense of gratitude that was associated with safety and well-being beyond the pandemic. As older adults, they put the pandemic, and its associated restrictions, within the larger context of their lives.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nLearning from the COVID-19 pandemic is paramount for governments, societies, policy makers, care home providers, care homes and their staff, residents and their families and friends, and researchers. Our study makes an important contribution as one of the first to study the impact of implementing isolation, social distancing and other restrictive measures for care home residents and their relatives in England.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0312509","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T18:36:14Z","timestamp":1733337374000},"page":"e0312509","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Living restricted lives \u2010 Understanding the impact of isolation, social distancing and other restriction measures on older care home residents and their relatives in England during the COVID-19 pandemic: A qualitative study"],"prefix":"10.1371","volume":"19","author":[{"given":"Sarah","family":"Sims","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Desai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4377-5063","authenticated-orcid":true,"given":"Ruth","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Marie","family":"Rafferty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shereen","family":"Hussein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Adams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Rees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Brearley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6285-180X","authenticated-orcid":true,"given":"Joanne M.","family":"Fitzpatrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,12,4]]},"reference":[{"key":"pone.0312509.ref001","unstructured":"World-Health-Organisation. 2020. WHO Director-General\u2019s opening remarks at the media briefing on COVID-19\u201311 March 2020. Available from: https:\/\/www.who.int\/director-general\/speeches\/detail\/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19\u201411-march-2020 [Last accessed 16th February 2023]."},{"key":"pone.0312509.ref002","unstructured":"Institute for Government. 2022. Timeline of UK coronavirus lockdowns, March 2020 to March 2021 2021 22nd April 2022]."},{"key":"pone.0312509.ref003","unstructured":"GOV.UK, 2020. Policy paper: COVID-19: our action plan for adult social care. Available from: https:\/\/www.instituteforgovernment.org.uk\/sites\/default\/files\/timeline-lockdown-web.pdf [Last accessed 16th February 2023]."},{"key":"pone.0312509.ref004","unstructured":"Age UK. 2019. Briefing: Health and care of older people in England. Available from: https:\/\/www.ageuk.org.uk\/globalassets\/age-uk\/documents\/reports-and-publications\/reports-andbriefings\/health\u2014wellbeing\/age_uk_briefing_state_of_health_and_care_of_older_people_july2019.pdf, [Last accessed 8th July 2024]."},{"key":"pone.0312509.ref005","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1093\/ageing\/aft077","article-title":"Health status of UK care home residents: a cohort study","volume":"43","author":"A. Gordon","year":"2014","journal-title":"Age and Ageing"},{"key":"pone.0312509.ref006","unstructured":"British Geriatrics Society. 2016. Effective healthcare for older people living in care homes. Available at: https:\/\/www.bgs.org.uk\/resources\/effective-healthcare-for-older-people-living-in-care-homes [Last accessed: 8th July 2024]."},{"key":"pone.0312509.ref007","unstructured":"CareHome.co.uk. 20204. Care home stats: number of settings, population and workforce. Available at: https:\/\/www.carehome.co.uk\/advice\/care-home-stats-number-of-settings-population-workforce [Last accessed: 8th July 2024]."},{"key":"pone.0312509.ref008","unstructured":"British Geriatrics Society. 2020. Managing the COVID-19 pandemic in care homes for older people (Good Practice Guide Version 4) Available at: https:\/\/www.bgs.org.uk\/sites\/default\/files\/content\/attachment\/2020-11-16\/Managing%20the%20COVID-19%20pandemic%20in%20care%20homes%20November%202020_0.pdf. [Last accessed 16th February 2023]."},{"key":"pone.0312509.ref009","unstructured":"World Health Organisation. 2024. COVID-19 vaccinations have saved more than 1.4 million lives in the WHO European Region, a new study finds. Available at: https:\/\/www.who.int\/azerbaijan\/news\/item\/16-01-2024-covid-19-vaccinations-have-saved-more-than-1.4-million-lives-in-the-who-european-region\u2014a-new-study-finds [Last accessed 8th July 2024]."},{"key":"pone.0312509.ref010","unstructured":"Office for National Statistics. 2022. Deaths involving COVID-19 in the care sector, England and Wales: deaths registered between week ending 20 March 2020 and week ending 21 January 2022. 2022. Available from: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/articles\/deathsinvolvingcovid19inthecaresectorenglandandwales\/previousReleases. [Last accessed 16th February 2023]."},{"key":"pone.0312509.ref011","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1111\/spol.12645","article-title":"COVID-19 and care homes in England: What happened and why?","volume":"54","author":"M. Daly","year":"2020","journal-title":"Social Policy & Administration"},{"key":"pone.0312509.ref012","author":"R. Booth","year":"2020","journal-title":"Government rejected radical lockdown of England\u2019s care homes, The Guardian"},{"key":"pone.0312509.ref013","doi-asserted-by":"crossref","first-page":"m2334","DOI":"10.1136\/bmj.m2334","article-title":"Let\u2019s be open and honest about covid-19 deaths in care homes","volume":"369","author":"D. Oliver","year":"2020","journal-title":"BMJ"},{"key":"pone.0312509.ref014","unstructured":"Care England. 2020. Questions and concerns that have been raised by Care England members. Available from: http:\/\/www.careengland.org.uk\/[Last accessed 16th February 2023]."},{"key":"pone.0312509.ref015","unstructured":"RCN Research Society. 2020. Survey of UK nurses and midwives\u2019 highlights their concerns about health, training and workload during COVID-19. Available from: https:\/\/www.kcl.ac.uk\/news\/survey-of-uk-nurses-and-midwives-highlights-their-concerns-about-health-training-and-workload-during-covid-19 [Last accessed 16th February 2023]."},{"key":"pone.0312509.ref016","unstructured":"GOV.UK, Coronavirus (COVID-19). Admission and care of residents in a care home during COVID-19. Version 2, updated 19 June 2020, Available from: https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-admission-and-care-of-people-in-care-homes. [Last accessed 16th February 2023]."},{"issue":"7","key":"pone.0312509.ref017","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1111\/jan.15181","article-title":"Guilt, tears and burnout\u2014Impact of UK care home restrictions on the mental well-being of staff, families and residents","volume":"78","author":"C. Giebel","year":"2022","journal-title":"Journal of Advanced Nursing"},{"key":"pone.0312509.ref018","doi-asserted-by":"crossref","first-page":"585373","DOI":"10.3389\/fpsyt.2020.585373","article-title":"Psychosocial impact of COVID-19 nursing home restrictions on visitors of residents with cognitive impairment: a cross-sectional study as part of the engaging remotely in care (ERiC) project","volume":"11","author":"R. O\u2019Caoimh","year":"2020","journal-title":"Frontiers in Psychiatry"},{"key":"pone.0312509.ref019","doi-asserted-by":"crossref","first-page":"100031","DOI":"10.1016\/j.ijnsa.2021.100031","article-title":"The impact of Covid-19-related distancing on the well-being of nursing home residents and their family members: a qualitative study","volume":"3","author":"J. Paananen","year":"2021","journal-title":"International Journal of Nursing Studies Advances"},{"issue":"5","key":"pone.0312509.ref020","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1017\/S0144686X21001161","article-title":"Doing time in care homes: insights into the experiences of care home residents in Germany during the early phase of the COVID-19 pandemic.","volume":"43","author":"M. Leontowitsch","year":"2023","journal-title":"Ageing and Society"},{"issue":"3","key":"pone.0312509.ref021","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1080\/14427591.2022.2066158","article-title":"The impact of the COVID-19 restrictions on nursing home residents: An occupational perspective","volume":"29","author":"G Richardson","year":"2022","journal-title":"Journal of Occupational Science"},{"issue":"1","key":"pone.0312509.ref022","doi-asserted-by":"crossref","first-page":"e12509","DOI":"10.1111\/opn.12509","article-title":"Exploring experiences of loneliness among Canadian long-term care residents during the COVID-19 pandemic: A qualitative study","volume":"18","author":"C.B. Smith","year":"2023","journal-title":"Int J Older People Nurs"},{"key":"pone.0312509.ref023","doi-asserted-by":"crossref","first-page":"59","DOI":"10.7748\/ns.35.8.59.s21","article-title":"The hidden impact of visiting restrictions: The well-being of care home residents needs to be considered in the event of local lockdowns or a second wave","volume":"35","author":"L. Lees-Deutsch","year":"2020","journal-title":"Nursing Standard"},{"key":"pone.0312509.ref024","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S0140-6736(20)30460-8","article-title":"The psychological impact of quarantine and how to reduce it: rapid review of the evidence","volume":"395","author":"S. Brooks","year":"2020","journal-title":"Lancet"},{"key":"pone.0312509.ref025","author":"A. Suarez-Gonzalez","year":"2020","journal-title":"Detrimental effects of confinement and isolation on the cognitive and psychological health of people living with dementia during COVID-19:emerging evidence"},{"issue":"7","key":"pone.0312509.ref026","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.jamda.2020.06.020","article-title":"Allowing Visitors Back in the Nursing Home During the COVID-19 Crisis: A Dutch National Study Into First Experiences and Impact on Well-Being","volume":"21","author":"H. Verbeek","year":"2020","journal-title":"Journal of the American Medical Directors Association"},{"issue":"8","key":"pone.0312509.ref027","doi-asserted-by":"crossref","first-page":"e050706","DOI":"10.1136\/bmjopen-2021-050706","article-title":"Protecting older people living in care homes from COVID-19: a protocol for a mixed-methods study to understand the challenges and solutions to implementing social distancing and isolation","volume":"11","author":"J.M. Fitzpatrick","year":"2021","journal-title":"BMJ Open"},{"issue":"6","key":"pone.0312509.ref028","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A. Tong","year":"2007","journal-title":"International Journal for Quality in Health Care"},{"issue":"6","key":"pone.0312509.ref029","doi-asserted-by":"crossref","first-page":"3450","DOI":"10.3390\/ijerph19063450","article-title":"Social Distancing and Isolation Strategies to Prevent and Control the Transmission of COVID-19 and Other Infectious Diseases in Care Homes for Older People: An International Review","volume":"19","author":"S Sims","year":"2022","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"pone.0312509.ref030","unstructured":"Stake, R. 2009. Qualitative case studies. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage Handbook of Qualitative Research (3rd Ed). Thousand Oaks, CA: Sage."},{"key":"pone.0312509.ref031","unstructured":"Care Quality Commission. (No date). About us: What we do and how we do it. Available at: https:\/\/www.cqc.org.uk\/sites\/default\/files\/20170504_CQC_About-us.pdf. [Last accessed: 8th July 2024]."},{"key":"pone.0312509.ref032","author":"V. Braun","year":"2022","journal-title":"Thematic analysis \u2010 a practical guide, Sage: London"},{"key":"pone.0312509.ref033","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/1471301207075625","article-title":"Participatory research; A method for process consent with persons who have dementia","volume":"6","author":"J. Dewing","year":"2007","journal-title":"Dementia"},{"key":"pone.0312509.ref034","article-title":"2020. Interviewing people living with dementia in social care research","author":"K. Samsi","journal-title":"Methods Review"},{"issue":"11","key":"pone.0312509.ref035","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19116559","article-title":"The Experience of COVID-19 Visitor Restrictions among Families of People Living in Long-Term Residential Care Facilities during the First Wave of the Pandemic in Ireland","volume":"19","author":"N. Cornally","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0312509.ref036","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1186\/s12877-022-03544-z","article-title":"Anxiety and loneliness among older people living in residential care facilities or receiving home care services in Sweden during the COVID-19 pandemic: a national cross-sectional study","volume":"22","author":"R.-M. Johansson-Pajala","year":"2022","journal-title":"BMC Geriatrics"},{"issue":"4","key":"pone.0312509.ref037","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1111\/jonm.13574","article-title":"Experiences of residents, family members and staff in residential care settings for older people during COVID-19: A mixed methods study","volume":"30","author":"M.R. Sweeney","year":"2022","journal-title":"J Nurs Manag"},{"issue":"3","key":"pone.0312509.ref038","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1080\/13607863.2022.2056137","article-title":"The impact of COVID-19 restrictions and care home strategies on residents with dementia as experienced by family carers in Italy","volume":"27","author":"I. Chirico","year":"2023","journal-title":"Aging Ment Health"},{"key":"pone.0312509.ref039","first-page":"386","article-title":"The Lived Experience of Implementing Infection Control Measures in Care Homes during Two Waves of the COVID-19 Pandemic","volume":"0","author":"D. Bunn","year":"2021","journal-title":"A Mixed-Methods Study. Journal of Long-Term Care"},{"issue":"5","key":"pone.0312509.ref040","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1080\/13691457.2021.1954886","article-title":"The covid-19 pandemic and care homes for older people in Europe \u2010 deaths, damage and violations of human rights","volume":"25","author":"J.C. Anand","year":"2022","journal-title":"European Journal of Social Work"},{"issue":"3","key":"pone.0312509.ref041","doi-asserted-by":"crossref","first-page":"e57","DOI":"10.1111\/hsc.12647","article-title":"2019. Facilitators and inhibitors of transition for older people who have relocated to a long-term care facility: A systematic review","volume":"27","author":"J. Fitzpatrick","year":"2019","journal-title":"Health and Social Care in the Community"},{"key":"pone.0312509.ref042","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12877-022-02759-4","article-title":"Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit","volume":"22","author":"A. Iaboni","year":"2022","journal-title":"BMC Geriatriatrics"},{"key":"pone.0312509.ref043","author":"K. Spilsbury","year":"2020","journal-title":"Less COVID19. Learning by experience and supporting the care home sector during the Covid-19 pandemic: key lessons learnt, so far, by frontline care home and NHS staff"},{"key":"pone.0312509.ref044","article-title":"The Senses Framework: Improving care for older people through a relationship-centred approach","author":"M. Nolan","journal-title":"Getting Research into Practice (GRiP) Report No 2. Project Report. 2006, University of Sheffield"},{"key":"pone.0312509.ref045","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1017\/S0144686X14001111","article-title":"Digging deep: How organisational culture affects care home residents\u2019 experiences","volume":"36","author":"A. Killett","year":"2016","journal-title":"Ageing and Society"},{"issue":"11","key":"pone.0312509.ref046","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1002\/gps.5567","article-title":"Dementia wellbeing and COVID-19: Review and expert consensus on current research and knowledge gaps","volume":"36","author":"K.Y. Liu","year":"2021","journal-title":"Int J Geriatr Psychiatry"},{"issue":"5","key":"pone.0312509.ref047","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.jamda.2021.03.010","article-title":"The Adverse Effects of the COVID-19 Pandemic on Nursing Home Resident Well-Being","volume":"22","author":"M. Levere","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0312509.ref048","doi-asserted-by":"crossref","first-page":"578015","DOI":"10.3389\/fpsyt.2020.578015","article-title":"Behavioral and Psychological Effects of Coronavirus Disease-19 Quarantine in Patients With Dementia","volume":"11","author":"A. Cagnin","year":"2020","journal-title":"Front Psychiatry"},{"issue":"1","key":"pone.0312509.ref049","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1186\/s12877-022-03364-1","article-title":"Relatives\u2019 perspectives on encounters and communication in nursing homes during the Covid-19 pandemic: a qualitative interview study","volume":"22","author":"E. Eriksson","year":"2022","journal-title":"BMC Geriatrics"},{"key":"pone.0312509.ref050","unstructured":"Amnesty International. 2020. As if expendable \u2010 The UK Government\u2019s failure to proect older people in care homes during the Covid-19 pandemic. Available from: https:\/\/www.amnesty.org\/en\/documents\/eur45\/3152\/2020\/en\/ [Last accessed 16th February 2023]."},{"key":"pone.0312509.ref051","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1080\/08959420.2021.1927620","article-title":"Technology Recommendations to Support Person-Centered Care in Long-Term Care Homes during the COVID-19 Pandemic and Beyond","volume":"33","author":"C. Chu","year":"2021","journal-title":"Journal of Aging & Social Policy"},{"key":"pone.0312509.ref052","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s12877-022-02794-1","article-title":"Person-centered dementia care during COVID-19: a qualitative case study of impact on and collaborations between caregivers","volume":"22","author":"K. Kazawa","year":"2022","journal-title":"BMC Geriatrics"},{"key":"pone.0312509.ref053","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jamda.2020.11.022","article-title":"Front-line Nursing Home Staff Experiences During the COVID-19 Pandemic","volume":"22","author":"E. White","year":"2021","journal-title":"Journal of the American Medical Directors Association"},{"key":"pone.0312509.ref054","doi-asserted-by":"crossref","first-page":"101649","DOI":"10.1016\/j.ijlp.2020.101649","article-title":"Isolating residents including wandering residents in care and group homes: Medical ethics and English law in the context of Covid-19","volume":"274","author":"K. 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