{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T14:47:32Z","timestamp":1778078852601,"version":"3.51.4"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Dowager Countess Eleanor Peel Trust"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Restrictions on family visitation to long-term care facilities (LTCFs) during the COVID-19 pandemic remain an area of contention for residents, family members and staff members. Current research has explored the experience of family members; however, fewer studies have explored the impact of visitation restrictions from the perspective of LTCF staff members. We examined the experiences of LTCF staff members in implementing visitation restrictions, including maintaining contact with families, in England over the course of the COVID-19 pandemic. Method: A sample of twenty-four LTCF staff members employed at eight LTCFs in one region of England was recruited. Qualitative, in-depth interviews were conducted with staff members to explore their experiences of implementing government policies during the COVID-19 pandemic. Thematic analysis was used to analyse data on maintaining contact and visitation with relatives. Results: Five broad themes were identified from the data. These were: (i) engaging with family members on visitation, (ii) facilitating visitation with family members, (iii) maintaining remote contact with family members, (iv) managing visitation restrictions with residents and (v) navigating equitable access for residents and family members. While some staff welcomed the introduction of national guidance on restrictions as a source to refer family members to for justification of the LTCFs\u2019 decisions to restrict access, others reflected on the negative effect of limited social contact on resident wellbeing and difficulties in implementing the guidance. At times, LTCFs felt conflicted in their responsibility for supporting family members in visiting at the same time as communicating, enforcing and policing visitation restrictions. Guidance on facilitating remote contact required substantial time and resources required to support it. Discussion: The extent to which restricting visitation was a proportionate response to reducing the spread of COVID-19, within the wider context of negative impacts on relatives and family members, is an ongoing debate. This study identified some of the challenges experiences by LTCF staff in implementing such guidance, and calls into question the practicality of restricting visitation. Further research is needed on how social contact can be maintained between relatives and their families during pandemics, which is both equitable and achievable.<\/jats:p>","DOI":"10.3390\/ijerph22020221","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T04:15:41Z","timestamp":1738728941000},"page":"221","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Exploring the Experiences of LTCF Staff in Implementing Visitation Policies in England During the COVID-19 Pandemic"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5861-8706","authenticated-orcid":false,"given":"Danni","family":"Collingridge Moore","sequence":"first","affiliation":[{"name":"Division of Health Research, Lancaster University, Lancaster LA1 4YW, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Cotterell","sequence":"additional","affiliation":[{"name":"Division of Health Research, Lancaster University, Lancaster LA1 4YW, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,5]]},"reference":[{"key":"ref_1","unstructured":"Organisation for Economic Co-Operation and Development (2021). Rising from the COVID 19 Crisis: Policy Responses in the Long-Term Care Sector, OECD Publishing."},{"key":"ref_2","first-page":"100295","article-title":"Mortality among Care Home Residents in England during the first and second waves of the COVID-19 pandemic: An observational study of 4.3 million adults over the age of 65","volume":"14","author":"Schultze","year":"2022","journal-title":"Lancet Reg. Health\u2014Eur."},{"key":"ref_3","unstructured":"Canadian Institute for Health information (2021). The Impact of COVID-19 on Long-Term Care in Canada: Focus on the First 6 Months, Canadian Institute for Health Information."},{"key":"ref_4","unstructured":"Office for National Statistics (2024, July 22). Older People Living in Care Homes in 2021 and Changes Since 2011, Available online: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/ageing\/articles\/olderpeoplelivingincarehomesin2021andchangessince2011\/2023-10-09#:~:text=In%202021%2C%20in%20England%20and,and%20male%20care%20home%20residents."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1017\/ice.2019.117","article-title":"Frequency of nursing home resident contact with staff, other residents, and the environment outside resident rooms","volume":"40","author":"Pineles","year":"2019","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1111\/jgs.12517","article-title":"Hospitalizations of nursing home residents in the last year of life: Nursing home characteristics and variation in potentially avoidable hospitalizations","volume":"61","author":"Xing","year":"2013","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e064914","DOI":"10.1136\/bmjopen-2022-064914","article-title":"Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review","volume":"13","author":"Searle","year":"2023","journal-title":"BMJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1007\/s41999-021-00531-2","article-title":"Nursing homes during the COVID-19 pandemic: A scoping review of challenges and responses","volume":"12","author":"Giri","year":"2021","journal-title":"Eur. Geriatr. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Dixon, J., Lorenz-Dant, K., Stubbs, E., Harrison Dening, K., Mostaghim, M., and Casson, D. (2023). Registered care home managers\u2019 experiences of responding to the national care home visiting guidance in England during the Covid-19 pandemic; a multi-method qualitative study. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-03935-w"},{"key":"ref_10","unstructured":"Department of Health and Social Care (2024, April 02). Coronavirus (COVID-19): Admission and Care of People in Care Homes 2020, Available online: https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-admission-and-care-of-people-in-care-homes."},{"key":"ref_11","unstructured":"Department of Health and Social Care (2024, July 22). Update on Policies for Visiting Arrangements in Care Homes, Available online: https:\/\/www.gov.uk\/government\/publications\/visiting-carehomes-during-coronavirus."},{"key":"ref_12","unstructured":"Department of Health and Social Care (2023, September 18). Adult Social Care: Our COVID-19 Winter Plan 2020 to 2021, Available online: https:\/\/www.gov.uk\/government\/publications\/adult-social-care-coronavirus-covid-19-winter-plan-2020-to-2021\/adult-social-care-our-covid-19-winter-plan-2020-to-2021."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Hockley, J., Hafford-Letchfield, T., Noone, S., Mason, B., Jamieson, L., Iversholt, R., Musslebrook, K., Palattiyil, G., Sidvha, D., and Quinn, N. (2021). COVID, Communication and Care Homes: A Staffs\u2019 Perspective of Supporting the Emotional Needs of Families. J. Long-Term Care, 167\u2013176.","DOI":"10.31389\/jltc.74"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Collingridge Moore, D., Garner, A., Cotterell, N., Harding, A.J.E., and Preston, N. (2024). Long term care facilities in England during the COVID-19 pandemic-a scoping review of guidelines, policy and recommendations. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-04867-9"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Schneider, P., Abt, M., Cohen, C., Marmier, N., and Ortoleva Bucher, C. (2023). The impact of protective measures against COVID-19 on the wellbeing of residents in nursing homes and their relatives: A rapid review. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-04300-7"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"54","DOI":"10.31389\/jltc.135","article-title":"No visitors allowed! The impact of COVID-19 restrictions on the psychosocial well-being of nursing home residents","volume":"2023","author":"Shaw","year":"2023","journal-title":"J. Long-Term Care"},{"key":"ref_17","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":"Levere","year":"2021","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"afab229","DOI":"10.1093\/ageing\/afab229","article-title":"Are we allowed to visit now? Concerns and issues surrounding vaccination and infection risks in UK care homes during COVID-19","volume":"51","author":"Giebel","year":"2022","journal-title":"Age Ageing"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cornally, N., Kilty, C., Buckley, C., O\u2019Caoimh, R., O\u2019Donovan, M.R., Monahan, M.P., O\u2019Connor, C.D., Fitzgerald, S., and Hartigan, I. (2022). 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. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19116559"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Nash, W.A., Harris, L.M., Heller, K.E., and Mitchell, B.D. (2022). \u201cWe are saving their bodies and destroying their souls.\u201d: Family caregivers\u2019 experiences of formal care setting visitation restrictions during the COVID-19 pandemic. The COVID-19 Pandemic and Older Adults, Routledge.","DOI":"10.4324\/9781003273462-7"},{"key":"ref_21","unstructured":"Care Quality Commision (2024, July 22). CQC to Stop Routine Inspections to Focus on Supporting Providers to Deliver Safe Care During COVID-19 Pandemic. Available online: https:\/\/www.cqc.org.uk\/news\/releases\/cqc-stop-routine-inspections-focus-supporting-providers-deliver-safe-care-during-cov-0."},{"key":"ref_22","unstructured":"(2024, July 22). Palliative Care in Long-term Care Settings for Older People. Available online: https:\/\/www.sicp.it\/wp-content\/uploads\/2018\/12\/9_EAPCLong-termcareRSAneuro2012.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e297","DOI":"10.1016\/S2666-7568(24)00008-4","article-title":"Involuntary closures of for-profit care homes in England by the Care Quality Commission","volume":"5","author":"Goodair","year":"2024","journal-title":"Lancet Healthy Longev."},{"key":"ref_24","unstructured":"Skills for Care (2024). Care Homes Without Nursing in the Adult Social Care Sector, Skills for Care."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1093\/ageing\/afz118","article-title":"Burnout in UK care home staff and its effect on staff turnover: MARQUE English national care home longitudinal survey","volume":"49","author":"Costello","year":"2020","journal-title":"Age Ageing"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1080\/08959420.2020.1851349","article-title":"The association between staff retention and English care home quality","volume":"33","author":"Allan","year":"2021","journal-title":"J. Aging Soc. Policy"},{"key":"ref_27","unstructured":"ATLAS.ti Scientific Software Development GmbH (2023). ATLAS.ti Mac, 24, ATLAS.ti Scientific Software Development GmbH."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_29","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":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.ajic.2021.07.001","article-title":"Impact of visitation and cohorting policies to shield residents from covid-19 spread in care homes: An agent-based model","volume":"49","author":"Nguyen","year":"2021","journal-title":"Am. J. Infect. Control"},{"key":"ref_31","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":"Verbeek","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.jinf.2020.07.027","article-title":"Increased risk of SARS-CoV-2 infection in staff working across different care homes: Enhanced CoVID-19 outbreak investigations in London care Homes","volume":"81","author":"Ladhani","year":"2020","journal-title":"J. Infect."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Marshall, F., Gordon, A., Gladman, J.R.F., and Bishop, S. (2021). Care homes, their communities, and resilience in the face of the COVID-19 pandemic: Interim findings from a qualitative study. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02053-9"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1080\/13561820.2020.1792425","article-title":"Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: Experiences of frontline workers in the English Midlands region, UK","volume":"34","author":"Nyashanu","year":"2020","journal-title":"J. Interprofessional Care"},{"key":"ref_35","unstructured":"(2024, July 22). A mixed-methods scoping review of long-term care facility design and associated outcomes. Available online: https:\/\/stmcollege.ca\/documents\/academic-initiatives\/faculty-research\/pywell-et-al.-review-of-ltc-design-2023-03-20.pdf."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Bradshaw, A., Ostler, S., Goodman, C., Batkovskyte, I., Ellis-Smith, C., Tunnard, I., Bone, A., Barclay, S., Vernon, M., and Higginson, I. (2023). Provision of palliative and end-of-life care in UK care homes during the COVID-19 pandemic: A mixed methods observational study with implications for policy. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1058736"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Saad, A., Magwood, O., Benjamen, J., Haridas, R., Hashmi, S.S., Girard, V., Sayfi, S., Unachukwu, U., Rowhani, M., and Agarwal, A. (2022). Health Equity Implications of the COVID-19 Lockdown and Visitation Strategies in Long-Term Care Homes in Ontario: A Mixed Method Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19074275"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.jamda.2021.12.022","article-title":"Reimagining Family Involvement in Residential Long-Term Care","volume":"23","author":"Gaugler","year":"2022","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1016\/j.jamda.2020.09.031","article-title":"Evaluating Perspectives of Relatives of Nursing Home Residents on the Nursing Home Visiting Restrictions During the COVID-19 Crisis: A Dutch Cross-Sectional Survey Study","volume":"21","author":"Wammes","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e2017533","DOI":"10.1001\/jamanetworkopen.2020.17533","article-title":"Coronavirus Disease 2019 Outcomes in French Nursing Homes That Implemented Staff Confinement With Residents","volume":"3","author":"Belmin","year":"2020","journal-title":"JAMA Netw. Open"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/2\/221\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:26:59Z","timestamp":1760027219000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/2\/221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,5]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["ijerph22020221"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22020221","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,5]]}}}