Early in the COVID-19 pandemic, in response to the disproportionately high rates of serious illness and death among residents and staff in U.S. nursing homes, public health officials imposed stringent limits on visits by outsiders to, and social interaction among residents in, such facilities. These restrictions were swiftly issued and implemented before unintended consequences could be fully assessed or stakeholder views systematically solicited. With time, as the requirements changed, some facilities modified their policies on internal and external contacts. What can be learned from this experience about public health decisionmaking that aims to protect vulnerable populations? Is it feasible to consider consequences beyond the direct health risks posed by a pathogen, and if so, which factors should enter into the policymaking process?
Through a national survey of LTC facilities and interviews with facility administrators, residents and their families, and policymakers, the project will investigate the factors and principles that influenced the policies adopted at various stages of the pandemic. Special attention will be paid to whether effects on ethical principles, such as beneficence, autonomy, and justice, have a role when the possible benefits of a policy are weighed against its possible harms.