番茄社区

Roughly a year after healthcare facilities shut their doors to visitors to protect patients and workers from COVID-19, many have begun to loosen their previous visitation restrictions. But some hospitals still won't budge, in spite of decreasing COVID cases, growing vaccination rates, and updated CDC guidelines -- leaving patients and their families with few ways to stay connected.

During the various peaks of the pandemic, barring visitors from healthcare facilities was understood as a necessary, but devastating, precaution. Lockdown protocols meant that many sick patients had to pass away alone or on FaceTime with a loved one, with their funerals held on Zoom.

Now, nearly 43% of U.S. residents have been fully vaccinated, and hospitals are slowly but surely opening themselves back up to visitors. In April, the CDC their healthcare guidelines, stating that indoor visits are permitted, but should be limited to critically ill patients.

The new guidelines recommend that hospital staff keep track of which visitors are vaccinated, make sure all parties remain 6 feet apart, and, if needed, limit the total number of visitors per patient to comply with capacity regulations and physical distancing requirements.

Hospitals, however, can choose their own policies.

Pleading for Change

For the last couple of months, vascular and interventional radiologist Mark Lessne, MD, has been making trips from his practice in Charlotte, North Carolina, to West Palm Beach, Florida, to visit his sick mother. Lessne's mother was receiving compassionate care at a long-term care facility called MorseLife, which to provide their residents with a "five-star senior lifestyle." It's also "the only senior care provider authorized by the State of Florida to offer cannabis-based therapies," according to its website.

Despite MorseLife's promise of top-tier care, Lessne said that he was constantly pleading with staff and administrators to let him see his mother for more than the allotted 1 hour, twice a week. During her time at MorseLife, Lessne disclosed that his mother has had multiple episodes of delirium, which had not happened before.

In an email shared with 番茄社区, Lessne wrote to a staff member about his mother's episodes, taking issue with the fact that she had been in isolation for the better part of 3 weeks and had barely been outside. (Isolated patients are nearly to develop delirium.)

"She'd call me in the middle of the night and ask me to pick her up from the movie theater," Lessne recalled.

Lessne asked staff members if he could spend 4-5 hours with his mom on one of his trips to West Palm, presenting them with relevant data and existing CMS and CDC guidelines to back up his case. Other healthcare facilities across Florida -- including in West Palm Beach -- have loosened their restrictions, in giving visitors up to a 7-hour window of time to see their loved ones. His complaints were shuffled between various staff members; no matter how far Lessne moved up MorseLife's administrative ladder, he said he always got the same vague response.

"The answer was always, 'That's our policy. We have no intention of changing it,'" Lessne said. "I know that we went through hell during the height of COVID, especially in South Florida ... But we need to have a judicious review of what's going on now."

Ultimately, Lessne was granted a 2-hour visit.

At the time of press, MorseLife had not responded to request for comment.

An Uneven Playing Field?

According to Alok Patel, MD, a pediatric hospitalist in San Francisco, visitation policies aren't just inconsistent from facility to facility -- patients in the same hospital may be granted visitor access because they are well connected, or "VIP" patients.

"They're able to make a phone call or ask for a favor," Patel explained. "In other words, [they] get preferential treatment that somebody else may not get."

In other cases, Patel told 番茄社区, a patient may just have someone in the hospital -- perhaps a nurse or physician -- who can strongly advocate for their needs and wishes.

As a pediatric hospitalist during a pandemic, it's not uncommon for Patel to see parents from more rural areas coming in with their children. His hospital's COVID restrictions permit only one parent to stay overnight with their child.

"What happens to the other parent? What if one of those parents has their own medical needs, or they're in their third trimester of pregnancy and could use an extra hand?" Patel wondered. "I think we really need to take a hard look at what visitation policies look like during the pandemic -- if they actually make sense and if they do right by our patients."

Patel has seen a wide range of responses to this predicament. Sometimes a parent is kicked out of a room and has to find their own place to stay, and other times there might be an especially compassionate unit supervisor on duty who lets both parents stay overnight in the hospital.

Only the Critically Ill

Critical care expert Wes Ely, MD, MPH, of Vanderbilt University in Nashville, told 番茄社区 that there's no reason why visits should be limited to the critically ill at this stage of the pandemic, as it states in the current CDC guidelines.

"How many people ended up [dying] because they didn't have family around them to give them the will to live?" Ely asked. "Would they be at the end of their life if they had gotten their loved ones earlier on?"

For hospitals trying to open themselves back up to visitors, the worsening in U.S. healthcare systems may be playing a significant role. In order for a healthcare facility to permit visits again, they need to have enough staff to properly process each visitor while not compromising their standard of patient care.

But Ely speculated that many healthcare facilities haven't yet changed their policies because they don't want to disturb a system that is already working; it stems from what he described as a "lag in thinking."

For him, keeping sick patients away from their families unnecessarily is "anti-medicine," and there's a logical next step. He hopes to see changes made on the national level, so that there can be some sense of widespread clarity on this issue.

"I think the CDC is being negligent right now in not saying explicitly that it's time for hospitals to reopen," Ely said. "They need to stop being passive about this."

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