“People Need to Know They Matter to Somebody”: Interdisciplinary Staff Perceptions of Compassionate Care Visits for Seriously Ill Residents in Nursing Homes During the COVID-19 Pandemic (Sci206)

1. Articulate the risk, benefits, and outcomes of compassionate care visits during restricted visitation in nursing homes as they pertain to psychological, social, and spiritual domains of care. 2. Explore potential approaches to improve care for people living with serious illness in nursing homes while balancing risk/benefit and equitable access to resources for safety precautions during restricted visitation. During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services announced strict guidance for compassionate care visitation (CCV) in nursing homes (NHs) to protect residents and facilities from outbreak yet permit residents’ visitors at the end of life. As a result, seriously ill NH residents, not imminently dying, experienced enormously high rates of social and physical isolation, and staff were left to interpret guidance and manage who could and could not have CCV. This qualitative descriptive study intended to illustrate NH staffs’ understanding, use, and perception of risk around CCVs for residents experiencing serious illness during the COVID-19 pandemic. We conducted semi-structured interviews and analyzed data using directed content analysis to assess staffs’ definition of CCVs, their facilities’ use of CCVs, and staffs’ perceptions of the risks and benefits of CCVs. Participants (N=24) included licensed and unlicensed nursing staff (eg, RN, LPN, CNA), social workers, and activities directors; were mostly female (88%) and White (79%); and had more than 3 years of experience working in NHs (79%). Results indicate the definition and use of CCVs simultaneously expanded over time supported by three themes: visits for those imminently dying, visits to support psychosocial needs, and visits to alleviate family concern. Throughout the themes, we found: 1) the benefits of CCVs—improved physical and emotional well-being—outweighed the risk of COVID-19 transmission and 2) the risks of CCVs were perceived as minimal when adequate safety precautions (e.g., screening, personal protective equipment, and vaccination) were available and used as risk mitigation strategies. The findings highlight the need to consider the physical and psychosocial consequences of social isolation of NH residents while expediently assessing the risk/benefit profile of CCVs and viral transmission and ensuring equitable access to safety precautions in NHs during public health crises.