‘Devil’s dilemma’: France lifts ban on nursing home visits as some warn against relaxing rules

After more than a month in seclusion, France’s 7,000 care homes for the elderly were told they could resume visits from family members starting on Monday but under strict conditions to ensure the safety of their residents.

With the elderly particularly vulnerable to Covid-19, all physical contact will remain strictly barred. But the government is hoping even visual contact will provide “solace” to both isolated residents and their anguished relatives.

The decision comes days after President Emmanuel Macron ordered an exception to one of the world's strictest lockdowns, asking his government to ensure families are allowed "to see the sick at the end of their lives, to be able to bid them adieu”.

Around the world, the elderly make up a disproportionate share of victims of the novel coronavirus, a highly infectious virus that has turned France’s state-funded care homes into ticking time bombs. 

Nursing home deaths account for more than a third of France’s total 19,000 coronavirus deaths – figures the government now documents meticulously after weeks of pressure. Just under half of the country’s care homes have been affected, with more than 15,000 confirmed cases among patients and 8,900 among staff between March 1 and April 14.

‘Lonely and depressed’

To protect the elderly, care homes have been operating in a vacuum for more than a month now, their residents isolated in their rooms. But experts have warned that confinement can take a different kind of toll.

Assistant nurse Sophie Marconet said weeks of solitary confinement were weighing heavily on the morale of residents at her Alsatian care home in hard-hit eastern France, where isolation was enforced in early March – a week before the rest of France.

“They’re lonely and depressed. In somes cases a ‘sliding syndrome’ (a rapid deterioration of one’s health) has kicked in,” she told FRANCE 24. “Many don’t understand why they are being kept in forced isolation, why they eat alone in their rooms, and why nobody comes to see them.”

Marcenat and her colleagues organise Skype sessions with the families whenever possible. They also answer regular phone calls from anguished relatives eager for news. But there is only so much companionship they can provide. The lockdown has put an end to communal meals in the dining room and every other form of social life. 

Marc Bourquin of France’s Hospital Federation, which oversees public nursing homes, said it was necessary for residents to have visitors, especially if coronavirus-related restrictions remain in place for months. 

“When workers see that a person is losing the taste for life because they can’t see their families, we have to find a progressive way to allow a minimum of contact,” Bourquin told The Associated Press. “The risk of virus will not disappear as long as there is no vaccine. We cannot condemn these people to never see their loved ones again.”

>> Covid-19 in France’s nursing homes: ‘Saying goodbye makes all the difference’

Experts have argued that contact is equally essential for families, particularly when they face the prospect of losing a loved one. In an interview with France Inter radio last week, psychiatrist Serge Hefez stressed the importance of being able to be with loved ones at their time of death. Hefez himself lost his mother while she was in lockdown in a nursing home.

“All the dignity our loved ones have at the end of their lives is when we are with them, hold their hand, reassure them, stay close to them during this passage from life to death; but many are being deprived of this,” he explained. “We are losing our humanity and entering a kind of barbarity with an over-protective hygiene system even though death is part of the rhythm of life.”

Balancing physical and psychological health 

Pascal Champvert, the head of AD-PA, France's main association representing care home directors, has argued in favour of easing restrictions on family visits, noting that the psychological health of many residents has deteriorated sharply after weeks of isolation.

"We must find a balance between the physical and psychological safety of our residents," he told French daily La Croix. "Even as we continue to protect them as far as possible from Covid-19, we believe it is urgent that they be able to re-establish links with their families."

As of Monday afternoon, none of the care homes contacted by FRANCE 24 had resumed family visits, with staff members suggesting the logistics were still being discussed.

Announcing the new measures a day earlier, Health Minister Olivier Véran said visits would be limited to two family members per resident, and would only begin once safety measures were in place. 

Véran assured the public that the country’s care homes had finally received the necessary protective gear after weeks of desperate shortages.

At her care home in Alsace, Marcenat confirmed that masks and gloves were more readily available, although gowns were still lacking. But she was sceptical that family visits could resume without endangering those in her care.

“I think it’s too early to start visits again, despite the sadness and anguish voiced by the families and of course our residents,” she said. “It’s too early for comfort.”

>> As coronavirus creeps into French care homes, a 'tsunami' of deaths goes uncounted

Sophie Santandrea, of private French nursing home group Synerpa, was equally cautious about allowing visits.

“It will depend on the protocols that are put in place, and whether they are very clear and sufficient” to protect everyone from exposure to the virus from visitors, Santandrea told AP.

‘It's about survival’

Other countries in Europe, home to the world’s oldest population, have been grappling with the same ethical quandary – one that Dutch Health Minister Hugo de Jonge has described as a “devil’s dilemma”.

Germany, which has fared better than most so far, allows nursing home patients to receive one visitor for up to one hour a day, and doesn’t restrict visits to palliative care facilities for those nearing the end. Other countries are making tentative steps in that director, while meeting stiff resistance.

In Britain, where the shortage of personal protective equipment, or PPE, has been particularly acute, health workers have warned against relaxing rules to ease the pain of families.

“As of this moment, I am very worried that we don’t have enough PPE for staff to protect themselves, let alone facilitate giving it to relatives to be able to see their loved ones during the end-of-life care,” Donna Kinnair, chief executive of the Royal College of Nursing, told AP.

There was similar opposition last week when Belgium’s government said it would allow one healthy visitor for each nursing home resident, with Prime Minister Sophie Wilmes warning that people “can die of loneliness”.

The government’s decision stirred a whirlwind of criticism amid cries it would endanger lives, overburden the staff and divert the already short supplies of protective equipment away from doctors and nurses. The plan has already been repealed in most of the regions that make up the Belgian federation.

Ursula von der Leyen, the EU Commission president, has been unequivocal on the subject, warning that “contacts with the elderly must be restricted as much as possible”.

“I realise it is difficult and that loneliness weighs heavy,” she said. “But it’s about survival."