Policy Decisionmaking in Long-Term Care: Lessons from Infection Control During the COVID-19 Pandemic

The COVID-19 pandemic focused attention on long-term care facilities' need for infection-control policies that balanced community safety and individual well-being. Infection-control policies were often developed, implemented, and mandated without the input or involvement of those who are most affected: residents and their family members, administrators, and staff. This failure led to declines in residents' physical and mental health. The pandemic exposed an opportunity-and an imperative-to reimagine long-term care in a way that is centered on the needs and preferences of those who receive care, their family members, and those who provide care. This study lays the groundwork for cultural change and a move toward inclusive policy decisionmaking in long-term care through a review of infection-control policy decisions and action items proposed in guided discussions with a diversity of stakeholders-long-term care residents, direct care staff, and consumer advocates to facility administrators, clinicians, researchers, and industry organizations. Transforming the culture of long-term care to elevate the needs of residents will require attention to facility leadership, along with steps to increase inclusiveness, transparency, and accountability in decisionmaking.