Patterns and Predictors of Reopening Nursing Homes to Visitors During the COVID-19 Pandemic

Statewide restrictions on visitors to nursing homes were widely used during the COVID-19 pandemic. This study examines the patterns and predictors of allowing outside visitors after a statewide ban on visitors was lifted.

A secondary analysis of publicly available data.

A total of 847 Ohio nursing homes that reported visitor policy data.

We obtained weekly visitor policies (October 29, 2020, to April 15, 2021) from the Ohio Long-Term Care Facility Visitation Dashboard. We merged visitor policies with resident, facility, and COVID-19 factors and conducted 2-level (nursing home, county) Hierarchical Generalized Linear Mixed models with backward variable selection to examine predictors of allowing visitors and reinstating bans.

Within 3 weeks of lifting the ban in Ohio on December 10, 2020, 51% of the 653 Ohio nursing homes with available data allowed visitors. The proportion of facilities that allowed visitors declined to 36% by November 25, 2020, but began increasing in late February and reached 81% by April 15, 2021. Of the 495 nursing homes that initially opened to visitors, 35% of them later reinstated bans, with half of these later allowing visitors again before March 2021. When nursing homes were first allowed to reopen, facilities with a recent COVID-19 infection among residents or staff were much less likely to allow visitors (relative risk, 0.38; 95% CI, 0.31-0.47). During a statewide increase in community COVID-19 infection rates, nursing homes in counties with higher rates were less likely to allow visitors (relative risk, 0.80; 95% CI, 0.63-0.99). Nursing homes that had more beds (relative risk, 1.61; 95% CI, 1.35-1.92) and higher overall 5-star ratings (relative risk, 1.27; 95% CI, 1.08-1.49) were more likely to reinstate bans.

The pattern of reopening nursing homes to visitors was marked by a slow progression and dynamic policy changes over time. The 2 primary predictors associated with reopening were facility and community COVID-19 status.