Infection Control Policy in Long-Term Care — Who Decides?

The coronavirus disease 2019 (COVID-19) pandemic underscores that long-term care residents and families who are most affected by facility policies are not well represented in decisionmaking. The value of including resident, staff, and family preferences and perspectives in governance of long-term care extends beyond the COVID-19 crisis.

In this Perspective, the author suggests a hybrid model for including long-term care residents and other stakeholders in the governance of their facilities. Long-term care policy could then incorporate these perspectives, reflecting the views of residents and families, in partnership with long-term care administrators and staff.

For infection control, inclusive governance could broaden the focus from infection rates and death to include rates of depression, delirium, cognitive decline, and physical deconditioning. The cultural shift to recognize patients, direct care staff, and families as stakeholders with perspectives to include in decisionmaking could improve infection control practices while also improving health-related quality of life for residents — a cultural shift that is long overdue.