Briefing on visiting care homes during COVID-19

The situation with COVID-19 is moving quickly, and while we have in place a series of webinars and other events to ensure elected members, officers and partners are updated, there are a number of issues which come up repeatedly or need slightly more detailed information. This briefing series is designed to provide accurate and up to date information on key issues. 


Guidance as at 19 December 2020

This Guidance should be read in conjunction with Government Guidance on lateral flow testing of visitors in care homes, which includes testing professional visitors who are not part of a regular testing regime, as well as family and friends. Tier 4 Guidance on visiting relatives should also be observed.

Principles

  • Visiting by family and friends should be supported and enabled wherever it is possible to do so safely, in line with latest published Government guidance, and within a care home environment that takes proportionate steps to manage the risks associated with any increase in visitors.
  • The Government’s guidance has been developed to support local system leaders, providers, staff, and families, to plan and carry out visits that provide meaningful contact as safely as possible.
  • This means care homes finding the right balance between the benefits of visiting to the wellbeing and quality of life of individual residents, and the increased risk of transmission of COVID-19 to social care staff and other clinically vulnerable residents.
  • Government is distributing lateral flow test kits to CQC registered care homes across the country for use with family, friends, with the stated aim of enabling tests for up to 2 visitors per resident, twice a week, by Christmas. Visitors will need to agree visits with the care home in advance, taking account of the additional workload this involves for care homes, and recognising that care homes will make their own risk assessments and may further develop visiting policies to ensure the safety of their staff and residents
  • While lateral flow testing can contribute to a reduction in the risks associated with care home visiting, it does not guarantee freedom from the risk of infection. Where lateral flow testing is being used, care must continue with robust infection prevention and control (IPC) measures in place and visitors must continue to wear the appropriate personal protective equipment (PPE), observe social distancing when in the care home, and observe good hand hygiene,as well as following any additional guidelines from the care home itself on whether physical contact with the person they are visiting is allowable.
  • Given that each care home is unique in its physical layout, environment and facilities, and that residents needs will vary, individual care home managers are best placed to decide how visits should happen in their care homes, in a way that best meets the needs of their residents, both individually and collectively.
  • The individual resident, their views, needs and wellbeing should be always considered when making decisions about visiting policy, while recognising that care homes also must balance individual needs with those of others living and working in the care home .
  • Visiting decisions should always involve the resident, or their representative, their family and friends, the care home provider and other relevant professionals such as social workers or clinicians, as appropriate.
  • Visits in exceptional circumstances such as end of life should continue in all circumstances (this includes those in Tier 4 areas).

Key messages

  • The registered manager is responsible for setting the visiting policy in their home, and on the basis of a dynamic risk assessment, taking into consideration the needs of individuals within their home, on the advice of the local Director of Public Health (DPH)
  • All care homes, regardless of tier, and except in the event of an active outbreak – should  enable outdoor visiting and ‘screened’ visits
  • In the event of an active outbreak, all visiting must be stopped until the outbreak is over, and any local outbreak management arrangements should be followed; the only exception to this would be end of life

Key messages - providers

  • Providers should facilitate visiting as set out in Government guidance wherever it is possible to do so in a safe and risk-managed way.
  • Providers should develop a dynamic risk assessment to help them decide visiting policy, and one which takes account of the individual needs of their residents as well as the physical and other features unique to the care home.

Key message - DPH and DASS roles

  • The local DPH and Director of Adult Social Services have an important role in supporting care homes to enable safe visiting, unless there is good evidence that a more restrictive approach in a particular care home is necessary.
  • Locally developed frameworks or guidance affecting care home visiting should enable care homes to exercise discretion on visiting policy, depending on their individual circumstances.
  • The default position in the Government’s guidance is that visits should be supported and enabled wherever it is safe to do so.
  • A DPH may provide advice for specific care homes, or provide a local framework and guidance relevant to a particular geographical area.
  • A DPH may also give direction to a specific home about steps they are required to take in order to allow visiting safely -including a Notice or Direction pursuant to the Public Health (Control of Disease) Act 2020 or a Direction pursuant to the Coronavirus Act 2020.

Key messages - the visitors

  • When developing their visiting policies, providers should undertake individual risk assessments where necessary, to assess the rights and needs of individual residents, as well as any specific vulnerabilities which are outlined in the resident’s care plan, and to consider the role that visiting can play in this.
  • Providers must consider the rights of residents who lack the relevant mental capacity needed to make decisions about visiting and who will fall under the Mental Capacity Act 2005 (MCA) and are protected by its safeguards. Where appropriate, advocates or those with power of attorney should be consulted, and if there is a deputy or attorney with relevant authority they must consent on the person’s behalf to any decision on visiting which affects them.

Key messages - the visits

  • Testing contributes to reducing the risks of visiting in care homes, but it does not mean there is no longer any risk, and visitors should be made aware of this.
  • Every visitor must return a negative test before each visit and having tested negative, must wear appropriate PPE, observe social distancing and good hand hygiene.
  • If these measures are observed, then it may be possible for visitors to have physical contact with their loved one as long as directions from care staff are followed and contact is kept to a minimum.
  • Visitor numbers should be limited to a maximum of two ‘constant’ visitors wherever possible to limit the overall number of visitors to the care home and the consequent risk of disease transmission from multiple different routes.
  • Visitors who test positive should immediately self-isolate and complete a confirmatory PCR test which should be provided to them by the care home. If this confirmatory PCR comes back positive, their household must also self-isolate and contacts may also need to self-isolate in line with current government guidance. Care homes should obtain consent from visitors prior to their participation in testing.
  • The Guidance sets out how care homes should set up a testing area for visitor testing, how they should communicate with visitors about the testing regime and what is expected of visitors to the care home.

Key message - indoor and outdoor visiting

  • Indoor visiting without testing can only happen in Tier 1 areas where visitor testing is not yet available in the particular care home.
  • Indoor visits in Tier 1 can go ahead provided they are limited to 2 people (preferably one), with social distancing, no physical contact, PPE use and good hand hygiene observed at all times.
  • Outdoor/screened visits can go ahead in all tiers without the need for testing, including Tier 4, as long as arrangements such as substantial screens, visiting pods, or window-visits are in place.
  • In Tier 4, close-contact indoor visits are not allowed.
  • Good IPC measures should remain in place including visits in the open air, under cover eg  awning, gazebo, open-sided marquee,or a dedicated room such as a conservatory which can be reached from the outside; remaining 2 metres apart at all times; space cleaned between each visit; the visiting space is used by only one resident and visiting party at a time, and is cleaned  between each visit; screens between the resident and visitor; good ventilation including doors and windows open where safe to do so and using ventilation systems at high rates where these circulate only fresh air.

Conclusion

Visits should happen in the context of robust practices for infection prevention and control throughout the care home and visitors must be made aware of the detailed expectations of them and which are set out in detail in the Guidance.