Supporting a safe return of family and friends to care homes

We are delighted the Government has published new Guidance on care home visiting. It acknowledges that “welcoming anyone into care homes from the community inevitably brings risk of COVID-19 transmission.
Old man with family members in the background

However, these risks can be managed and mitigated, and they should be balanced against the importance of visiting and the benefits it brings to care home residents and their families.’

We recognise that family and friends are not just “anyone” and many of you have shown such patience in the face of significant emotional and physical turmoil for yourselves and your cared for.

From 8 March 2021 the Government advice is to support safe visiting:

  • Every care home resident will be able to nominate a single named visitor who will be able to enter the care home for regular visits.

These visitors should be tested using rapid lateral flow tests before every visit, must wear the appropriate personal protective equipment (PPE) and follow all other infection prevention control measures (which the care home will guide them on) during visits.

Visitors and residents are advised to keep physical contact to a minimum. Visitors and residents may wish to hold hands however, we should always be mindful that physical contact can risk transmission, so if we are able, we should try to keep it to a minimum. There should not be close physical contact such as hugging.

This is always a challenge for families, but it is important that the visitor remains the same person as far as possible.

  • Residents with the highest care needs will also be able to nominate an essential care giver. Good news for those relatives/friends who, previously helped their cared for with some daily living tasks – like eating and drinking.
  • Care homes can continue to offer visits to other friends or family members with arrangements such as outdoor visiting, substantial screens, visiting pods, or behind windows.

If the care home has an COVID-19 outbreak or is in an outbreak situation visiting has to stop (except in exceptional circumstances such as end of life – and for essential care givers, unless there are specific reasons not to do the latter) to protect residents, staff and visitors.

For more details on what is a definition of an outbreak – see section 1.4 in the guidance.

Many of you will no doubt have studied the guidance and have had conversations with you relative or friend’s care home so may already understand the following. If not, and to start a positive conversation we have a template you may wish to consider/adapt.

What we think you need to know

  • In most circumstances, even for infection control reasons supervision during a visit (by staff) will not be necessary but may be useful for the first visit.
  • Neither you nor the resident need to have been vaccinated in order to be able to visit but it is strongly recommended that when invited to have the vaccine you take up this opportunity.
  • Care home managers are best placed to decide how their care home enables visiting. We, like the guidance, would encourage managers, residents and families to work together to find the best ways forward. Managers are responsible for the wellbeing of the whole home.
  • For safety, visiting needs to be planned and therefore ad-hoc or unannounced visits will not be possible. Care homes are encouraged to have a simple booking or appointment system in place.
  • Homes should have visiting policies developed around a dynamic risk assessment.

You may see that there are different rules for different residents or groups of residents, based on an assessment of risk of contracting COVID-19, as well as the potential benefits of visits to them.

A home should be sharing a copy of the risk assessment(s) underpinning their visiting policy with the residents and their families, to help explain decisions.

  • Where a resident doesn’t have the capacity to discuss or decide on a nominated visitor, the care home is encouraged to discuss the situation with the resident’s family, friends and others who may usually have visited them.

Where this is the case, a person can only be nominated if this has been determined to be in the resident’s best interest (see section 1.3.)

  • If applicable, social workers can be approached by anyone to support the visiting conversations, in particular to help resolve any issues or concerns, and ‘to ensure professional support and or oversight, where required.’
  • For residents with particular needs which may make it challenging to follow some of the detailed advice there will need to be tailored visiting policy (within the principles of the guidance). For example, those who are unable to leave their rooms, those living with dementia or those who may lack relevant mental capacity.
  • If there is a restriction to visitors in place, alternative ways of communicating between residents and their families and friends should be offered. The care home should provide regular updates to residents’ loved ones on their mental and physical health, how they are coping and identify any additional ways they might be better supported, including any cultural or religious needs.

Testing

  • Care homes have information around the practicalities of administering test and registering results and you will need to consent to the test prior to having the test and visiting.

Please clarify with your home the booking time/arrangements – so you are clear when to turn up for a test. (For example, if you have a 11am visiting appointment, do you turn up to the home at 10.20am so there is time for testing and putting on PPE etc?)

As a visitor, if you test positive you must leave the grounds immediately, go home and self-isolate, avoiding public transport wherever possible.

You must follow government guidance for households with possible or confirmed coronavirus (COVID-19) infection and immediately self-isolate and complete a confirmatory polymerase chain reaction (PCR) test which the care home should provide. This can be returned either through a courier or through a Royal Mail priority post box.

If the confirmatory PCR comes back positive, your household must also self-isolate and contacts may also need to self-isolate in line with current government guidance for households with possible or confirmed coronavirus (COVID-19) infection.

If you have recently tested positive for COVID-19 you should not be routinely retested within 90 days, unless you develop new symptoms.

  • The home should be clear on their infection prevention control advice and what will happen if people do not follow the advice. This may include asking you not to touch anything in the room, being asked to avoid visiting anywhere on the way to the home (for example to buy flowers, etc.)

Staff may talk about gifts and will ask that these be easily cleaned by the care home. For example, a box of chocolates that can be wiped down. They may also ask some screening questions (examples are given in section 2.5).

It is important to follow such instructions carefully – this help reduce the risk to you as well as others.

Essential care givers

  • For residents who have a greater degree of personal care, a care home can enable and support the nominated visitor to provide this care and they will be able to visit more often. The essential care advice also includes for situations such as a resident refusing to eat unless they do so in the company of a partner or loved one.
  • These visitors are a central part of delivering the appropriate care and support to the resident, and as such play a role alongside professional members of the care home staff.
  • As closer physical contact with the resident will happen, or more time is spend in and around the care home – it is important that such people take further steps to reduce the risks (to themselves to residents and staff members) of infection, and the home should discuss these in detail. It is a good idea to have what is agreed written down.

Outdoor and ‘screened’ visits (limited to two visitors at any one time)

  • Care homes should facilitate this type of visit in a way that reduces the risks to visitors, residents and staff.
  •  Where possible visits should be in the open air (which could include gazebo, awnings etc.). Visitors must remain at least two metres apart.

Some homes have outdoor structures commonly known as ‘visiting pods’, which are enclosed to some degree, but are still outside the main building of the home. Other homes are using conservatories that can be accessed from outside the home.

In such cases: The space must only be used for one resident (who may be accompanied if appropriate by an essential care giver and they can sit with the resident whilst the visitor sits the other side). Such space is subject to regular enhanced cleaning between each visit.

    • If there is a single-entry point, then the visitor and the resident must enter at different times.
    • There must be a substantial screen between the resident and visitor
    • There is good ventilation.
    • Use of speakers or assisted hearing devices helps to avoid the need to raise voices and therefore increase transmission risk.

Preparing for a visit

We recognise that for many, visiting and seeing a resident has been very limited for so long. For those who find themselves in this position you may find the following helpful in preparing for a visit. (Some of this is detailed in the guidance and other information has come from working with others.)

Giving yourself time to think about your own emotions and expectations ahead of visiting may help. Have simple aims – as you build up your visits over time, your regular contact and presence will have an effect.

Be prepared to talk and be with your relative without them immediately knowing you. They may not immediately recognise you and may become unsettled during the visit.

  • Where you haven’t seen your relative or friend for some time, it’s likely you both will look different - our hair is probably longer (as we haven’t managed to get to a hairdresser for some time). You will be harder to recognise in PPE and your voice will be muffled.
  • It may be useful to ask the home to share recent photos of you both, to have a clear photo attached to you so the resident can see your image. If possible, talk to them beforehand about what you’ll wear on the day of the visit etc. Wearing your hair in a familiar way may help – as this is something the person will be able to see (assuming you not wearing a hair net and are avoiding a hat.)
  • Appeal to the senses - a familiar scent, piece of clothing or
    shared music, may help with rebuilding your connection with each other.

You can read the full Government Guidance Document here: 

Read the guidance

 

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