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Care Home Visitor Guidance

National Guidance

  • For the Full Government Guidance Click here
  • For a summary from the perspective on Mental Capacity Law and Policy click here

 

Key messages are as follows: 

  1. 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 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, but should bear in mind that any contact increases the risk of transmission. There should not be close physical contact such as hugging
  2. residents with the highest care needs will also be able to nominate an essential care giver.
  3. 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.

Visiting Guidance Webinars

  • Click here for slides 12th April 21
  • Click here for slides 8th March 21
  • Click here for recording 8th March 21
  • LFT On site Testing Guidance for Adult Care Providers Click here
  • PPE Audit Tool can be found here
  • Hand Hygiene audit tool can be found here
  • PPE Demonstration video click here

Hertfordshire Framework for Visits

 

Hertfordshire  Framework for Care Home Visits during COVID

This document outlines the approach Hertfordshire will be taking regarding family and nonessential visitors into care homes and includes appeals process and checklists for visiting, testing and residents leaving.

 

Click here to read

Click here for the Appeals template

Hertfordshire  Arrangements for Family and Other Non-Essential Care Home Visits – Letter from the Director of Public Health and Director of Adult Care Services – 5th March 2021

Summary:  We, like you, want to make visits to care home residents happen as soon as possible and as safely as possible because of the immense strain restrictions have placed on residents and their loved ones. This can only happen if we all do everything we can to prevent the spread of infection in the home and the community.

 

New Government visiting guidance with effect from 8th March 2021

You will have seen that Government guidance has been issued. This guidance provides that:

  • With effect from 8th March 2021, each resident can now have one visitor who can hold hands with their loved ones without the need for a screen; and up to two visitors at a time for “screened” or outdoor visits.
  • The guidance differentiates between visitors and essential “care givers”
  • We also want to take the opportunity to remind you that visits in exceptional circumstances, such as a resident at the end of the life should always continue at all times for residents, even when the home is closed to visitors.
  • All visitors must continue to be screened to check for COVID-19 symptoms, wear appropriate Personal Protection Equipment (PPE) whilst in the care home, follow social distancing where possible and follow good hand hygiene.
  • For indoor visits without screens, visitors will also need to be tested with LFD tests.

 

In outbreak situations

  • If a home has an outbreak (two or more cases which are linked) then all visits must cease until the outbreak is over (28 days from when the last date of the positive case). Homes may appeal through the usual established process for either all or some of the home (for example a wing of the home or a separate bungalow) to open before 28 days, which is outlined in our guidance document.

 

Click here to read full letter

Types of Visits

Type of visit Number of visitors PPE requirements Testing requirements Visits stopped
Essential “care giver” (indoor) 1 consistent

Same requirements as staff working within the care home

 

The home needs to ensure that the visitor has had appropriate training in safe donning and doffing in PPE, including disposal of PPE

Take a rapid lateral flow test before every visit except in the circumstances outlined in the guidance. This must include a minimum of 2 tests a week: one rapid lateral flow test on the same day as the PCR test, and one rapid lateral flow test 3 to 4 days later. If the visitor is visiting less than twice a week, they will need to make arrangements with the care home to carry out the twice weekly testing. These rapid lateral flow tests must be done on site and visitors cannot self-test at home

Take a weekly PCR test and share the result with the home. Care homes should use their existing PCR stocks to test these visitors and these should be registered as ‘staff’ tests using the care home unique organisation number (UON) and be returned via courier with other staff tests

The “care giver” will be subject to additional testing in line with care home staff should the care home be engaged in rapid response daily testing or outbreak testing

*Positive in last 90 days

Visits should continue even if a home has an outbreak unless there are specific reasons
Single named visitor (indoor) 1 consistent

Type II R masks, aprons and gloves always and following the home IPC measures, especially in hand hygiene.

Visitor should wear eye protection if the resident is coughing.

 

The home needs to ensure that the visitor has had appropriate training in safe donning and doffing in PPE, including disposal of PPE

 

 

Lateral flow test must be undertaken before each visit and must be negative

If they test positive, the visitor must be given a confirmatory PCR test to take home, immediately be asked to go home and self-isolate.

The area they have been in must be deep cleaned and the home should contact trace within the home for any potential contacts.

 

*Positive in last 90 days

Visits must be stopped if the conditions are met in the local guidance
Screened visits or outdoors Visitor numbers should be limited where possible, with a maximum 2 visits per each time

Type IIR masks are required but please ensure infection control advice and social distancing is maintained.

 

No testing is required for these visits Visits must be stopped if the conditions are met in the local guidance
Exceptional circumstances (end of life) This is based on the individual situation Appropriate PPE for the type of visit

No testing is required

However, the home may choose to use lateral flow testing if identified in their risk assessments

Visits should continue even if a home has an outbreak unless there are specific reasons

Other type of visits

Type of Visit

Number of Visitors

PPE Requirements

Testing Requirements

Visits Stopped

Professional visitors e.g health professionals (including mental health and therapists, ambulance), CQC and monitoring, Equipment deliverers and collection, social workers – who are part of their organisations regular testing programme

n/a

Appropriate PPE for this type of visit as per the homes request and national guidance

No testing is required as these individuals are under their own regular testing regime.

Visits can continue even if the home has an outbreak

Other essential visitors who are not regularly tested through their organisation (e.g maintenance)

n/a

Appropriate PPE for this type of visit as per the homes request and national guidance

Speak to the individual to understand whether they are part of a regular testing programme

If not, we would recommend they should have a lateral flow test unless in exceptional circumstances

Visits can continue even if the home has an outbreak, but this needs to be risk assessed by the home

 

*Positive in last 90 days – Visitors who have recently tested positive for COVID-19 should not routinely be retested within 90 days. This means that some visitors will not need to be tested regularly because they will still fall into this 90-day window. These visitors MUST SHOW EVIDENCE OF the result of their positive PCR result to show that they are currently exempt from testing until the 90-day period is over. Once the 90-day period is over, visitors should then continue to be tested. They should still continue to follow all other relevant IPC measures throughout these 90 days, including social distancing, maintaining good hand hygiene and wearing PPE

Tools to Support Visiting

All homes need to check their processes and policies. Utilise the Visiting and LFD testing checklists below

  • Checklist for residential care services visiting arrangements click here
  • Resident visiting out to family home click here
  • Care Home Lateral Flow Testing click here
  • Click here for the Appeals template

Lateral Flow National Resources:

Entry to Care Homes for Professionals

 

Visiting professionals could include;

  • Equipment Team (Deliveries and Collections)
  • Physio,
  • Occupational Therapists,
  • District Nurse,
  • Dietetics,
  • GP,
  • EEAST
  • CQC inspectors
  • CCG colleagues

 In all circumstances professionals should be wearing the correct PPE to ensure your IPC standards are met.

Visiting professionals guidance updated

Following feedback, the revised guidance regarding testing for professionals visiting care homes is now published. Please note that these changes should be implemented by 22nd March. The full guidance can be found at the below link:

https://www.gov.uk/government/publications/coronavirus-covid-19-lateral-flow-testing-in-adult-social-care-settings/testing-for-professionals-visiting-care-homes

We have worked with care home providers, Dr Jenny Harries the Deputy Chief Medical Officer for England, Public Health England and NHS England to develop this new guidance. The guidance strengthens the existing approach for testing professional visitors to care homes in order to reduce the risk of Coronavirus transmission.

The key changes are:

·         Professionals should not be allowed to enter a care home without a negative LFT result, with the exception of the following scenarios:

·         An emergency

·         Overridden by the care home manager following a risk based decision

·         Their entry is required by law, such as CQC inspectors

·         For NHS professionals, care homes should see evidence from the professional of a negative rapid lateral flow test within the last 72hrs, which shows they are following the NHS staff testing regime.

·         As per the previous guidance, professionals who are not part of regular testing for NHS staff or CQC inspectors (for example, professionals such as podiatrists or engineers) will need to be tested at the care home in the same way as visitors.

·         If they are visiting multiple care homes in one day, they will now only need to be tested at the first care home they visit that day and can use evidence of this test at the next care home they visit that day.

·         CQC inspectors will now test at home using a lateral flow test on the day of a care home inspection, in addition to their weekly PCR.

·         Like care home staff, visiting professionals are exempt from testing for 90 days following a positive PCR test, unless they develop new symptoms.

Care Homes Not Offering visits

The government’s guidance says that visiting should be allowed to happen wherever it can be done safely.

Care home managers and staff will know best how things should run in their care home. For example, there might have to be limits on how many visitors can come in, or how often, because of the amount of space or layout of the rooms.

Sometimes there will be good reasons (like an outbreak) why the home cannot offer the visiting you would like.

But our guidance clearly says that the care home should not put blanket bans in place.

We expect all care homes to do what they can to follow our guidance. And they should explain to everyone what they are doing and why.

If you think the care home is not doing this please raise the matter with the home. If you are not satisfied that the issue is resolved, you can contact the Care Quality Commission (CQC). [contact details then given

Contact Tracing

 You should be contact tracing when you have a positive COVID-19 staff, resident / service user, professional or visitor result in your Care Service.

Who is a contact?

  • A ‘contact’ is a person who has been close to someone who has tested positive for COVID-19
  • They can be staff, residents, professionals, visitors and external contacts
  • Contact tracing is a fundamental part of outbreak control to prevent the spread of infections
  • Identifying contacts promptly will support to reduce further transmission so please do not wait for Test and Trace to contact you
  • Outside of work use the NHS COVID-19 app
  • Remind staff to always alert their manager if they are contacted by Test & Trace