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Care Home Visitor Guidance

Care Home Visiting Out Local and National Guidance

Updated 14th May

Visits in to the homeClick Here for Guidance

  • Care home residents can now have up to 5 named visitors (including the care giver), but only 2 can visit at the same time
  • An outbreak in a care home is now 14 days after the last laboratory confirmed or clinically suspected cases were identified in a resident or member of staff in the home. Unless it has been identified as the new variant, in which case it will be 28 days. Therefore homes will only be closed for 14 days if they need to close to visitors.
  • By the summer they want to have visiting as relaxed as possible but with the retention of IPC measures

 

Visits out to the home Click Here for Guidance

  • Overnight stay in hospital is defined as high risk and therefore requires 14 day isolation on return back to the care home
  • Visits to some indoor locations can now take place without the need for 14 day isolation on return. If they have testing regime for that setting, the resident should participate in that testing e.g day centre are asked to take those attending, bi-weekly and there must be a risk assessment undertaken by the home
    • to go to work or take part in education or training
    • for medical appointments such as GP appointments, excluding overnight stays in hospital
    • to take part in other activities necessary to maintain an individual’s health and wellbeing (for example, going to a day centre or to a place of worship)
  • Currently the guidance states overnight visits indoors must be followed by 14 days isolation but the guidance states care homes need to complete an individualised risk assessment on each decision made

If you have any questions regarding the guidance contact the hub on assistance@hcpa.info

 

Lettet from the 4th may letter from Hertfordshire County Council in conjunction with the following guidance. The letter states some additional local advice.

National Care Home Visiting In 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.

Care Home Visiting In 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 County Council Framework for Care Home 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

Care Home Outbreak Guidance Updated

Following recent guidance change,  Covid 19 Outbreaks in care homes will now be considered concluded when there has been 14 days clear since the date of the last positive result (resident or staff) rather than the 28 days. Therefore care homes should complete their whole home testing of residents and staff after day 14 to confirm the outbreak is over.

If the home is closed to visitors due to an outbreak, the home can now open up for visitors once the outbreak has been declared over (after 14 days)

The exception to this, is, if a new variant has been found and in these cases the length of the outbreak will be 28 days.  Health Protection Team will inform you if this happens.

 Please remember that the day of the first positive result should be counted as Day 0.

Care Home Types of Visits In

 

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
Five named visitor (indoor) 5 consistent (Two at a time)

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, Covid-19 positive or has respiratory symptons.

 

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 Care Home 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 of the care home and required to isolate for 14 days 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 guidance updated 20th May 2021

Many visiting professionals work in a variety of different settings per day, including care homes. Given the substantial risks to care home residents if COVID-19 is introduced to the home, it is essential that professionals and all staff are tested regularly before visiting care homes to reduce the risk of transmission across different settings and to help keep residents and staff safe.

Care home managers have ultimate responsibility for the safety of their care home, including the residents and staff. This includes ensuring policies are followed, including infection control measures and testing.

 

Click here for full guidance

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.

NHS professionals visiting care homes who are part of regular staff testing

This includes all patient-facing NHS staff entering care homes, including for example community services, ambulance services and GPs.

Given the risks, the default position is that a visiting professional should not be allowed entry to a care home without proof of a negative test within the last 72 hours – demonstrating they are following the testing regime for NHS staff.

In emergency visits such as a 999 response, it is not appropriate to ask for or provide proof before entry to a care home, given the potential delay this could cause and the implications for prompt management of the emergency situation. Further guidance is given below. However, all NHS professionals visiting care homes must follow the NHS testing regime and be testing twice a week.

Care homes must ask the NHS professional when they were last tested and see proof of the result and date of the relevant professional’s test.

Proof may include:

  • an email or text from NHS Test and Trace
  • a screenshot of where the professional has to upload their test result
  • a date-stamped photo of the test cartridge itself
  • signed confirmation from their manager
  • the NHS signed log included with the test kits provided to NHS staff

If it has been more than 72 hours since the NHS professional was tested, the care home should test the individual before entry to the care home.

If the individual has not been tested (or is unable to provide proof) and it is not possible to test prior to entry, the care home will need to make a risk-based decision regarding whether to permit entry, taking into account the reason and urgency of the visit. The default position is that without proof of a recent negative test or a negative rapid LFT on the door of the care home, the professional should not be admitted. Visiting professionals can, of course, conduct a test at home prior to visiting a care home if this would make better use of their time in the working day.

Testing for CQC inspectors visiting care homes

Like NHS staff, Care Quality Commission (CQC) inspectors have a regular testing regime. In addition to their current weekly PCR testing, CQC inspectors should be tested using rapid LFT on the day of their visit to a care home or care setting (including extra care or supported living settings). This should be conducted at home by the CQC inspector, in line with the MHRA’s recommendations on use of such tests as close as possible before their visit to the care home or care setting.

As above, the CQC inspector should provide evidence to the care home or care setting of the negative rapid LFT result from earlier in the day when they arrive. This evidence could be the text or email from NHS test and trace or a photo of the rapid LFT cartridge with the time and date stamp.

As CQC inspectors by law have a right to enter a care setting as part of an inspection, they should not be denied access if they do not provide this evidence.

CQC policy is that inspectors are only allowed to visit care homes or other settings if they have been tested as per this policy, and adhering to the testing policy is a requirement of the risk assessment carried out prior to a visit to a care home or care setting.

Professionals not regularly tested through NHS or CQC staff testing

As detailed in previous guidance, professionals who are not part of a regular testing regime (that is, those who are not included in NHS staff and CQC inspectors) should be tested on the door of the care home. Professionals who have to visit multiple care homes per day do not need to be tested at a care home more than once a day.

Professionals should be tested, using rapid LFT testing, on the door of the first care home they visit on that day. The testing process is set out in the visitor testing guidance (‘On-site testing for adult social care services’). These professionals should then use the email or text they receive from NHS Test and Trace with their result and show this as proof at each care home they visit.

As above, care homes should ask professionals when they were last tested and request to see proof of the result and date of the relevant professional’s test. If the professional is unable to provide proof, they should be tested at the care home door.

Care Homes Not Offering Visits In

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

Visits in and out of Supported Living settings

Maintaining opportunities for visiting and spending time together is critical for the health and wellbeing of people being supported, and their relationships with friends and family. In addition, for many people, there are important reasons for having in-person visits, as not doing so may be difficult to understand and lead to distress.

There are risks that need to be considered – even where people are vaccinated – but these are risks that can be appropriately managed.

As stated above this guidance is intended for supported living settings, but many of the principles are applicable to extra care housing for older people. It may also be a useful resource for the wider supported housing sector, such as retirement or sheltered housing.

The approach described below for developing a policy and mitigating the risks of visits (both into and out of the home) has 3 key elements:

  • people living in supported living settings live in their own homes and should be treated as such. This means they, and their visitors, need to follow the same national restrictions as other members of the public, including following each step in the government’s roadmap around social contact. The roadmap and associated regulations provide some flexibilities which may apply to people in certain supported living settings (such as exemptions for some indoor gathering and in relation to forming support bubbles)

  • supported living managers should seek to support and facilitate these opportunities wherever it is safe to do. They should develop policies for visits into and out of the setting, that are based on a dynamic risk assessment, and include consideration of the individual needs of the people who live there. These risk assessments should be developed in consultation with them

  • supported living managers should also work with the people being supported to identify what further steps they can take in order to manage and mitigate risks that arise from visiting

The default position set out in this guidance is that visits should be supported and enabled wherever it is safe to do so.

 

To read full guidance details click here