There has been a lot of controversy about care home visits over the past 18 months and providers have been at the forefront of balancing the risks to residents posed by Covid-19 and promoting their human rights. With ever changing rules on Covid-19 compliance and the emergence of new variants of the virus it is of extreme importance that providers keep up to date with guidance on visits to ensure residents rights are respected, upheld and promoted.
What does the Care Home Visiting Guidance say?
The government guidance on care home visiting was last updated on 25 November 2021. While it is clear there are no nationally set restrictions on friends and families visiting their loved ones in care homes, it states an expectation that providers facilitate visits wherever possible in a risk-managed way.
- Arrangements should be made between visitors and the care home in advance of the visit.
Providers should have clear guidance available informing visitors what they need to do, who they need to contact and what is expected of them to facilitate visits. Providers should be flexible in meeting the communication preferences of visitors to ensure no one is inadvertently restricted from visiting.
- The duration of visits should not be limited. Some Providers have received criticism for trying to limit visits to set time lengths which could be interpreted to be breaching a residents human rights, in particular the right to respect for private and family life.
- Visits should take place in a room most practical and comfortable for the resident (for example residents with dementia may be more comfortable in their own room with familiar belongings).
- Visitors should receive a negative lateral flow test on the day of their visit.
Such tests can be carried out at home or when they arrive at the care home. Essential care givers need to follow additional testing arrangements as set out in the guidance.
- Physical contact should be supported to help health and wellbeing, as long as IPC measures are in use, such as visiting in a ventilated space, using appropriate PPE for the visit, and hand-washing before and after holding hands. Gloves are not needed for hand holding.
Providers should ensure they have appropriate, accessible PPE and handwashing facilities available for visitors at all times to facilitate safe visits.
- Residents should be supported to undertake visits outside of the care home.
Examples of visits outside the care home include for a short walk, to attend a place of worship or for a longer visit including an overnight stay to see family and friends. The guidance is clear that residents will only need to isolate following an emergency stay in hospital if they test positive for Covid-19, or after a visit that has been deemed high-risk following an individual risk assessment. Risk assessments should, among other things, take into account the vaccination status of the resident and people they came into close contact with, the results of any lateral flow or PCR tests taken and whether people they had contact with have since tested positive for Covid-19.
- Visiting restrictions due to an outbreak should only be in place for 7 to 8 days following negative testing. There is a caveat that this is subject to a risk assessment by the Health Protection Team, but if there have been 2 rounds of whole home PCR testing taken 4 to 7 days apart that come back negative it could result in an outbreak being declared over before the usual 14 day period.
- Visitors should not enter the care home if they are feeling unwell, even if they have tested negative for Covid-19 and are fully vaccinated. The guidance is looking to protect residents from other transmissible viruses such as flu, RSV and norovirus which can be just as dangerous to residents. The guidance advises providers to instruct visitors to avoid the care home until at least 5 days after they feel better. While this measure may be viewed as sensible, it could also be seen as overstretching as such requirements were not officially in place pre-Covid-19. Questions may be raised as to whether certain levels of recommended visiting restrictions will be in place permanently in a post-Covid world, in order to protect residents. Such matters are more difficult to police as providers will be relying on the honesty of visitors to inform them of any such symptoms but as long as the provider is clearly communicating the advice from their end this should be sufficient to protect them from criticism.
Providers should also check whether their local Public Health departments have issued any additional guidance or advice for providers in their area. For example, some Public Health authorities are only allowing providers to open up to visitors before the end of an outbreak if they have sought direct permission from the authority. Practices outside of this additional guidance could result in action being taken by Public Health, Quality Monitoring teams or CCG’s.
Will the CQC be interested in Care Home’s approaches to visiting policies and approaches?
The CQC itself has been under pressure from the Joint Committee on Human Rights about protecting human rights in care homes. It’s response to a public letter written by the Committees Chair, MP Harriett Harman, was published on 19 November 2021 and highlighted the CQC’s commitment to ensuring such rights were protected. As part of its updated monitoring approach the CQC will be checking how providers are facilitating visits and other forms of contact to residents in accordance with current guidelines with a focus on those particularly at risk of social isolation. The CQC’s letter confirmed it expects providers to be delivering an individualised approach to visiting and will raise further questions if they see providers following a ‘general policy’ on visiting. The CQC has the power to take action against providers who are not following the government guidance or are not considering visiting arrangements in an individualised way.
It is likely that given the upcoming festive period increasing numbers of family members and friends will be keen to see their loved ones. Providers need to ensure they have reasonable visiting policies in place that are not overly restrictive otherwise they could find themselves subject to CQC or local authority action alongside complaints from residents and visitors.
If you are experiencing any difficulties around visits, visiting policies or find yourself subject to the CQC or local authority scrutiny regarding visits, the Ridouts team can assist. Please call 0207 317 0340 or contact us at firstname.lastname@example.org.