Introduction & Previous Guidance
This is the fourth article I have written examining the developing Government guidance on the issue of admissions into care homes during the COVID- 19 pandemic. On Friday 19 June 2019, the government issued an updated version (v.2.) of its Guidance “Admission and Care of Residents in a Care Home during COVID-19” (the “New Guidance”).
Prior to this, the most recent guidance on the topic of admissions could be found in “COVID-19: Our Action Plan for Adult Social Care” (“the Action Plan”) published on 14 April 2020.
It may be recalled that, prior to the publication of the Action Plan, the Government guidance (v1 of Admission and Care of Residents in a Care Home during COVID-19 dated 2 April 2019) stressed that it was expected that residents would be admitted to Care Homes even if these patients may have COVID-19, whether symptomatic or asymptomatic. As set out in my previous articles, a fundamental flaw with that Guidance was that, although it stated “The Hospital Discharge Service and staff will clarify with care homes the COVID-19 status of an individual and any COVID-19 symptoms, during the process of transfer from a hospital to the care home”, it was widely known that testing of residents before admissions to care homes at that time was not widespread or commonplace and indeed the 2 April 2020 Guidance went on to state that “Negative tests are not required prior to transfers / admissions into the care home”.
From the outset of the pandemic, until very recently, we have been contacted by Providers sharing experience of feeling effectively forced by commissioners to accept new admissions of residents to Care Homes from acute settings regardless of COVID-19 status. This was due to the existence of the above Government Guidance issued on the false premise that all Providers were appropriately resourced to put appropriate isolation measures in place. This was met with anger, disappointment and fear in the sector that it was exacerbating to the spread of COVID-19 throughout care homes.
The part that admissions of COVID-19 residents from hospitals into care homes has played on the spread of the virus has been highlighted in the media of late. This has included publicity around a request for Judicial Review raised by Dr Cathy Gardner, who lost her father to Covid-19 in a care home, of the Government’s strategy of releasing hospital patients into care homes without Covid-19 tests.
The New Guidance
Since the Government committed in the Action Plan to testing all residents prior to admissions into care homes what does the New Guidance, issued on Friday 19 June add regarding admissions?
The DHSC website states that the New Guidance has been updated in line with the care homes support package announced by the Government on 15 May and the latest advice on testing and infection prevention and control.
The New Guidance stresses that all residents being discharged from hospital or from another care setting and those being newly admitted from the community, “should be isolated for 14 days in their own room.”
Whilst the new guidance continues to recognise that there may be a small number of people who need to be admitted into care homes after having tested positive for COVID-19, the guidance finally clearly states that:
“No care home will be forced to admit an existing or new resident to the care home if they are unable to cope with the impact of a person’s COVID-19 illness for the duration of the isolation period.”
As previously set out in the Action Plan, if appropriate isolation/cohorted care for individuals with COVID-19 is not available with a local care provider, the individual’s local authority will be asked to secure alternative appropriate accommodation and care for the isolation period.
This is to be funded by the £1.3 billion made available by the Government via the NHS to support enhanced discharge and the Government expects the NHS and local authorities to work together to put this into practice.
The New Guidance goes on to state that:
“Care Home Managers and proprietors need to undertake a balanced risk assessment when considering the implementation of this Guidance. This must consider the needs of all residents and staff in the care home to ensure that they are taking timely and proportionate measures for each setting.”
This has been the approach we have been advising Providers to take since the outset of the pandemic, mindful that resident safety and their regulatory obligations in that regard must be the primary concern. It is not clear why it has taken the DHSC four iterations of its guidance on admissions, after countless COVID-19 deaths in care homes, to acknowledge that the decision on whether to admit someone with possible COVID-19 into a care home setting must always be a risk based decision for the individual care home to make.
The updated Guidance can be accessed in full here.