Update: Designated settings scheme for people discharged to a care home

Topics covered: care home, COVID-19, COVID-19 regulations

On the 7th February 2022 the Department of Health and Social Care published an update to their guidance on people being discharged from hospital to a care home with a positive coronavirus (COVID-19) test.

The current requirement is for hospitals to undertake a COVID-19 PCR test on all people discharged into a care home in the 48 prior to discharge. All individuals who test positive should be discharged into a designated setting in the first instance to see out their isolation period. A designated setting is intended for individuals who are leaving the hospital and require care, who are returning to a care home and are likely to be infectious with COVID-19 or are within an appropriate formal isolation period having tested positive. Guidance related to designated settings apply to clinical ward and hospital discharge teams, registered providers, care home staff, local authorities and commissioners. To further support safe and timely discharge whilst protecting care home residents and staff from COVID, the Department of Health and Social Care (DHSC) have worked with the CQC to develop a designation scheme to identify specific care homes that will act as designated settings.

Currently, every person must receive a COVID-19 PCR test result within 48 hours before discharge from hospital – except for those who are known to have previously tested positive for COVID-19 and are within 90 days of their symptom onset or positive test date and have no new COVID-19 symptoms. Individuals who are negative within 48 hours before discharge from hospital, should be discharged to a care home in line with requirements set out in the admission and care of residents in care homes guidance.

Individuals who receive a positive test result within 48 hours before discharge, undergo a clinical assessment to determine their onward movement and isolation requirements.

Step 1:

A person who requires a nursing home and has received a positive PCR test for COVID-19 whilst being within 90 days from their initial illness or positive test date. The individual must no longer meet the criteria to reside in an acute hospital setting, and have no underlying severe immunosuppression.

Step 2:

The hospital clinical team, in conjunction with an infection specialist if required, undertake a clinical assessment against the following 2 questions:

Question 1:

Has the individual completed their isolation period from their symptom onset or positive test result? Isolation can only be stopped when clinical improvement criteria is met such as:

  • Clinical improvement with at least some respiratory recovery
  • Absence of fever (less than 37.8°C) for 48 hours without the use of medication
  • No underlying severe immunosuppression

Question 2:

Is the individual free from any new COVID-19 symptoms?

If the answer to both these questions is ‘no’ the individual may pose an infection risk and should be discharged to a suitable designated setting to complete their isolation period.

If the answer to this question is ‘yes’ the individual may be discharged to any care home in line with requirements set out in guidance on admission and care of residents in care home during COVID-19.

Self-isolation periods is currently 10 days following a positive test result. Individuals who are able to take lateral flow tests should test from day 5, if 2 consecutive negative lateral flow tests are received 24 hours apart, the individual can end self-isolation before 10 days.

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