Visiting loved ones in care homes.

The government has updated the guidance on visiting loved ones in care home.

This guidance applies from 2 December 2020 and supersedes previous guidance on visiting policies for care homes.

Visiting is a central part of care home life. It is crucially important for maintaining health and wellbeing and quality of life for residents. Visiting is also vital for family and friends to maintain contact and life-long relationships with their loved ones and contribute to their support and care (often as essential carers).

Welcoming people into care homes from the community inevitably brings infection risk. But that is a risk that care homes can mitigate. It is a risk that should be balanced against the importance of visiting and the benefits it brings to care home residents and their families.

Visiting should be supported and enabled wherever it is possible to do so safely – in line with this guidance and within a care home environment that takes proportionate steps to manage risks.

This means finding the right balance between the benefits of visiting on wellbeing and quality of life, and the risk of transmission of COVID-19 to social care staff and clinically vulnerable residents.

We are distributing rapid (lateral flow) tests to care homes across the country to be used for visitors. Care Quality Commission (CQC) registered care homes will receive these tests during December and have sufficient quantities to test up to 2 visitors per resident, twice a week by Christmas. Visitors will need to arrange visiting with the care home in advance, and will need to be mindful of the additional workload for the care home and that the care home will need to make their own assessments and may develop further policies to ensure the safety of the residents they care for and their staff.

While rapid testing can reduce the risks around visiting it does not completely remove the risk of infection. In addition to using testing, care homes must use robust infection prevention and control (IPC) measures, visitors must continue to wear the appropriate personal protective equipment (PPE) (as described below), observe social distancing in general when in the care home and good hand hygiene, and follow any guidance the care home itself provides on physical contact with the person they are visiting.

This guidance has been developed for the purpose of supporting local system leaders, providers, staff, and families to plan and carry out visits that provide meaningful contact as safely as possible.

Each care home is unique in its physical layout, surrounding environment and facilities. Residents vary in their needs, health and current wellbeing. Care home managers are best placed to decide how visits should happen in their own setting in a way that meets the needs of their residents both individually and collectively.

The individual resident, their views, their needs and wellbeing should be considered for decisions about visiting, while recognising that the care home will need to consider the wellbeing of other residents as well.

These decisions should involve the resident, their family and friends and the provider and other relevant professionals such as social workers or clinicians where appropriate.

All decisions should be taken in light of general legal obligations, such as those under the Equality Act 2010 and Human Rights Act 1998, as applicable. Providers must also have regard to the DHSC ethical framework for adult social care.

We recognise how important visiting is as residents approach the end of their lives. As has been the case throughout the pandemic response, visits in exceptional circumstances such as end of life should continue in all circumstances.

Overview of visiting practice supported by this guidance

Key message

Each care home (the registered manager) is responsible for setting the visiting policy in that home. They should do so on the basis of a dynamic risk assessment taking into consideration the needs of individuals within their home and with regard to the advice of the local Director of Public Health (DPH).

All care homes – regardless of Tier – and except in the event of an active outbreak – should seek to enable:

• indoor visits where the visitor has been tested and returned a negative result – see section 2.1 below

• outdoor visiting and ‘screened’ visits – see section 2.3 below

Visits in exceptional circumstances including end of life should always be enabled – see section 2.4 below

In all cases it is essential that visiting happens within a wider care home environment of robust Infection Prevention and Control (IPC) measures, including ensuring that visitors follow (and are supported to follow) good practice with social distancing, hand hygiene and Personal Protective Equipment (PPE) use.

In the event of an outbreak in a care home, the home should immediately stop visiting (except in exceptional circumstances such as end of life) to protect vulnerable residents, staff and visitors (see section 1.4 below)

1. Developing the visiting policy in the care home

1.1 Advice for providers when establishing their visiting policy

Key message

Providers should facilitate visiting as described in this guidance wherever it is possible to do so in a risk-managed way and in line with the principles set out below.

Providers should develop a dynamic risk assessment to help them decide how to provide the visiting opportunities outlined in this guidance, in a way that takes account of the individual needs of their residents, and the physical and other features unique to the care home.

Providers are best placed to design individual visiting arrangements that take account of the needs of their residents and what is possible within the layout and facilities within the home. In this context, the provider must develop a dynamic risk assessment that assesses how the care home can best manage visits safely, and how this is delivered.

This dynamic risk assessment should consider relevant factors relating to the rights and wellbeing of the residents. It may be appropriate or necessary for providers to apply different rules for different residents or categories of resident, based on an assessment of risk of contracting COVID-19 in relation to such residents, as well as the potential benefits of visits to them. This is further explained in the advice for providers when taking visiting decisions for particular residents or groups of residents section below.

The risk assessment should also consider factors relating to the layout, facilities and other issues around the care home – to help determine:

• the rooms in which visiting will happen, where and how visitors might be received on arrival at the home to avoid mingling with other visitors, staff or residents etc

• how the testing arrangements described in section 2.1 below will operate

• the precautions that will be taken to prevent infection during visits (including PPEuse and hand washing)

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