As England entered its second national lockdown on the 5th of November 2020, new restrictions came into effect across the country. The care sector has its own guidance set by the Department of Health and Social Care (DHSC) and is supported by Public Health England (PHE). To help protect care staff, residents and visitors from spreading or contracting COVID-19, and to increase infection control measures in care homes, restrictions for visitation have been temporarily upgraded. Loneliness and isolation can have a major negative impact on the overall health and wellbeing of elderly and vulnerable residents. It can cause anxiety, depression and other adverse emotions or behaviours. Visitors bring many benefits to care homes. It’s a chance for people to socialise, stay up to date with personal interests, and during the pandemic, feel a sense of normality. So, what is the new guidance for arranging visits and how long will it last? Here are 7 key questions answered from the official guidance.

1. What is the role of PHE and the directors of public health?

The directors of public health (DPH) are part of PHE and its their job to suppress and manage infectious outbreaks at a local level. This means each local council will have an outbreak plan that has been put together by a director of public health, which includes advice for care homes. DPH also have the powers to stop care homes from allowing visitors entirely, except for in exceptional circumstances.

2. Who decides the visitation procedures?

This is now effectively a joint effort by the care provider and the DPH. Because care settings are all unique in their layout, facilities, resources and resident needs, the DHSC have acknowledged that care providers are best suited to decide how to deliver visits. However, providers have advised to communicate with its staff, residents and the family and friends of residents to reach a decision that works for everyone. Before visitors are allowed to enter, the care provider must first create a risk assessment, taking into account the advice issued by the DPH and their own ability to manage visits safely. If the risk is too high and there aren’t enough infection control measures in place, the care provider should consider increasing safety before allowing visitors. If the risk of COVID-19 is too high in a local area, the DPH has the power to stop visitors all together, or issue further specific steps.

3. What should be included in a visitation risk assessment?

Individualised resident risk assessments should first be carried out to assess the rights and needs of each individual, as well as any vulnerabilities, and whether visitors would play a beneficial part of their ongoing care. Checking your care plans is a good way to find out if your residents depend on or benefit from regular visits, or if they might be satisfied temporarily trading visitations for extra safety. The general layout, facilities and resources need to be taken into account. Is there a safe area accessible from the outside for visitors to enter through, is there enough space for visitors to pass through safely, is there enough PPE, antibacterial gel or infection prevention equipment to go around, or are there enough staff available to monitor and disinfect meeting rooms? These are some things to consider. Staff, residents and their family and friends should also be involved in the discussion. Are any residents or staff particularly vulnerable? Do any regular visitors need additional support or accessibility? Are any residents particularly anxious about visitors coming in?

4. Are visitors allowed in exceptional circumstances?

Visitors are to be allowed in exceptional circumstances, no matter what PHE have advised at a local level. However, there’s no definitive list of exceptional circumstances. What can be deemed exceptional seems to be at the care provider’s discretion. However, an end of life situation is frequently mentioned as being the only example.

5. What should I consider when arranging visitors?

There should be a booking system in place where visitors can choose a slot. This allows time for the provider to prepare and make others aware. Accepting visitors ad hoc is discouraged. Where possible, there should only be one constant visitor per resident, but two at the very most is also acceptable if there is good reason. Care providers should also keep a record of their visitors temporarily, in case any COVID-19 cases are found and can be reported. Ideally, visits should take place outside or in an open-air environment, but in the colder months this may be challenging. Alternatively, a conservatory or room that can be accessed from outdoors is acceptable. This is because visitors must enter the space from outside, where possible. PPE must be used and social distancing measures must be adhered to. A protective screen should be installed to separate the resident from the visitor, and good infection prevention and control practice must be maintained throughout the visit and through the wider area. You should clearly communicate all restrictions and measures to staff, residents and visitors to prepare them for these changes in advance.

6. Can we have visitors if there are cases of COVID-19 at the setting?

In the event of COVID-19 outbreaks, the guidance states visitation arrangements must stop immediately. Some care providers will also have local policy or outbreak management arrangements in place, which should be followed. After the COVID-19 cases are brought under control, visitation can continue as long as there are appropriate infection prevention and control measures in place, taking into account what was learned from the recent outbreak.

7. When will restrictions end?

We’re not sure yet. The DHSC will review its guidance before the national lockdown comes to an end on 2nd of December 2020. This means restrictions could potentially stay in place for longer if the number of coronavirus cases and transmission rates haven’t significantly changed. Alternatively, each region could find themselves with different restrictions, as Prime Minister Boris Johnson stated the plans are to return to a tier-based system after lockdown concludes. [Update 02/12/20] The UK has moved into a tier system. To find out visiting guidance for your tier, follow the links below: Tier 1 – Medium alert Tier 2 – High alert Tier 3 – Very high alert

Finding the balance

Although visitation has been reviewed and improved since the first national lockdown, there’s still a lot to consider, especially with extra input from PHE. Care providers are now tasked with the delicate job of finding the balance between keeping everyone physically safe and denying its resident a healthy social experience by disallowing visitors. There isn’t a win-win situation for everybody, but with proper infection prevention and control measures in place, everyone has a better chance at remaining safe. If care providers do opt to prohibit visitors, technology can offer a great temporary solution in the form of video chatting until it’s safe to commence visitation again. Please see the full government guidance to help you plan your visitation process.

Using CareDocs

Your residents’ digital Care Plans can be quickly searched to find useful information to form your risk assessment. Once you have finalised your visitation procedures, you can create a new or update an existing digital Policy & Procedure document so your staff can easily find it, read it and confirm they have understood it. You can also use our COVID-19 feature to track visitors and symptoms, so you have a record of who has visited and the name of the resident they saw.

Sources

GOV – visiting arrangements in care homes for the period of national restrictions:  www.gov.uk/government/publications/visiting-care-homes-during-coronavirus/update-on-policies-for-visiting-arrangements-in-care-homes GOV – COVID-19 outbreak management:  www.gov.uk/government/publications/reporting-outbreaks-of-coronavirus-covid-19/covid-19-early-outbreak-management Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.