Opening with care – supporting meaningful contact in care homes

The Scottish Government has published new guidance which supports “meaningful contact” to resume between care home residents and their loved ones from this month, March 2021.

The guidance recommends that care homes can now restart indoor visiting for up to two visits per resident per week (and up to two designated visitors). One person should visit at a time.

Care homes will first need to make arrangements to do this and meet a set of safety conditions.

This guidance - “Open with Care: Supporting Meaningful Contact in Adult Care Homes” - sets out how indoor contact in care homes will gradually increase while minimising COVID-19 risks to residents, staff and visitors. It has been developed with input from relatives of care home residents, care home providers and others.

This is now possible as there are multiple levels of protection in place, including:

• Testing policy prior to hospital discharge.
• Testing policy for community admission.
• Community transmission levels.
• Effective Infection Prevention Control.
• PPE (adequate, available and proper used).
• Testing (all staff, others, designated visitors).
• The vaccine.

There are two main sets of guidance for care homes published on 24 February, focused on resuming regular, meaningful contact with friends and family and visits into the home by volunteers, spiritual/faith representatives and professionals plus wellbeing activities.

Orkney Islands Council/NHS Orkney Integration Joint Board chair Councillor Rachael King said the relaxation of restrictions leading to the reuniting of loved ones, in as safe a way as possible, is welcome.

“Thanks to everyone's efforts within our communities, the prevalence of COVID-19 has remained comparatively low in Orkney. The roll out of the vaccination programme and enhanced testing programmes has led us to this point alongside multiple other protections, including infection prevention and control measures.

“Our care home staff will be encouraging and supporting safe, indoor visiting as soon as possible.”

Frequently Asked Questions and Answers provided by the Scottish Government

When will care homes be able to resume meaningful contact?

It is expected that all care homes across Scotland will be opened with care by mid-March.

How are you continuing to protect residents against COVID-19?

Safeguards and protections have developed considerably in recent months alongside the evidence about how to protect against the virus. There are now multiple layers of protection in place: testing policy prior to hospital discharge; testing policy for community admission; community transmission levels; effective IPC; PPE (adequate, available and properly used) testing (all staff, others, designated visitors) and the vaccine.

Care homes will update their existing risk assessment in line with the new guidance.

What PPE will visitors be required to wear when visiting my relative?

People coming into the care home to see loved ones will be asked to wear a fluid resistant surgical mask (FRSM) and these will be provided by the care home to the person visiting.

Physical touch should also be supported when a fluid resistant surgical mask is worn by the person visiting, as are brief hugs or embraces.

Are visitors required to take a COVID test?

We recommend that designated visitors are tested in a designated area in the care home before going to be with a resident. All guidance and requirements for PPE and social distancing should be observed by care home staff supporting visitor testing.

What happens if a visitor tests positive for COVID-19 - does this mean an outbreak investigation needs to start in a care home?

If a visitor tests positive, they will be asked not to go ahead with the visit, and instead to go home and self-isolate and seek a confirmatory PCR test. The care home will wish to notify their Public Health team. If guidance has been followed as above, then this should not trigger an outbreak investigation.

How long will visitors be able to visit their loved one for?

Time limits for residents’ contact are not defined in the guidance. This is to enable residents, relatives and care homes to work together to agree contact that accommodates individuals’ needs and circumstances as well as practical issues to safely receiving visitors to all residents in the care home.

Support for essential visits is unaffected, which should always be compassionately and generously enabled by care homes when needed.

When will care homes be able to offer daily visits?

There are no set target dates. Individual care homes need to move from two designated visitors at a pace that reflects their confidence and capacity.

Will visitors be able to visit their relative or friend in their room?

Residents should be supported to be with loved ones in their own room, if they wish.

Can visitors use the toilet in care homes?

Yes. Visitors should access dedicated toilet facilities for visitor use only, ensuring frequent enhanced cleaning is in place.

Does this guidance allow children to visit?

Initially, children under 16 would not normally be a designated visitor for indoor visits and the guidance explains the reasons for this. When restrictions ease and care home residents can have more visitors, children under 16 should be considered. Children and young people can be part of outdoor meetings with care home residents. Children and young people should be supported to attend essential visits, where desired.

Will contact stop again?

Meaningful contact between care home residents and their loved ones should return to being the usual practice in care homes in all but exceptional circumstances. These circumstances are outlined in the guidance and will include, for example, when there is a COVID-19 outbreak in the care home.

How will visiting advice change when we’re in different Levels?

From February 2021, contact between care home residents and loved ones will not usually be tied to the local level.

Are care homes across Scotland offering different levels of contact?

It is now recommended that all care homes begin preparations and implementation immediately to support full adoption and embedding of the guidance, accommodating up to two designated visitors per resident each week in the first instance. There may be a brief period while care homes need to make arrangements to resume indoor visiting safely. Some visiting arrangements may differ based on the needs, circumstances and preferences of individual residents.

How does the vaccination programme affect visiting?

The Scottish Government does not recommend that care homes make it compulsory for people to have had the COVID-19 vaccine before going in the care home. Vaccination is one of a number of safeguards that together allow meaningful contact to resume.

Can residents who are new admissions to a care home and need to self-isolate receive visitors?

The period of self-isolation should be observed so designated visitors would not normally be considered in this period. However, essential visits should be supported, generously and sympathetically as the resident and family will be in an unfamiliar setting and contact may be needed to alleviate distress.

Will care home residents be able to leave the care home or go out in groups?

The guidance is focused on reintroducing indoor visiting, which is the preferred and recommended approach to good quality contact with residents and loved ones. Whilst it is recognised that other forms of visiting are used (such as outdoors - at windows, in garden pods or marquees - or indoor, fully screened off adapted rooms), these should not be viewed as replacements to indoor visiting. As conditions improve care homes should begin to assess the opportunities for residents to safely leave the care home.

Additionally, care homes’ ongoing efforts to support residents who do not have regular designated visitors should be encouraged but are not the focus of this guidance.

Full details of the Scottish Government guidance is available here: https://www.gov.scot/publications/coronavirus-covid-19-adult-care-homes-visiting-guidance/