Care home visits during lockdown 3.0
As of 5 January 2021, the whole of England is under lockdown again. And, once again, the Government’s guidance on visiting care homes has changed. This article summarises the current rules across England.
Can I visit relatives in care homes?
The “Stay at Home” guidance published by the government, indicates that, “Visits to care homes can take place with arrangements such as substantial screens, visiting pods, or behind windows. Close-contact indoor visits are not allowed. No visits will be permitted in the event of an outbreak.”
The, “Visiting care homes during COVID-19” guidance (updated 12 January 2021) further provides that, “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.”
It is therefore not acceptable for providers to simply put blanket policies on care home visits unless there is an outbreak in the home, in which case, the home should immediately stop visiting (except in exceptional circumstances such as end of life). According to the guidance, each care home has responsibility for setting the visiting policy in that home, and this should be done 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.
In summary, all care homes, except in the event of an active outbreak, should seek to enable:
- outdoor visiting and ‘screened’ visits, and
- visits in exceptional circumstances including end of life should always be enabled
Close-contact indoor visits in care homes will not be allowed during the lockdown. Visits should happen in the open air wherever possible, however, this may not be realistic during the winter, in which case, the visitor and resident must remain at least 2 metres apart at all times or the visit can take place at a window. Some care homes have outdoor structures which are enclosed to some degree but are still outside the main building of the home, these can be used. Where this is not possible, a dedicated room such as a conservatory can be used.
In enabling care home visits, it is the responsibility of providers to ensure the following:
- the visiting space is used by only one resident and visiting party at a time, and is subject to regular enhanced cleaning between each visit
- the visitor enters the space from outside wherever possible
- where there is a single access point to the space, the resident and visitor enter the space at different times to ensure that safe distancing and seating arrangements can be maintained effectively
- there is a substantial screen between the resident and visitor, designed to reduce the risk of viral transmission
- there is good ventilation for spaces used (for example, including keeping doors and windows open where safe to do so and using ventilation systems at high rates but only where these circulate fresh air)
- consider the use of speakers, or assisted hearing devices (both personal and environmental) where these will aid communication. This will also avoid the need to raise voices and therefore transmission risk
In all cases, visitor numbers for a resident should be limited to a single constant visitor wherever possible, with an absolute maximum of 2 constant visitors in order to limit the overall number of visitors to the care home. Visitors and residents should wear appropriate PPE and follow social distancing.
What about care home residents who lack mental capacity?
When considering their visiting policy for people who lack the relevant mental capacity needed to make particular decisions, staff will need to consider the legal framework offered by the Mental Capacity Act 2005 (MCA) individually for each of these residents and should not make blanket decisions for groups of people. It may be appropriate or necessary for providers to apply different rules for different residents or categories of resident. This is further explored in “Advice on caring for residents without relevant mental capacity, the MCA and Deprivation of Liberty Safeguards (DoLS)” (updated 12 January 2021) which focuses on new scenarios and potential ‘deprivations of liberty’ created by the outbreak. It provides that during the outbreak, the principles of the MCA and the safeguards provided by the deprivation of liberty safeguards (DoLS) still apply. In many scenarios created or affected by the pandemic, decision-makers in care homes will need to decide if new arrangements constitute a ‘deprivation of liberty’ (many will not) and if the new measures do amount to a deprivation of liberty, whether a new DoLS authorisation may be required (in many cases it will not be).