Statement of support from Devon County Council and Devon Care Home Collaborative for care home visiting
Devon County Council (DCC) is working with care home providers and through the Devon Care Home Collaborative to support arrangements for family and friends to visit people who live in care homes. We all recognise the enormous value of such contact.
Our collective priority is to ensure the safety and wellbeing of residents, staff, and visitors. The COVID-19 pandemic still presents real challenges to the safety of care home residents particularly. We recognise and appreciate the efforts that care home providers and their teams have made, and continue to make, to deliver safe care and enable visiting for family and friends where possible.
We are fortunate in Devon to be able to learn from the early pilot of use of lateral flow testing for visitors which, when carefully implemented, can enhance the safety of visiting arrangements. A negative lateral flow test does not remove risk, and care home providers will need to continue to dynamically assess risk and exercise judgement about when, and in what circumstances, visits can be safely supported. We recognise these are difficult judgements to balance.
Steve Brown, Devon’s Director of Public Health supports the use of lateral flow tests as part of the wider testing programme and a care home’s visitor policy, within the context of dynamic risk assessment. Visits must however take place with robust Infection Prevention and Control as outlined in the current guidance. Advice is kept under constant review in line with current guidance and evidence
DCC and local healthcare partners will do all that we can to support care home providers through these challenging times.
Questions and Answers
Current guidance on COVID-19 lateral flow testing of visitors
A dynamic risk assessment is a process of assessing risk in developing and changing situations.
Q1. When can care homes start testing?
A1. Care homes which already have a managed device (to register tests and record results) can begin testing now, provided staff training is completed. Other care homes should not begin testing until devices are provided; tests and results can be recorded as required; and staff training has been completed.
Q2. Implementing testing in care homes will require additional staffing. Is this something that the 20% of the IPC grant fund could be allocated to, by Devon?
DCC has agreed to allocate IPC grant funding to support additional staff time to enable visiting.
ICG funding support for care home staff
DCC is keen to support homes over the Christmas period and has assigned an element of the Infection Control Fund 20% allocation. Care homes will receive a single payment week commencing Monday 14 December.
The payment has been calculated on an 8-hour shift paid at £11.92p/h as per the personalised fee model for a 4 week period.
- Homes with 9 beds or less will be paid for 1 shift per week for 4 weeks
- Homes with between 10 and 31 beds inclusive, will be paid for 2 shifts per week for 4 weeks
- Homes with 32 beds and over will be paid for 4 shifts per week for 4 weeks.
Providers are also able to utilise their Infection Control Fund dispensed in October to support with visiting costs as per the grant determination.
Q3. Where should swabbing take place?
Current guidance includes the following considerations:
- make sure there is a separate area for visitors to test and await results without entering other parts of the home
- if possible, this area should have a separate entrance. If this is not possible, visitors should don PPE before entering the care home
- make sure the visitor can enter and immediately put on PPE
- follow other key considerations include social distancing, disability access, and fire safety regulations.
Q4. If there are two visitors from the same household and/or who visit together, and one tests positive on the day, does the care home stop both visiting?
A4. This may be a question to clarify in your visiting policy. Visiting should be suspended pending the outcome of the PCR test for the visitor who tested positive on lateral flow test.
Q5. What support is there from DCC for care homes if visitors refuse a test?
A5. Current guidance advises that visitors who do not wish to take a test or who find that testing is not available, should discuss this with the care home manager. Alternative arrangements for a visit may still be possible e.g. through a window, and care homes should make their position clear in their visiting policy/dynamic risk assessment.
Should a prospective visitor, a resident or the care provider approach DCC seeking its view, DCC will indicate its support for the reasonable Provider’s position and encourage both parties to explore alternative arrangements for a visit. Where there is disagreement between parties, DCC’s operational teams will become involved at the request of either party to support resolution.
Q6. Currently insurance underwriters have not provided a definitive answer around cover for care homes undertaking lateral flow testing. Is DCC concerned about this?
A6. This is a national rather than local issue and one which DCC cannot influence.
Q7. What is our local health and care ‘system’ position on wearing masks and gloves?
A7. We advise care homes to follow the current guidance which recommends visitors wear disposable gloves, a disposable plastic apron and surgical, fluid resistant masks.
Good hand hygiene is essential before putting on or taking off PPE including gloves, and visitors should continue to socially distance from staff and other residents. Disposable gloves are single use items and not suitable to be decontaminated by washing or hand sanitiser.
Q8. Should visitors be walking through communal areas of a care home?
A8. Dynamic risk assessment by care home providers should consider their local environment, risks, and options. Visitors should continue to socially distance from staff and other residents.
Q9. What type of contact can visitors have with residents?
A9. Holding hands and personal contact are allowed if you have a negative test result and PPE, but visitors should minimise contact as much as possible to reduce the risk of transmission. Bringing food for the resident is also allowed. Visitors should keep PPE on at all times.
Good hand hygiene is essential before putting on or taking off PPE including gloves, and visitors should continue to socially distance from staff and other residents.
Q10. What is DCC’s view if care homes choose to close to visitors during 22 – 28 December?
A10. Individual care homes need to take a view and make this clear in their dynamic risk assessment/visiting policy. Dynamic risk assessments need to take into account factors such as an increase in community risk owing to relaxation of household distancing requirements, the staffing capacity required to support visiting, and availability of your teams to undertake core requirements.
DCC does not support a blanket ban on visiting, and any decision to close for a period must have provision for exceptions to be made e.g. end of life visiting and in cases of individual best interest decisions relating to exceptional requests, wellbeing or detriment.
Q12. If care home providers have to make the decision to not support a visit, can DCC support the care home provider to liaise with families?
A12. Yes. We recognise that care home providers are skilled at managing communication with families however this may be difficult in relation to such an emotionally charged issue. Where a care home providers and resident or family member are in disagreement, DCC operational teams may be called upon to support resolution.
Q13. If care homes open their doors to visitors this week, it could result in increased numbers of outbreak care homes over the Christmas period. Is Devon prepared for this? What support can DCC offer to Care Homes if there are outbreaks over Christmas?
A13. DCC has increased out of hours cover for the Provider Response Cell to support with managing outbreaks. We have been providing some staffing support ‘in extremis’ where Care Homes in outbreak are unable to make arrangements for safe staffing levels.
There is also implicit in the question a system of wider health and care “system” capacity. All acute healthcare providers are under pressure – while recognising the very significant health and social benefits of visiting, it is essential that visiting is carefully managed to minimise risk.
Q14. What is HSE’s involvement and role within Infection Prevention and Control in care homes?
A14. HSE is continuing to conduct spot checks and inspections on workplaces including care homes. They are carrying out spot checks by calling and visiting workplaces, often unannounced, to ensure they are following government guidelines on being COVID-secure. In order to reach as many workplaces as possible nationally and to support the core work of our inspectors, they are working with trained and approved partners to deliver the spot check calls and visits. HSE is supporting businesses proving advice and guidance on how to manage the risks posed by the virus in the workplace. Most of the checks HSE undertakes indicate that businesses are making workplace adjustments in line with the recommended COVID-secure guidance. Officers that visit premises will be carrying identification from their business and a letter of authorisation from HSE. If you wish to verify who it is calling you or the officer at your door is working for HSE, please call 0300 790 6896. For more information is available on the HSE website.