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Visitors' protocol - CPA briefing for care providers

Contents


Updated February 2021

Introduction§

This protocol was first published in June 2020 following understandable calls from residents, friends and families, providers and staff to enable visiting to residential homes after a long and protracted period of ‘lockdown’, in line with changes within the wider community.

We have reviewed and updated our Visitors’ Protocol to reflect but not duplicate updated official guidance and to provide practical examples of how care services can open up the home more regularly in a way which is safe and proportionate to their localised understanding of risk.

The Government has announced that from 8 March 2021, care homes can permit one regular visitor per resident. Further details and guidance are due to be published. We will review and update this document when this is available.

This document should be read alongside the latest versions of Government information including:

Government guidance on visiting care homes during coronavirus 

Plans to allow one regular indoor visitor from 8 March 2021 (Press Release)1

Government guidance for supported living

Government guidance for home care settings

Government shielding guidance

Purpose§

This protocol aims to provide a set of principles and top tips to help people using care and support to have the opportunity to safely receive visitors during the COVID-19 pandemic, while minimising the risk of its introduction to, or spread within, the care setting. 

It is primarily aimed at care settings which cater for older people, including people with dementia, such as residential and nursing homes. However, it will be of help for other care settings such as those supporting working age people with a range of vulnerabilities, including physical, sensory or learning disabilities.

This CPA protocol recognises how difficult it has been for both people using care and those who care for them (loved ones and staff) to restrict visits, and the importance of finding ways to enable visits again in a risk-based, balanced way, and help to reduce the inevitable anxiety experienced by the families and friends of those in care settings as they have been unable to visit them for some time.

This is intended to complement and not to replace Government guidance or the very creative and innovative ways in which care providers have been facilitating ‘virtual’ visits, connecting people via technology to keep in touch, while acknowledging that these have, understandably, been more effective for some groups than others.

We have therefore removed duplication of Government guidance from this edition of the protocol.

Principles for considering how to enable visitors to care settings§

Care providers should take a dynamic risk-based approach to how they facilitate and manage visits to care settings, which will need to consider the safety of all their residents, staff and visitors and minimise the risk of any COVID-19 infection.

This will have to balance the risk of harm to residents not having visits, with the risk of harm to residents, staff and visitors. Care providers will need to ensure they take a person-centred approach to their visiting policy, taking account of individual needs and capabilities.

Types of visits§

Visits may occur in a number of ways, depending on existing guidance and local circumstances. Some examples are outlined below.

  • Indoor visits (one regular visitor): From 8 March 2021, residents will be allowed a single visitor to hold hands indoors with their relative or contact in a care home, and make repeat visits under carefully designed conditions to keep residents, staff and visitors safe. Tests will be required before entry and PPE will need to be worn on site. The Government is due to publish further guidance.
  • Window visits: This will need safe ground floor window access for both residents and their visitors and the relevant social distancing and PPE measures will need to be observed.
  • Garden visits: Relevant PPE measures and social distancing will apply. Independent access to the garden will be needed to avoid visitors moving through the care setting to the garden. Providers will need to consider how to facilitate garden visits in different weather conditions, how to ensure cleaning of areas and any items used between visits and keep everyone safe, whatever the weather.
  • Drive through visits: These are facilitated visits in the car parks of homes. Again, any relevant PPE measures and social distancing will apply.
  • Designated areas within a care setting where settings allow for this: depending on the physical layout of the care setting, it may be possible to enable visits to an identified location inside the care home reserved for this purpose, that facilitates good ventilation, social distancing, ease of access by residents, and limits visitor journeys through the residential areas. An example might include the use of a conservatory as a designated visiting area.
  • In-room visits: These visits may continue to be facilitated as appropriate, in line with national guidance in relation to essential / end of life visits to ensure the person can die with dignity and comfort, taking into account their physical, emotional, social and spiritual support needs.

The range of visits made available will be negotiated between the care providers, their residents, their staff and their visitors. It may be possible for residents and visitors to have visits in a variety of these forms, as circumstance allow.

Policies and procedures§

Care providers should work closely with their staff teams and care managers to provide appropriate support, policies and procedures to enable staff to facilitate visits safely and in line with all the relevant guidance.

Care providers may wish to consider developing a short individual visiting plan for each resident (My Visiting Plan) with the overall care plan, tailored to their visiting wishes and preferences, taking account of their individual needs and capabilities and the circumstances of the family/ friends who the resident would like to be able to visit them.

Government guidance currently does not mention children, but it does recommend limiting visitors to one constant visitor. In practice, care homes have not found a way to be able to accommodate requests for children to visit because there are so many potential complexities in managing visits by children, depending on age and behaviour. Care homes need to be fair and risk based in based in their approach. Care homes can consider alternatives to visits in person for children.

Visits between residents and their visitors must operate fully in line with the latest infection prevention and control guidance including provisions relating to the use of designated areas for visits and the use of social distancing practices, good hand hygiene, use of PPE for visitors and residents.

Visits will need to be booked in advance for a specific day, time and length of visit, to enable visiting to be re-established within the setting. Visitors must check in with the care provider on the day prior to their visit, just in case the situation in the care setting has changed.

Providers may wish to create a ‘Responsible Visitor Code’ which sets out a range of responsibilities that visitors must abide by prior to and during any visit.

The code could state that visitors must:

  • book visits in advance for a specific day, time and length of visit
  • check in with the care provider on the day prior to their visit, to ensure the situation in the service has not changed
  • be free of any COVID-19 symptoms for at least 10 days prior to the visit, as per Government guidance
  • not be unwell on the day of their visits
  • not be self-isolating as a result of advice from NHS Test and trace
  • provide the necessary information required by the provider at the visits (e.g. honest response to screening requirements about COVID-19 risk factors, compliance with NHS Test and Trace arrangements)
  • comply with the infection prevention and control measures, including a temperature test, mandatory hand hygiene, the use of PPE as required and social distancing requirements, remaining in the designated visiting area
  • ensure that any gifts brought to give to the individual they are visiting can be sanitised, in line with relevant infection prevention and control (IPC) guidance.

Care providers will discuss with potential visitors the best way to get to and from the home. Wherever possible, visitors should a try to walk or travel by car and avoid public transport when visiting the home.

Supported visits§

Some visitors themselves will need support – such as a sighted guide - in order to visit a care home resident.

As previously stated, the approach to enabling visitors has to be based on the circumstances of the individual care setting (including both residents and staff), the individual needs of the residents within that setting, and the external COVID-19 environment around that care setting. Personalised risk assessment is key, and it is the responsibility of the care provider to make that assessment.

For example, if the visitor is blind or partially sighted, they are very likely to require the support of a sighted guide. A sighted guide provides support for someone whose sight is not sufficient to safely negotiate an unfamiliar environment. This may be another family member or friend – and would therefore be a second visitor.

Permitting a visitor to bring a sighted guide with them, or providing a member of staff to act as a sighted guide, is a reasonable adjustment to make if the care home assesses that it is safe to do so.

The home should expect them to comply with the same infection prevention and control requirements as any other visitor. If the care home does not want two people with the resident at the same time, they could arrange for the sighted guide to wait in another empty space, or if available, in their car.

Essential Family Carers (EFC)§

Many family members and friends of care home residents provide essential day-to-day support to help maintain their physical and mental wellbeing. That may include help with eating, drinking, cleaning, or keeping in touch with others.

Some care providers have introduced an Essential Family Carers visiting scheme which, when in line with Government and the local Director of Public Health guidance, can enable EFC support to be reintroduced.

Care home group, Methodist Homes (MHA), define an Essential Family Carer (EFC) as:

“A resident’s family member or friend whose care for a resident is an essential element of maintaining their mental or physical health. Without this input a resident is likely to experience significant distress or continued distress. Although we have used the word Family, we recognise that you may be a resident’s friend and not a family member. Also, we acknowledge that you may not see yourself as a ‘carer’ but as a partner or a supporter of your relative. We chose the term after consultation with a group of resident’s family members and John’s Campaign.”

Care homes may want to develop a similar arrangement.

Care homes should consider:

  • Can the task be carried out by a care worker, rather than an EFC?
  • What are the residents’ preferences?
  • Does the resident have specific needs/characteristics that mean they reply heavily on an EFC to provide support or advocacy (e.g. cultural, religious, gender or sexuality issues)?
  • Is the resident unable to maintain relationships through other arrangements, such as outdoor visits or through technology?
  • What is the impact on the resident of the lack of regular contact with the EFC?

If an EFC is identified, care homes may wish to put in special arrangements over and above those required for other visitors. For example, they may require that EFCs must:

  • have a negative COVID-19 test within the last week prior to a visit (with appropriate paperwork to confirm this)
  • confirm that they are willing to comply with the homes infection control policy
  • allow the care home to retain contact details, in case they need to share these with the NHS Test and Trace scheme
  • agree any limits to length and frequency of visits with the care home.

For more ideas, see MHA’s More than just a visitor: A guide for Essential Family Carers.

Volunteers§

In relation to volunteers, Government guidance says that:

“Where volunteers usually support residents the provider or manager should carefully consider whether their support is more aligned to that of a staff member or a regular visitor and apply the appropriate oversight and infection-control procedures.”

Mental capacity§

Government guidance states that:

“Providers must consider the rights of residents who may lack the relevant mental capacity needed to make particular decisions and, where appropriate, their advocates or those with power of attorney should be consulted. For example, some people with dementia and learning disabilities may lack the relevant capacity to decide whether or not to consent to a provider’s visiting policy. These residents will fall under the empowering framework of the Mental Capacity Act 2005 (MCA) and are protected by its safeguards.

When considering their visiting policy, staff will need to consider the legal, decision-making framework offered by the MCA, individually for each of these residents. The government has published advice on caring for residents without relevant mental capacity, and on the MCA and Deprivation of Liberty Safeguards (DoLS), during the pandemic.

Regard should be given to the ethical framework for adult social care, and the wellbeing duty in section 1 of the Care Act 2014. Where the individual has a social worker or other professional involved, they can support the provider in helping consider the risk assessment.”

Ability to suspend visiting§

In the event of any suspected or actual outbreak of COVID-19, or a suspected or known case of COVID-19 within a home, visitor restrictions may need to be immediately implemented which suspend some of these enabling approaches and will include exclusion of any non–essential visitors. This should be implemented in a transparent manner with open and clear communication to residents and relevant family members.

Care providers will vary their own responses to enabling visits in person to care settings as OVID-19 risks change within their local community, using their dynamic risk-based approach.

Effective communication§

Care providers will ensure that they communicate effectively with relatives and other key stakeholders in an open and transparent way about their approach to visiting, in line with the recent joint statement: Keeping Connected: transparency.

Learning as the situation develops§

Care providers will be able to review their visiting policies as they learn from their implementation of opening up to visitors and as the wider COVID-19 situation and guidance/ advice evolves.

Suggestions for future consideration from consultees of family representatives on this protocol include: exploring ways in which children may be enabled to visit safely and how a potential ‘staff support volunteer role’ may be possible to enable those relatives who used to visit regularly and spend a lot of time at the care setting and assist with meals/ other activities to return in the longer term. 

Rights and responsibilities§

This protocol includes a set of rights and responsibilities for both care providers and visitors which put the welfare and wellbeing of residents/ people receiving care at the heart of the approach to developing their visiting policies.

RIGHTS

Care providers have the right to:

Visitors have the right to:

Mitigate risk of infection by refusing entry to their home to anyone, or requesting that a person leave the premises, for any justifiable reason consistent with this protocol.

Access care homes in accordance with the entry requirements set out in the visiting policy of the care setting.

Consider increased visitor restrictions when an outbreak (including non-COVID-19) occurs within the home, or declared outbreak / clusters have occurred within the home’s local area or if there are other extraordinary circumstances that require it, and usage of such circumstances will be closely monitored.

Be notified by timely and regular updates and information about what is happening in the home, in relation to visiting and local COVID-19 prevalence and transmission risk.

 

Be provided and supported with additional ways to connect such as video conference or telephone calls in addition to a limited number of in-person visits.

RESPONSIBILITIES

Care providers have a responsibility to:

Visitors have a responsibility to:

Follow Government and local Director of Public Health guidance, including guidance on visitors.

 

Provide a clear policy and information on how they will facilitate visitors, using a dynamic risk-based approach, and make this publicly available as needed.

Follow the home’s visiting policy and Visitor Code, including booking in advance.

Provide clear information about how the visit will work and the infection control measures that must be followed.

Not to visit when unwell or displaying any signs of a cold/flu, respiratory or COVID-19 symptoms.

Appropriately support staff in order to facilitate visits including written processes and procedures.

Respond truthfully to COVID-19 screening questions asked by staff and to sign the checklist / visitor.

Treat all visitors with respect and courtesy, and to provide clear instructions about the visiting policy

Treat all staff with respect and courtesy, and to follow their instructions on the visitor policy.

Proactive communication with residents and families where an outbreak occurs, and the impact on the visiting policy.

Follow visiting requirements including, infection and prevention control measures such as washing hands, use of visiting windows, remaining indesignated areas and social distancing requirements – as directed by the care home staff, and provision of contact details to support NHS Test and Trace – and that failure to do so may affect the future ability to visit.

Useful links

Visiting arrangements in care homes – Department of Health and Social Care

Coronavirus information – Care Provider Alliance

Statement on visitations to Learning Disability services – Care England

GOV.UK resources for adult social care on coronavirus

How to work safely in care homes – GO.UK

More than just a visitor: guide for Essential Family Carers – MHA

John’s Campaign

Residents and Relatives Association

Carers UK

Disclaimer§

The CPA assumes no responsibility or liability for any errors or omissions in the publication of this communication. The information contained in this update is provided on an “as is” basis with no guarantees of completeness, accuracy, usefulness or timeliness. It does not constitute legal advice.