Gemma Nicholas, solicitor at Ridouts, offers legal advice on care home visiting policies during COVID-19.
Images that will be remembered from this pandemic are those of friends and family visiting their loved ones through the windows of care homes. These images are illustrative of how much harder it has been to stay in touch with someone who lives in a care home during the pandemic. Visits were severely restricted during the first lockdown and the guidance on visiting care homes has changed throughout the various lockdowns and tiered systems. However, in light of the improved facilities for visiting indoors and outdoors at care homes as well as increased access to testing and PPE, the challenges faced by care providers to facilitate visitors are slightly different during this third lockdown.
Visiting Care Homes during COVID-19 was updated on 12 January 2021 and applies for the period of the third national lockdown which began on 6 January 2021. The updated Guidance supplements The Health Protection (Coronavirus, Restrictions) (No.3) and (All Tiers) (England) (Amendment) Regulations 2021. The guidance highlights the importance of visits generally in that they are a central part of care home life and are crucial for maintaining the health and wellbeing of residents. Care providers should support and enable visiting wherever it is possible to do so safely in line with the guidance. Essentially, it is about finding the right balance between the benefits of visiting for residents’ wellbeing and quality of life and mitigating the risk of transmission of COVID-19.
It is acknowledged in the updated Guidance that: “Each care home is unique in its physical layout, surrounding environment and facilities. Residents vary in their needs, health and current wellbeing. Care home managers are best placed to decide how their care home can best enable visiting in a way that meets the needs of their residents both individually and collectively.”
Therefore, in accordance with the updated Guidance, the Registered Manager is responsible for undertaking a dynamic risk assessment taking into consideration the needs of individuals within their home with regard to the advice of the local Director of Public Health.
The updated Guidance is easier to navigate for the primary reason that we are not currently working in a system of tiers. When we were in a tiered system, those living in Tier 4 were allowed to visit friends and family in a care home. Visiting a member of one’s household, a close family member or friend was listed in Schedule 3A(2)(7)(e) of The Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020 as a reasonable excuse/exception to the general restriction that “no person who lives in the Tier 4 area may leave or be outside of the place where they are living without reasonable excuse”. However, if the care home was in Tier 4, the visit should be outdoors or ‘screened’. If the care home was in Tiers 1, 2 or 3 the visit could be indoors where the visitor had been tested and returned a negative result. The substance of the previous version of the Visiting Care Homes during COVID-19 guidance is largely the same as the current version. The current guidance is easier to navigate in that the guidance that applied specifically to Tier 4 now applies nationally.
The key message is: “All care homes, except in the event of an active outbreak, should seek to enable outdoor visiting and ‘screened’ visits…visits in exceptional circumstances, including end of life should always be enabled.”
Outdoor visiting is challenging to facilitate during winter. Whilst some care providers have temporary outdoor structures, sometimes referred to as ‘visiting pods’, this is not the case for all. Alternatives to visiting pods include the familiar window visits or use of an awning, gazebo, open-sided marquee or a conservatory. It would appear that where a visiting pod or conservatory is used for visiting, the visit is considered as an indoor visit so there would need to be a Perspex screen between the resident and the visitor (designed to reduce the risk of viral transmission), for it to fall into the category of a ‘screened’ visit. That said, the guidance refers to the use of screens for all visits whatever the building structure. In addition, the following guidance should be observed:
Visitor and resident should remain at least 2 metres apart.
The visiting space is used by only one resident and visiting party at a time.
There is good ventilation.
Visitor numbers should be limited to a single constant visitor wherever possible.
Appropriate PPE must be worn throughout the visit.
Ridouts Professional Services is currently providing a free e-surgery every Tuesday at 10am covering various issues affecting the Adult Social Care sector, including COVID-19 related issues. To book your place please email firstname.lastname@example.org