Coronavirus (Covid-19)
Out of Care Home Visiting Policy

Introduction

This policy describes the arrangements for residents of care homes to make visits out of Lymehurst in line with new Government and public health guidance, which took effect from 12 April 2021 with supplementary guidance since issued with effect from 4 May 2021. The guidance forms part of the Government’s road map to ease the Covid-19 restrictions as the risk levels reduce.

Policy Statement

Lymehurst continues to apply its infection control measures fully in line with this latest Government and public health guidance in recognition of the fact that because care home residents are amongst the most at risk by virtue of their age and frailty to being seriously and possibly fatally ill if they are infected by the virus.

Therefore, they will be advised to make visits outside of Lymehurst only if they can meet the criteria set out in the latest government guidance which is to the effect that visits outside Lymehurst can be made by any resident of any age living in a care home (not just those of working age as described in previous guidance).

However, the guidance sets out some very strict conditions, which should be integrated in to a care home policy. These can be summarised from the guidance as follows.

“This guidance sets out the approach that care homes should take to planning and supporting visits out of Lymehurst where residents wish to make them. It explains the measures that should be taken by Lymehurst, the resident and others taking part in the visit — to manage the risks.

The most significant of these is the requirement that a resident making a visit out of Lymehurst should isolate for 14 days on their return (the day of return is day zero).

This is to ensure that — in the event they have unknowingly become infected while out of Lymehurst they minimise the chances of passing that infection on to other residents and staff. We recognise that in practice, this is likely to mean that many residents will not wish to make a visit out of Lymehurst”.

Definitions

The term “out of home” visit includes any venturing outside care home for a set purpose, which could include the following (as permitted within the local tiering regulations):

  • to be taken to or to visit family members or friends

  • to go shopping

  • to visit a café or restaurant

  • to attend a sporting event or place of entertainment

  • to attend or take part in a local community event.

This policy applies mainly to out of home visiting to relatives and friends, particularly over a longer period, though other forms of visiting will be considered.

Principles to be Followed

Lymehurst bases its policy on the current Government guidance (updated 12 April), as follows.

  1. Lymehurst welcomes that under some circumstances and where it is safe to do so, residents can take part in out of home visits.

  2. Lymehurst accepts that it is responsible for setting its own out of home visiting policy and arrangements in line with national and local public health guidance provided by the local Director of Public Health (DPH) through their outbreak management team or group and adult social care services staff who are responsible for their care and support.

  3. It will do so based on dynamic risk assessments for Lymehurst as a whole and individual risk assessments carried out fully in line with the latest government guidance.

  4. Lymehurst will support out of home visits that are clearly in the best interests of the residents who want to make them or in responding to requests made on their behalf if the person cannot decide because of mental incapacity.

  5. Lymehurst will ensure that all out of home visits are conducted in a risk-managed way that considers:

  1. the needs of the service users

  2. their safety and security when making the visit

  3. the practicalities involved in ensuring the visits can be safely made

  4. the risks to other residents from subsequent exposure to infection.

  1. Its decisions will thus be based on balancing the benefits to its residents (and reducing harm because of lack of going out) against the risks of increasing Covid-19 infections and their consequences to the person and other residents.

  2. Lymehurst recognises that decisions to allow out of home visiting and under what circumstances will be made in line with local intelligence from testing and vaccination on the community and of residents and staff, transmission risks in the local community and other information provided by Lymehurst, for example, through its Capacity Tracker updating.

  3. It will continue to assess the rights and needs of individual residents, particularly those with specific vulnerabilities as outlined in their care plans and will consider the importance of their making out of home visits in promoting their health and wellbeing.

  4. It will also give particular consideration to a resident who wishes to visit someone on compassionate grounds such as to someone close to them who is terminally ill.

  5. It will continue to make appropriate best interest decisions with the help of all involved in their care in respect of residents who lack mental capacity and who might be subject to deprivation of liberty authorisations.

  6. It will follow all Government and local guidance in respect of the arrangements needed to ensure safe out of home visiting by residents under the new testing procedures and vaccination programmes.

  7. It is recognised that there is no bar to out of home visits in any tier, but there is more flexibility for out of home visits when both care home and place to visit are in a Tier 1 area.

  8. With any combination of factors in respect of both tiers 2 and 3, the risks of out of home visits within them clearly increase and Lymehurst will only support them when it is completely satisfied that all risk have been fully assessed and all necessary control measures put in place.

Implementation

Preconditions

The care provider recognises that out of home visiting for any reason can only take place if:

  • there is no-one who is known to be infected with Sars-Cov-2 living or working in Lymehurst and there has been no outbreak for a period that has been agreed with the local public health protection team

  • there are no residents who have been self-isolating as recent known contacts of someone who has recently tested positive for the virus via NHS test and trace

  • other residents who have been only recently admitted or discharged from hospital have returned negative tests prior to admission and are following current guidance to self -isolate for the required period.

Conditions to be met

Lymehurst will follow all Government and local, guidance and ensure that:

  • anyone who wishes to go out of Lymehurst (and has a right to do so) has a full risk assessment that takes into account their capacity to consent to the arrangements being made

  • if unable to consent the person will have a mental capacity assessment to decide if the arrangements being proposed or planned are in their best interests and are safe

  • the risk assessment will include any risks to Lymehurst and its other residents

  • the risk assessment includes the risks of exposure to the virus in making the visit, including in the use of transport, during the visit from other people, or after the visit, including the risks their visit out has caused to other residents and staff.

Factors to consider

Lymehurst recognises that residents might not have had the chance to leave Lymehurst for a significant period. The visit or outing therefore will have to be carefully planned, and consider:

  • the purpose and nature of the outing or visit

  • if it involves being indoors (higher risk) and/or outdoors (lower risk)

  • if it involves use of private or public transport

  • if it involves mingling with people whom the person might not know their exposure risk

  • how much support the person will need from staff or others to make the visit

  • how far the “rules” about physical distancing, wearing of face coverings and hand hygiene will be adhered to

  • if there are less risky alternatives to achieving the same purpose as the outing or out of home visit

  • the amount of time available to plan the outing or visit and to take all the precautions necessary to make it safe

  • the availability of rapid antigen testing, which can be carried out before and after the visit or outing.

Planning the Out of Home visit

Lymehurst is following Government guidance in respect of care home residents who wish or seek to spend time with their families or friends following the easing of the current restrictions .

Lymehurst will ensure that any resident who is making an out of home visit should during that time only mix with people from one other household. Lymehurst will also ensure that everyone “hosting” an out of home visit must have had a negative result from a Covid test taken immediately preceding the visit. For instance, the test could be taken when the family go to Lymehurst to collect the resident for the visit. Care homes should make use of the lateral flow devices (LFDs) they have been supplied with for this purpose”.

Lymehurst understands that a visit would not go ahead as planned if there is any positive test result, In this case the individual tested should immediately self-isolate and complete a confirmatory polymerase chain reaction (PCR) test which should be provided to them by Lymehurst. If the confirmatory PCR comes back positive, their household must also self-isolate and contacts may also need to self-isolate in line with current government guidance.

Lymehurst will ensure and enable the following.

  • The resident will be tested immediately before their visit out of Lymehurst with a lateral flow device (LFD), and if the result is positive, the visit should not go ahead. The resident must be immediately isolated in the care setting, complete a confirmatory PCR test, and contact with the local health protection team should be made urgently.

  • During the course of a visit the resident and those they are visiting should keep physical distancing, wash hands regularly, let plenty of fresh air into rooms by opening windows and doors and consider wearing a face covering.

  • “Hosts” of the visiting person should be aware of their responsibilities to minimise the risk to Lymehurst resident and others in Lymehurst on their return by following all these safety measures, which should include minimising their risks to exposure before and during the visit.

  • That the resident will need to isolate for 14 days following the visit and show no signs or symptoms before returning to the life of Lymehurst.

  • If any of the “hosts” have symptoms of Covid-19 or have tested positive for Covid-19 during the visit, the resident will self-isolate in the visiting setting if possible; or will be quarantined in Lymehurst if there is no alternative to their remaining with strict infection control procedures enforced until the “all clear” is given, which will include repeated testing.

  • In line with Government guidance and the making available of the necessary testing resources Lymehurst will ask anyone who is likely to be in close (albeit physically distanced) and continuous contact with the resident to have a LFD test immediately before the visit.

  • Lymehurst should be notified in advance of a resident returning from an extended visit away so that it can manage the risks of the person importing SARS CoV-2 into Lymehurst. This will be achieved through testing and the resident self-isolating for 14 days before rejoining the communal life of Lymehurst.

Communicating with Host Families and Households

Lymehurst will follow Government guidance in respect of enabling visits to be conducted safety and successfully, including supporting hosts on how to prepare for a visit, including where testing is being used, and how to keep the resident safe during the visit.

Lymehurst accepts that the arrangements for each set of visits will vary and need to be highly individualised.

Exceptions to the Above
(In line with Government Guidance with effect from 4 May 2021)

Lymehurst will follow the supplementary government guidance that takes effect from 4 May 2021, which allows residents to leave Lymehurst to spend time outdoors, without subsequent isolation for 14 days in the following circumstances:

  • residents may be accompanied by:

  • a member of care home staff

  • one or both of their nominated visitors

  • their essential care provider (where applicable)

  • care homes should discuss arrangements with residents’ nominated visitors, or essential care provider, in advance

  • visits should take place solely outdoors, except for the use of toilet facilities

  • there should be no visits to indoor spaces (public or private)

  • the exception to this is that residents will be able to access polling stations

  • visits should not involve the use of public transport.

Lymehurst recognises that all outdoor visits should take into account the current local Covid-19 situation and they would be reviewed or stop if there was any increase in local community prevalence that would increase the risks to residents and staff.

Lymehurst will follow the guidance in respect of visits to a polling station with elections being held on 6 May to the effect that:

  • any residents who wish to vote will be supported to do so and will be accompanied to the polling station by a member of care home staff to help facilitate a safe journey

  • residents (and staff accompanying them) will adhere to all physical distancing measures in place at the polling station.

Lymehurst notes that residents can obtain an emergency proxy vote by 5pm on polling day if by adhering to local public health advice or guidance they will be prevented from going to the polling station. Lymehurst recognises that this could be the case where a resident has tested positive for Covid-19, or there has been a new or recent outbreak in their care home.

Mental Capacity

In making these arrangements, Lymehurst will observe the rights of residents who may lack the relevant mental capacity needed to make particular decisions about their needs for the out of home visits and visiting plans. It will make all such arrangements in line with individual needs by following best interests decision — making as set out in the mental capacity laws, and where appropriate in consultation with their advocates or those with power of attorney.

However, it also recognises that people with dementia or without mental capacity for other reasons might also be the ones who will benefit most by making the visit, and their needs given high priority.

Staff Involvement and Training

All staff are made aware of the policy and of the changes made over time. They are also consulted in respect of individual risk assessments, decisions and arrangements, the new rapid testing approach and local test and trace programmes.

Reference

For more information about visiting out of care homes, visit the GOV.UK website.

Provider:

Narin Perry

Date:

11th May 2021

 

 

Source URL: https://brighthr.croneri.co.uk/topics/social-lives-service-users-emergency-planning-care/coronavirus-covid-19-out-care-home

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