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 current government and public health guidance, which takes effect from 25 February 2022. The guidance is developed under the following headings:

For out of home visiting the Government’s key message is:

“We expect and encourage providers to facilitate residents to take part in visits out of Lymehurst. This could be for a short walk, to attend a place of worship or for a longer visit including an overnight stay to see family and friends.”

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 act in line with the latest government guidance when making visits outside of their home to minimise the risks of being exposed to SARS-CoV-2, when out, and risking exposing other care home members in consequence.

Definitions

The term “out of home” or “outward” visit includes any venturing outside care home for a set purpose for a short or longer period, which could include the following:

  • to go or to be taken to visit family members or friends
  • to stay with family and friends for one or more nights
  • to go away on holiday
  • to have a period in hospital
  • 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
  • to go to a place of work or education.

This policy applies to all outward visits as described here.

Principles to be Followed

Lymehurst bases its policy on the current government guidance (applying from 25 February 2022), as follows.

  1. 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.
  2. Lymehurst welcomes that where it is safe to do so, residents should take part in out of home visits as any other community member.
  3. It will do so based on 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:
    a: the needs of the service users
    b:their safety and security when making the visit
    c:the practicalities involved in ensuring the visits can be safely made
    d:the risks to other residents from subsequent exposure to infection.
  6. 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.
  7. 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 status of 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. If, with any combination of factors, the risks of out of home visits clearly increase, Lymehurst will only support them when it is completely satisfied that all risks have been fully assessed and all necessary control measures put in place.

Implementation

Preconditions

The care provider recognises that out of home visiting can take place provided that:

  • 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 Health Protection Team (usually 7–14 days)
  • a prospective out of home visitor has not been in close contact with other residents who have been self-isolating because of testing positive for the virus or who are meeting “return to home” requirements
  • 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.

Where any of the above applies Lymehurst will act on public health advice to stop or restrict outward visiting along with the other measures being taken to control the outbreak or risks of infection to Lymehurst.

Lymehurst is also mindful of the implications of having its residents vaccinated, which should on the one hand help to reduce infection risks and therefore allow for more outward visiting. On the other hand it recognises that there will continue to be some level of risk from infection even when fully vaccinated, which must be considered in terms of its policy.

Conditions to be met

Lymehurst will follow all government and local guidance and ensure that:

  • anyone who wishes to go out of Lymehurst even when subject to some self-isolation measures (as described in government guidance of 25 February 2022), has a right to do so and 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.

Risk factors to consider

Lymehurst recognises that under some circumstances 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 (lower risk) or public transport (higher risk)
  • if it involves mingling with people whom the person might not know their exposure risk (higher risk)
  • if it involves an emergency visit or overnight stay in hospital (considered higher risk)
  • how much support the person will need from staff or others to make the visit
  • how far the current “rules” about physical distancing, wearing of face coverings and hand hygiene will be adhered to (risks will increase with non-adherence)
  • 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 vaccination status of residents, the people they are visiting, and staff, including the extent of second vaccinations
  • the availability of rapid antigen testing, which can be carried out before and after the visit or outing
  • levels of infection in the community with current variants of concern.

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.

Lymehurst will advise any resident who is making an out of home visit to only mix with people who are their “usual contacts” whose Covid (and vaccination) status is known.

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. The vaccination status of the “hosts” will also be regarded as an important potentially mitigating factor.

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 follow the current government “stay at home” guidance with any other household members who test positive.

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 should stay in the care setting away from other residents.
  • Lymehurst will contact the local health protection team if there is evidence of an outbreak in Lymehurst.
  • During the course of a visit the resident and those they are visiting are advised to keep safe 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.

Returning to Lymehurst from an outside visit

Lymehurst does not usually require residents to self-isolate on return from an outside visit, with some exceptions discussed below. However Lymehurst will always carry out a risk assessment in terms of:

    • the number of people involved in the visit and contacts (though Lymehurst appreciates that it has no automatic right to this information)
    • an understanding of the vaccination status of the people involved in the visit
    • the available information from recent LFT results
    • other information about the risks posed by the visit.

Returning to Lymehurst from an outside visit

  • Lymehurst asks residents who are returning from an emergency stay in hospital, (which is regarded as higher risk than from a planned stay) to isolate from other residents for 10 days on return; though (government guidance indicates) they may continue to make visits outside of Lymehurst in risk assessed ways.
  • Lymehurst might also ask residents returning from other high risk situations to isolate from other residents for a similar period of time.
  • In either of the above cases, Lymehurst will offer residents, who have been fully vaccinated, on return from a high-risk outside visit or emergency stay in hospital, a lateral flow test on day four, five and six which, if all are negative, means that they can end their period of self-isolation from other residents.
  • If the resident has not been fully vaccinated, Lymehurst will ask the person to self-isolate for 10 days on return, but with a view to ending their self-isolation earlier if testing negative on days six, seven and eight.
  • Residents who have planned overnight stays in hospital do not need to isolate on return provided that:
    • they are fully vaccinated and preferably boosted
    • test negative on a PCR test on return (self-isolating until the results are known)
    • complete all other testing requirements.

Other considerations

  • If any of the “hosts” have symptoms of Covid-19 or have tested positive for Covid-19 during the visit, Lymehurst will ask the resident to self-isolate in the visiting setting or back in Lymehurst until the “all clear” is given, from repeated testing (as described above).
  • Lymehurst will ask anyone who is likely to be in close (albeit physically distanced) and continuous contact with the resident to have an 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 the periods after returning from high-risk situations 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.

Additional Out of Care Home Visiting Issues

Lymehurst will support residents in leaving Lymehurst to spend time outdoors.

When outside residents and escorts are expected to follow the rules set for everyone. Lymehurst recognises that all outdoor visits should consider 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 recognises the importance of frequent testing of residents who make regular trips outside Lymehurst, for example, for medical appointments, and of any staff or others who accompany them.

Lymehurst will assess risks of possible infection and transmission from care staff who accompany a resident on trips outside particularly to high-risk situations; taking into account their vaccination status, wearing of suitable PPE, adherence to good IPC practices and regular LFD test results, all of which will lower any situational risks.

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, see the latest Guidance on Care Home Visiting (updated 25 February 2022) on the GOV.UK website.

Provider: Narin Perry
Date: 01/03/22

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

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