Coronavirus (Covid-19)
Care Home Visiting Policy

Introduction

This policy revises the arrangements for visiting this care home in line with the latest government guidance (with effect from 25 February 2022). There is a separate Out of Care Home Visiting Policy to which the same guidance applies.

The guidance follows these headings:

The key messages included in the guidance under these headings include the following.

  1. Essential care givers — Every resident is entitled to have an essential care giver, who can visit as frequently and regularly as needed. The essential care giver does not count as one of the nominated visitors and can continue to visit if there is an outbreak or during periods of isolation.The essential care giver should follow the same testing arrangements as care home staff, and when providing direct personal care, should follow the same PPE and infection control arrangements as care home staff. (However, an essential care giver is not subject to the current vaccination requirement as are paid staff.)
  2. End-of-life visits — Lymehurst should be flexible when considering requests for people to visit a resident who is approaching the need for or receiving end-of-life care. Visitors should use lateral flow tests in line with Lymehurst’s testing arrangements for visiting. (See section on Essential Purpose Visiting.)
  3. Professional visits — Care homes should facilitate necessary visiting by health, social care and other professionals. Lymehurst should ensure visiting professionals meet vaccination requirements, where applicable, and follow agreed testing, IPC and PPE measures.
  4. Infection prevention and control — Lymehurst must manage their visiting arrangements in relation to the risks from Covid-19 and other infections such as flu by adhering to standard infection prevention and control practices.
  5. Risk assessments — Lymehurst should assess the risks and benefits of visits for each person and develop a suitable visiting plan that provides the benefits in a risk controlled way. (Risks include those to others as well as the individual.)
  6. Testing arrangements — Lymehurst must have a testing regime in place that enables safe visiting to take place, which can be adapted to changing needs.
  7. Visits out of Lymehurst — Lymehurst should support residents to take part in visits out of Lymehurst, whether for a short walk or for a longer visit, including an overnight stay with family and friends. (See separate Out of Care Home Visiting (England) Policy.)
  8. Communicating with families and visitors — Lymehurst should provide clear advice and instructions to enable safe visiting to take place.
  9. Care home outbreaks — Lymehurst should take all necessary steps to control any outbreak of infectious illnesses in line with its infection prevention and control policy, which will usually have an impact on its visiting arrangements. With Covid, Lymehurst can now re-open its doors to visiting after 7–8 days (instead of 14 days) after an all clear (as determined by negative testing).
  10. Working with public health and adult social services — Lymehurst should expect local authorities to support its visiting polices assuming that they enable safe visiting to take place. The authorities should only recommend a more restrictive approach it is needed on public health grounds and then only for as long as necessary. The Government would not support the idea of blanket visiting bans imposed by local authorities in the current circumstances.
  11. Support and information — The Government recommends a care provider to seek information and support for their visiting polices from national provider and professional organisations such as Care UK and the Care Providers’ Alliance.

(Source: See Guidance on Care Home Visiting, updated 25 February 2022.)

Definitions

Lymehurst uses the same definition of “visitor” as in its main policy, ie someone who does not live or normally work on the premises as a paid staff member or accredited volunteer and who comes to Lymehurst for a short period of time to see residents or staff.

For the purposes of this policy visitors include people who:

  • visit residents on a personal or social basis regularly or occasionally, eg relatives, friends and others who come to see an individual resident
  • provide professional services to residents such as GPs, community nurses, pharmacists, occupational therapists, physiotherapists, ministers of religion, social workers, advocates, hairdressers, opticians, etc. Lymehurst requires all these types of visitor to be fully vaccinated before they come onto Lymehurst in line with its mandatory vaccination policy and the new regulations (see Coronavirus (Covid-19) Mandatory Vaccination of Staff, Volunteers and Visiting Professionals in Care Homes Policy)
  • deliver, provide or supply goods and services that have been bought or commissioned by Lymehurst, staff or residents, including repairs and maintenance; these might also be subject to the mandatory vaccination requirement if they work entails entry into Lymehurst
  • come to Lymehurst to see staff members for any reason — they might also be subject to the mandatory vaccination requirement to obtain entry into Lymehurst
  • visit Lymehurst on a professional or business basis, eg external managers, inspectors and other personnel from the employing organisation or similar who may not be coming specifically to see individual residents, but who may have some contact with them depending on the nature and purpose of their visit; they are subject to the mandatory vaccination requirement to obtain entry into Lymehurst.

Scope of Policy

This policy applies mainly to relatives and friends of residents and others who might need to have direct contact with residents. With other visitors, Lymehurst will continue to apply all required infection control measures, including health and safety risk assessments, the appropriate use of PPE, regular testing and proof full vaccination. In these ways Lymehurst is committed to minimising and mitigating the risks of infection into, through and from Lymehurst. Lymehurst has a separate Out of Care Home Visiting (England) Policy.

Policy Statement

Lymehurst’s visiting policy will always be adapted to the changing conditions concerning the spread of Covid-19 and the associated Government policies and guidance. The current policy reflects government guidance with effect from 25 February 2022.

Lymehurst understands that any longer-term continuation of these arrangements will depend on how well Covid-19 is being brought under control and the continuing effectiveness of success of the vaccination programme, including boosters.

Lymehurst welcomes the Government’s current position, which recognises that visiting is:

  • a central part of care home life
  • crucial for maintaining the health, wellbeing and quality of life of residents
  • vital for family and friends to maintain contact and lifelong relationships with their loved ones and to contribute to their support and care.

Lymehurst welcomes the lifting of the restrictions on the number of visitors and length of visiting times from 25 February 2022 but recognises that visiting must be made safe to all concerned. It continues to apply its infection control measures fully in line with this latest Government and public health guidance.

It acknowledges that, despite the vaccination roll out and its evident effectiveness, care home residents are still at risk by virtue of their age and frailty to being seriously and possibly fatally ill if they fall ill with Covid-19.

Lymehurst is committed to making its visiting policy available and well communicated to its residents and families, so that they understand fully the reasons for any restrictions, arrangements and changes that might need to be made in line with local and national developments regarding Covid-19. (See guidance point 8 in the Introduction.)

Approaches Taken During Restrictions

Lymehurst recognises that the guidance on visiting has been issued in stages in line with the severity of the threat caused by the Covid-19 outbreak. The continuing thread is that there still cannot be completely open visiting for care home residents as stated in its default Visiting and Visitors in Care Homes (England) Policy, which is in abeyance until the current national restrictions to control the spread of Covid-19 are fully lifted.

During this period, Lymehurst has arranged for suitable alternative means of relatives and others who would normally be visiting for keeping in contact with residents and Lymehurst through, for example, telephone, messaging, social media, Facetime, Relaatvies Gateway and Zoom. These methods are well established and will continue as options even after the lifting of the current visiting restrictions, particularly where there are outbreaks of Covid-19 and other infectious illnesses that require temporary restrictions on visits.

Visiting Policy Principles

With any set of arrangements, Lymehurst will continue to have in place or be ready to put in place all essential safety measures to:

  • keep safe physical distances between people, which should be a minimum of 1m in casual social interactions in Lymehurst
  • ask visitors to wear masks when moving through and around Lymehurst
  • ensure high quality infection prevention and control practices before, during and after each visit
  • ensure any number of people visiting in line with Lymehurst’s policy can do so safely
  • have entry and exit arrangements for visitors that minimise risks of possible cross-infection
  • ensure good ventilation in every visiting area
  • supervise the arrangements to ensure all safety precautions are being followed
  • continue to assess and manage all risks.

Visiting Arrangements

  1. Lymehurst accepts that it is responsible for setting its own visiting policy and arrangements in line with national and local public health guidance.
  2. It considers that visits should be supported and enabled wherever it is safe to do so and it recognises that the visiting policy and arrangements will be very much subject to local circumstances and will have to be adjusted to meet any changes in these. These changes include:
    a: the circumstances of Lymehurst in terms of, for example, its location, resident needs, current staffing situation and its experiences with the Covid-19 outbreak
    b: the local circumstances of the Covid-19 epidemic, including past and current incidence and transmission risks, and the prevalence of new SARS-CoV-2 variants.
  3. It will take a risk assessment and management approach taking into consideration the needs of individuals within their home and with regard to the advice of the local Director of Public Health (DPH) through their outbreak management team or group.
  4. Decisions over visits will balance the benefits to its residents (and reducing harm because of lack of visits) against the risks of increasing Covid-19 infections and their consequences to a vulnerable group of people.
  5. It will (as applicable):
    a: continue the policy of “essential care givers” (as defined in government guidance) where in exceptional circumstances close contact personal care can be provided from a close relative/person who is critical for the resident’s immediate health and wellbeing (not only to end-of-life care). The “essential care givers” will be supported to follow standard testing arrangements and the same PPE and infection control arrangements as care home staff. (See the section on Testing Arrangements for Essential Care Givers.)
    b: allow “indoor” visits by named visitors to pre-appointed areas and at pre-appointed times that can be supported by prior LFT testing and/or visitors who have been vaccinated against Covid-19 (recommended in the government guidance).
    c: adapt its policy of “outdoor” visits adapted to the situation and weather as indicated by the risk assessments and information on community transmission rates and any evidence of a Covid-19 outbreak in Lymehurst
    d:continue with its current approach of taking a flexible approach to visiting required on compassionate grounds where a resident is receiving end-of-life care, following government guidance on suitable testing arrangements. (See guidance point 2 in the Introduction and section on Essential Purpose Visiting.)
  6. Lymehurst will ensure that all visits are conducted in a risk-managed way that considers the needs of our service users and the practicalities arising from the physical features and layout of Lymehurst.
  7. 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 visits in promoting their health and wellbeing.
  8. Residents will be fully involved in naming and receiving their visitors and the arrangements for their visits.
  9. Lymehurst 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 and involving them as fully as possible.
  10. It will follow all government and local public health guidance in respect of the arrangements needed to ensure safe visiting of residents whenever this takes place. It will always ensure safety is never compromised and will adopt Government and local public health advice on any form of visiting.
  11. Lymehurst understands that fully vaccinated residents do not need to isolate if they have been identified as a close contact of someone who has tested positive for Covid-19 and therefore can continue to receive visits on a risk managed basis.
  12. When setting up any new visiting arrangements, it will ensure that they can be accessed and used safely without risk to and from the other parts of Lymehurst. Any such arrangement will follow all public health guidance on:
    a: a safe number of visitors that can be allowed at any one time or over a period of time
    b: how Lymehurst should support visitors to reduce the risks of their spreading the virus to Lymehurst and of being infected from their visits to Lymehurst, which might include prior testing, the wearing of face coverings, which visitors should wear in communal areas and good hand hygiene practices, etc
    c: the infection control measures required for the use of the visiting areas, including the wearing of face-coverings and for access and exit
    d: the infection control measures to be taken by staff during visiting, including appropriate use of PPE and cleaning schedules.

Visiting Arrangements After a Care Home Outbreak

Lymehurst understands that an outbreak is defined as two or more confirmed cases of Covid-19, or clinically suspected cases of Covid-19 among people in the same setting, with the onset of symptoms within 14 days.

Lymehurst also recognises that an outbreak will impact on its visiting arrangements. In the event of an outbreak in this care home, it will stop indoor visiting (except in exceptional circumstances such as end of life).

It will also restrict movements out of Lymehurst as far as possible. It will however allow essential care givers to continue to visit indoors as long as neither the essential care giver nor the resident they visit is Covid-19 positive.

If a resident is Covid-19 positive, the essential care giver will be allowed to continue visiting in exceptional circumstances because, for example, the resident is suffering severe distress or is terminally ill. Lymehurst will consider the vulnerability and vaccination status of the essential care giver and ensure that they receive appropriate IPC support.

In the event of an outbreak, Lymehurst will maintain contact between residents and their otherwise visitors (who are not essential care givers) by, for example:

  • allowing visits in well-ventilated spaces with substantial screens, visiting pods or from behind windows
  • telephone calls
  • video calls
  • newsletters
  • emails, letters, cards or photographs.

In organising any arrangements, Lymehurst will carry out a risk assessment of the impact of the outbreak and of the feasibility of alternative visiting arrangements, which will not increase the infection risks. Lymehurst understands that it might need the advice of the local Health Protection Team and Local Authority to carry out the risk assessment and to act on its outcomes.

Lymehurst understands that if the outbreak appears contained as evidenced by negative whole care home PCR testing, the outbreak control restrictions may be lifted following a risk assessment by the HPT. This may mean that outbreak measures may only be in place for 7–14 days depending on the test results and no new cases, allowing the current visiting arrangements to resume.

Testing Procedures

While testing procedures are required, Lymehurst will (as applicable to local situations):

  • ensure visitors are tested on each visit in line with the current guidance
  • ensure visitors are wearing the appropriate PPE, including face coverings in higher risk areas, and following standard infection control measures such as hand hygiene
  • have a designated entrance or outside dry space for people to put on any necessary personal protective equipment (PPE)
  • have a designated area for any testing to be carried out, which is away from the main visiting area, which can also be used while the tests are being processed
  • ensure the designated area is well ventilated and complies with fire safety and other health and safety regulations and is robust enough to withstand repeated cleaning with chlorine-based agents
  • ensure all physical distancing, face covering and hand hygiene requirements are followed prior to the testing results being available with hand sanitisers being readily available
  • ensure all prospective visitors are made well aware of the requirement to be tested, the timescales involved, the need for their consent, what testing involves and the potential benefits to the visiting experience
  • advise them of what would happen if they tested positive, ie the visit would not go ahead; they should then follow government guidance on self-isolating with other members of their households and the information fed into NHS test and trace
  • have designated visiting areas, which can include residents’ room, ensuring that they do not increase any risk to anyone else in Lymehurst and to which all safety measures can be applied.
  • encourage all visitors to be fully vaccinated and receive a booster as soon as possible.

Testing Arrangements for Essential Care Givers

Lymehurst will follow all government guidance in relation to visitors defined as “essential care givers”.

Visitors who might be engaged in personal care and support as designated “essential care-givers” will be required to follow the same testing regime as care staff (including any changes to that).

Other Testing Arrangements

Visitors who have recently tested positive for Covid-19 should not be retested within 90 days unless they develop new symptoms. This means that some visitors will not need to be tested regularly because they will still fall into this 90-day window. These visitors should use the result of their positive result to show that they are currently exempt from testing until the 90-day period is over.

Once the 90-day period is over, visitors should then follow the current testing arrangements and all other relevant IPC measures throughout these 90 days, including maintaining good hand hygiene and wearing PPE.

Face Coverings and Physical Distancing

Lymehurst will follow current government guidance and recommendations about the use of face coverings to reduce risks when people meet in enclosed public spaces and will encourage, subject to the risk factors present, residents and visitors wear face coverings and continue to maintain a safe physical distance.

Lymehurst in consultation with its public health partners will always exercise discretion in instances where on the one hand residents are frightened or affected adversely by having to or seeing their visitors in face coverings and on the other hand, visitors have reasonable grounds for not wearing them, which can be discussed at pre-visiting planning.

Where it has been agreed that face coverings should not be worn, but the visit is not supported by testing, all parties will be reminded of the importance of maintaining safe physical distancing and hand hygiene procedures, (which apply to everyone at all times).

Visiting Schedules

Under the present circumstances Lymehurst recognises that all visits will have to be pre-booked and with limited availability some order of priority might need to be established.

It will base its priorities on the following.

  • The importance to the wellbeing of the individual to have a resumption or continuation of visits and their expressed wishes.
  • The degree of harm that might occur without any visits.
  • The risk factors that are involved including the vulnerability to infection for the person concerned.
  • The degree of compassion that is involved, eg if the person is receiving end of life care or is likely to be receiving it in the near future.
  • The importance of visiting to the person in the context of their overall care plans.
  • The effectiveness of the current contact or visiting arrangements in place.
  • The willingness of prospective visitors to go through the new testing procedures if and when adopted by Lymehurst.

Lymehurst will ensure that the visiting arrangements will be planned, including times, frequency, and duration, which, however, can be variable according to individual need, and agreed in consultation with residents and their families and with professionals involved in a person’s welfare.

Each resident will have a visiting plan, which will set out the arrangements for that individual together with an agreement outlining people’s responsibilities for the safe and successful conduct of the arranged visits.

All visitors will be asked to provide separately, using the slips or electronic tools available, their contact details in addition to the usual signing of the visitors’ book, which is required on other grounds, in line with the Government’s test and trace guidance. This information will be held for 21 days after each visit before being destroyed in line with data protection laws.

Communicating with Residents, Families and Visitors

Lymehurst will follow government guidance in respect of enabling visits to be conducted safely and successfully, including supporting visitors on how to prepare for a visit, including where testing is being used, and taking everyone’s vaccination status into account.

Lymehurst accepts that the arrangements for each set of visits will vary and need to be highly individualised. Lymehurst has developed several tools to ensure it communicates consistently and effectively with all visitors.

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 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 the new visiting supported by testing approach from the closer contact that will be possible, and their needs given high priority.

Essential Purpose Visiting

Lymehurst considers that it is still important to maintain its essential visiting policy on in-home visits but with a flexible approach in line with government guidance for visiting on compassionate grounds. If someone must visit outside of the regular visiting arrangements for an essential purpose such as being with someone who is receiving end of life care we still ask them to check with Lymehurst beforehand to discuss the essential nature of the visit, its advisability and the safety issues in respect of residents and staff that should be addressed.

Lymehurst will encourage all visitors to take advantage of local SARS-CoV-2 testing facilities to provide reassurance that they are safe to visit, and the rapid testing arrangements that are being introduced.

Visitors’ Risk Assessments

When visiting a resident of our care home we will still ask the person(s) to:

  • check with us before visiting that everything is in order and that they do not have any symptoms for Covid-19
  • check if they might have had any contact with anyone who might have been in contact with an infected person or someone carrying the virus and take a decision about visiting based on an assessment of any risks
  • sign a short agreement form to this effect
  • be careful about being in physical contact with the person being visited and other people who they might meet
  • carry out good hand hygiene practice by washing hands carefully before and after any contacts made — using the soap and hand sanitiser gels and paper towels provided
  • help staff to carry out the procedures that have been put in place to keep everyone safe from the virus and its spread
  • report and discuss with us any concerns about the health of the person whose welfare is your concern.

We are confident that with these precautions in place we will be able to keep our residents safe.

Lymehurst will update this visiting policy in the light of further developments, particularly if there are further cases of Covid-19 in Lymehurst or evidence of increased risk from community transmission that has been identified by local Public Health.

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.

Provider: Narin Perry
Date: 01/03/22

References

  • COVID-19: Visitors’ Protocol (updated September 2021), Care Providers Alliance, available on the Care Providers Alliance website
  • Guidance on Care Home Visiting (updated 25 February 2022), available on GOV.UK website (applies to England)

 

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