Open with Care - supporting meaningful contact in care homes: guidance

05 Maximising safe and meaningful contact

Care homes should work to increase the frequency and duration of meaningful contact with residents. In the first instance, resuming indoor visiting should involve up to two designated visitors weekly, visiting one at a time. This should however be seen as the minimum starting point with consideration given to increasing the number of visitors and frequency of visiting, as and when the care home judges it is safe to do so, with expert advice and support from oversight arrangements where appropriate.

Some care homes for younger adults may be able to increase opportunities for visiting more quickly than other care homes as their population has a lower COVID risk profile.

Care homes, depending on the structure of the care home, may wish initially to support meaningful contact within a designated visiting area rather than residents' own rooms. This should be considered a short term measure as meaningful contact is resumed, and care homes should continue their rigorous attention to safety precautions such as cleaning of frequently touched surfaces and airflow, recognising that there are potentially increased risks associated with multiple visitors using and accessing the same space.

5.1 Increasing the frequency and duration of contact

Care homes can take advice from local oversight partners when considering relaxations to indoor and outdoor contact with loved ones to ensure that conditions locally, and in the care home, are suitable and safe.

The following tables illustrate broad increments to increasing indoor and outdoor contact between residents and loved ones:

The above guidance is focused on reintroducing indoor visiting, which is the preferred and recommended approach to good quality contact with residents and loved ones. Whilst it is recognised that other forms of visiting are used (such as outdoors - at windows, in garden pods or marquees - or indoor, fully screened off adapted rooms), these should not be viewed as replacements to or substitutes for, indoor visiting. Additionally, care homes' ongoing efforts to support residents who do not have regular designated visitors should be encouraged, but please note, these are not the focus of this guidance.

Care homes, opening with care, for all residents is at the heart of this new approach.

Time limits for residents' contact are not defined in this guidance. This is to enable residents, relatives and care homes to work together to agree contact that accommodates individuals' needs and circumstances as well as practical issues to safely receiving visitors to all residents in the care home. Care homes may wish to use booking systems when resuming meaningful contact.

Support for essential visits is unaffected, which should always be compassionately and generously enabled by care homes when needed. The scenarios where essential visits should be supported are discussed later in this guidance.

Care homes will need to apply the guidance flexibility and sympathetically to accommodate individual resident circumstances and preferences, for example if a resident has only one designated visitor.

5.2 Children and young people

Children under 16 are not recommended as a designated visitor for routine indoor visiting at this stage however care homes should use their discretion. This is due to a range of factors that mean there are fewer protections in place for this age group (for example, they are not included in visitor LFD testing and will not be COVID-vaccinated at this stage), and may present additional more practical challenges for the care home with managing and sustaining visitors safety precautions.

As further relaxations to meaningful contact are appropriate, children under 16 should be considered as part of increasing the frequency of the visitors, and following infection prevention and control and personal protective equipment advice.

Young people 16 and above can be designated visitors, following all the relevant safety measures outlined earlier.

Effective immediately, children and young people can be supported to meet with residents outdoors and should be included in limits to total group numbers.

In relation to essential visits – children and young people should be considered for essential visits as and if appropriate, because of the pressing importance of these visits. In these instances, personal protective equipment and infection prevention and control measures should continue to be in place, with additional care that precautions are met as appropriate (e.g. young children).

5.3 Maximising high quality contact alongside infection prevention control

Residents should be supported to be with loved ones in their own room, if they wish. This is the preferred location but other person centred alternatives, for example a designated room for visiting, can be considered in the short term as opening up is embedded.

Continued attention to safety measures in relation to the pandemic are essential for everyone. This includes hand hygiene, PPE as appropriate, ensuring good airflow (as far as reasonably comfortable), and rigorous cleaning of surfaces before and after visits. Full infection prevention and control advice is provided for care home staff by Health Protection Scotland and should continue to be used to support time between residents and their loved ones – see Annex 2 - Supporting Documents section for document weblink.

People coming into the care home to see loved ones will be asked to wear a fluid resistant surgical mask (FRSM) and these will be provided by the care home to the person visiting. Hand and wrist jewellery should be removed and forearms uncovered to support good hand hygiene when spending time together indoors.

They do not need to use other PPE such as gloves and aprons, unless instructed by the care home. Physical touch should also be supported when a fluid resistant surgical mask is worn by the person visiting, as are brief hugs or embraces. Risk of transmission can be further reduced if a FRSM is worn by the resident where possible.

Circumstances where visitors are likely to be asked by the care home to wear additional PPE (such as aprons or gloves) mainly relate to involvement in personal or direct care with the resident. Care homes should advise and provide visitors with necessary PPE when they are keen to be involved in care, and loved ones are asked to follow care home advice on this matter.

Staff should wear aprons as single use items when working closely with residents. This protects their uniform from contamination and prevents cross contamination when they work with other residents.

Gloves are not necessary for people visiting as good hand hygiene is sufficient. Staff must wear gloves when contact with body fluids is anticipated.

Care homes should continue to support people visiting with training on robust hand hygiene as well as the correct processes and location for putting on and taking off PPE, including surgical masks.

Care homes should continue to support people visiting with training on robust hand hygiene as well as the correct processes for putting on and taking off PPE, including surgical masks.