Open with Care – supporting people in adult care homes to have meaningful contact with others: progress report

Introduction and context

Open with Care – Supporting meaningful contact in care homes: guidance was published on Wednesday 24 February to support meaningful contact to resume and continue, at all stages of the pandemic, between care home residents and their loved ones.

At the time of publication, most of Scotland was in Level 4 of the Strategic Framework with a Stay at Home order, meaning only essential visits were supported in care homes. Consequently, the percentage of adult care homes that supported indoor visiting was 2.7 per cent (at 22 February). Since then, there has been a sustained increase such that, on 14 June, 97 per cent of all responding care homes reported indoor visiting was underway (90 per cent of registered care homes who have submitted data in previous 30 days). Over the same time period, the number of confirmed outbreaks in care homes has fallen.

About this report

This report provides a high-level overview of progress with implementation of Open with Care since it was published four months ago. Drawing on national performance statistics, sector and family feedback, it provides an overview of key areas where partners and care homes can best continue efforts to improve and embed good quality, meaningful contact as the norm. It recognises the excellent progress so far and going forward emphasises the importance of full and consistent adoption Open with Care, to support good quality contact for all residents.

The report closes with recommendations to continue progress. Efforts by care homes and local oversight teams to improve and embed meaningful contact and strengthen awareness of Open with Care are key. This drive to meaningful contact is just the first step towards the more fundamental goal of resuming support to meaningful lives, for all residents.

The aims of Open with Care

The underlying principle of Open with Care was a move away from the language of 'visits' towards supporting good quality meaningful contact between care home residents and their loved ones. The central themes driving Open with Care included:

• That the balance of harms between COVID-19 transmission and the impact of isolation should be fully considered.
• Residents' individual needs, preferences and human rights are important considerations.
• Contact with loved ones should be seen as much more than 'visits' and loved ones as more than 'visitors'.
• Meaningful contact can promote well-being and prevent mental and physical deterioration.
• Minimum (not maximum) guidelines on the quantity and quality of contact, with flexibility for care homes to increase to daily and group visits, as they felt able.
• A focus on indoor visiting in residents' rooms as the preferred way for contact to take place, where the resident supported this.
• Pods and other environments that separate residents from loved ones not recommended as replacements for indoor contact.
• Emphasis on the importance of consistent, generous and sympathetic support to essential visits for circumstances such as distress, to prevent or respond to a decline in residents' wellbeing, and approaching end of life.
• A focus on a whole-systems approach with everyone playing their part.
• Follow-up support with a series of care home and partner workshops, and printed resources to all care homes.
• The importance of COVID-19 protections to support safe visiting.

Open with Care highlighted the need for a whole-systems approach and acknowledged the roles that key partners play in supporting the reintroduction of visiting, outlining a set of recommendations to guide their input. Local oversight arrangements were seen as the key local monitoring and support mechanism and the national framework for multi-agency, multi-professional oversight guidance emphasises the continued role for these local groups.

Third sector representative organisations and families and friends of care home residents were also key in the development and delivery of Open with Care by providing expert information and experiences to related national policy and clinical groups.

Since publication of Open with Care, a range of further guidance has been produced, with shared principles and approach. This includes guidance for professionals visiting residents in care homes, advice on residents making outings away from the care home and supplementary information, updated regularly with answers to practical questions raised in feedback. Open with Care has been developed with the aim of being accessible and in plain English with public-facing guidance also available on NHS Inform. This core suite of documents is illustrated below:

This report draws on data and feedback from a range of sources, including:

• Care homes, via the national Turas Care Home Management reporting tool.
• Care Inspectorate contact and/or complaints regarding indoor visiting.
• Data from the Action on Rights team, which supports people (mainly relatives of residents), to resolve concerns about a care home's visiting policy.
• Consultation by TIDE (Together In Dementia Everyday) with care home residents' relatives and staff, and who provide resources to support the restoration of the important relationships between care homes, residents and their families.
• Feedback from national workstreams
• o Adult Social Care Clinical and Professional Advisory Group's (CPAG) Engagement subgroup, which includes family members and third sector organisations representing people living in care homes.
• o Open with Care Short Life Oversight Group which includes oversight representatives, public health/health protection, nurse directors and clinicians, social work, the Care Inspectorate, Scottish Social Services Council, care home providers and member organisations, third sector organisations, and relatives' representatives including National Dementia Carers Action Network (NDCAN), and Care Home Relatives Scotland (CHRS).
• CHRS – qualitative feedback from their members and member surveys.