Open with Care: supporting meaningful contact in adult care homes – principles

Visiting guidance

Overview

The following sets out current guidance for supporting visiting, outings, and activities in adult care homes when there is no outbreak:

• care homes supporting residents to see and spend time with others should be the norm and support should be as per pre pandemic arrangements
• there should not be any restrictions to the frequency or length of visits into or out of the care home, unless there is an active outbreak. This means care homes should not be routinely using booking systems for visits. However, visiting should remain manageable for care home staff and the resident themselves
• visitors may provide care including personal care to the individuals they are visiting during the visit. They should discuss this with the care home to ensure there is an understanding of any risk and mitigations that may need to be in place to enable the visitor to complete the care activity
• PHS guidance advises that in determining the number of visitors for a resident at one time, care homes should consider the built environment of the home, including factors such as ventilation and size of the area where visiting will occur, in addition to the wishes of the residents themselves
• visitors with COVID-19 symptoms (or test positive for COVID-19) should not attend the care home and should follow ‘stay at home’ guidance. (exceptions can be made for 'end-of-life' visits)
• visitors who live with someone following the ‘stay at home’ guidance are recommended to avoid visiting the care home during this time
• vaccination is encouraged for all visitors
• visits by children or babies should be supported unless they are unwell
• people living in care homes who are well enough and are not COVID-19 positive, can go on outings away from the care home. The care home should support this in line with their care plan and support needs
• people living in care homes should be able to participate in activities outside of the care home and should follow advice for the public when doing so
• it is vital that care homes routinely support meaningful activities for people, including communal activities, where this meets individual choice and preferences
• arrangements for supporting visits from pets should be in place
• advice from PHS on community group visits including in-reach activities, such as school or adult choirs

Visiting during an outbreak

Where there is an outbreak within the home, as advised by the local Health Protection Team (HPT), residents should continue to be supported to stay connected with people important to them by default through their named visitors. The following outlines the current guidance for visiting, outings, and activities in adult care homes during an outbreak:

• residents can now identify up to three named visitors, and one named visitor can visit the resident in their private room each day
• named visitors may also be able to spend time with a resident who is self-isolating because of being COVID-positive. This should be discussed in advance of the visit with the care home who will take advice from the local health protection team following their risk assessment
• flexibility will need to be applied, for example where support is needed by one named person to visit e.g. an elderly spouse or due to other individual circumstances
• it should be possible to change named visitors to take account of family circumstances
• regardless of outbreak status, essential visiting should continue to be supported. This is in addition to named visitors and is not restricted by numbers, frequency or length of time spend with the resident
• if the resident is well enough, unless they are COVID-19 positive, have COVID-19 symptoms, or symptoms of another infection, they can continue to go on outings from the care home in line with the support needs within their care plan. However, in some circumstances the care home, following advice from their local health protection team, may recommend that residents do not leave the home for a short period of time, while the outbreak is ongoing
• during an outbreak, visits from clinical and social care professionals will be prioritised due to the essential nature of support for resident health and wellbeing. Advice will be provided by the HPT

Current IPC measures in place to support visiting and outings

When visiting a care home, the guidance on face coverings for Coronavirus (COVID-19) in social care settings including care homes should be followed.

The key points are:

•  visitors do not need to wear a face mask or a face covering including in communal areas. However, they may choose to wear one and this should be supported.

• visitors should continue to follow requests by the care home in relation to IPC precautions and mask wearing in particular situations
• if a resident is self-isolating as a COVID-19 case and during an outbreak, visitors should wear a fluid resistant surgical mask (FRMS), provided by the care home, and follow the care home’s processes according to the IPC guidance
• care homes can offer visitors transparent face masks, where these are available when residents have communication challenges. Transparent face masks have been made available through usual supply routes, and should these fail, from Social Care PPE hubs
• after outings away from the care home, routine lateral flow device (LFD) testing of residents is no longer recommended. ARHAI Scotland guidance refers to the respiratory symptom assessment questions to inform a risk assessment on return from visits and to be vigilant of any new symptoms amongst residents. If a resident has inadvertently been in contact with a case whilst on an outing, this information should be shared with the care home as soon as it is known, so that the risk in the care home after that visit can be fully assessed

In addition to the measures noted above visitors to care homes should continue to be symptom vigilant and follow any requests to test as requested by the care home, in line with national guidance.