Coronavirus (COVID-19): care home outbreaks - root cause analysis

13. Carer Perspectives

The review group took the view that given the very recent deaths in these care homes, it was not the appropriate time to directly approach the affected relatives. In order to gain a carers and relatives perspective we were directed to the recently established group 'Care Home Relatives Scotland'. This group have been campaigning for improved visiting arrangements within care homes and the examples they gave of the distress experienced by residents and carers, due to lack of contact since the lockdown in March, were both powerful and moving. 

Any consideration of visiting policy must keep in mind the delicate balance between maintaining a safe environment in relation to footfall, as described earlier in this report, with the clear adverse impact on the mental and physical health of residents who are unable to comprehend the rationale in relation to restrictions. This was particularly clearly highlighted by those we spoke with in the stark differences between visiting allowed in care homes, when compared to that facilitated in hospital settings. We heard of the distress of families caused by the variance in local implementation of national visiting guidance by care homes, which was sometimes driven by overall corporate policy rather than local conditions. In our discussions with other stakeholders it was emphasised that the views of this group in seeking substantially enhanced access to care homes are not universally supported by all, and there are many who support a very cautious approach to the lifting of visiting restrictions. This is clearly an issue which is being kept under active review and changes to the visiting guidance, were made in September, create the possibility of enhanced levels of indoor visiting subject to the meeting of a number of criteria. On the day we met with the carers (23/10/20), further changes were announced, which introduced the possibility of COVID-19 testing for relatives, as a mechanism to improve visiting arrangements, as we move into winter and outdoor visiting becomes less viable.

Setting the parameters for visiting involves a balancing of risks and harms. The submission, to DPH by care homes, of local risk assessments for visiting plans are not always timeously authorised, and this is understandable given the pressures on DPH and departments given the pressures on them mentioned elsewhere in this document. The changes already made and those envisaged in the coming months clearly moves closer to the position being advocated by the Care Home Relatives Group. They did however emphasise that changes to the guidance need to be accompanied by active encouragement of care providers to implement the guidance and not to delay or add arbitrary local criteria. An example was given of the 4 week COVID-19 clearance status required to trigger the possibility of indoor visiting, being extended to 6 weeks by some care homes. It is understandable that homes will act with an abundance of caution, however the frustrations of carers will be added to, and the adverse impact for residents potentially amplified, if the national guidance is not consistently applied.         

Recommendations:

• Context specific care home level guidance is required locally, in line with national guidance, for visiting and care practices within the individual home that makes it easy for consistency in application of IPC needs in a risk based and proportionate way to enable compassionate care in a homely setting

• Provision of a 'Visiting champion' or other similar arrangement is desirable in ensuring that advice and guidance relevant to specific contexts is readily available and consistently applied