An update on "days out" during Covid-19

At Palms Row we know the value to our residents of having visits from family and friends. However, we have to balance this with maintaining the health and safety of our residents and staff. Our first priority continues to be to reduce the risk of COVID-19 transmission and future outbreaks within the homes.

We have taken into consideration the balance between the benefits to the residents, against the risk of introducing infection into our care homes, or spreading infection from the care home to the community.

We have taken into consideration the fact that our residents are a particularly vulnerable group of people. Their ages and their physical health conditions are such that they may be more seriously affected if they were to develop COVID-19.

We have taken into consideration current Government advice on visiting care homes.

In the face of new variants of the virus, we still need to be cautious to ensure we protect those most at risk in our homes while ensuring outside-the-home visits can go ahead as safely as possible to help limit the spread of COVID-19.

This policy refers throughout to residents, but it also applies to patients.

GUIDANCE ON OUTSIDE-THE-HOME VISITS

· The government has announced that all care home residents will be able to participate in more out-of-home visits without having to isolate on their return.

· From Tuesday 4 May, residents will be able to leave their care homes to visit a friend or family member’s garden, or go on walks in places such as parks, public gardens etc. They will not have to self-isolate when they return.

· Residents must be accompanied by either a care worker, or nominated visitor, and follow the government guidelines of washing hands regularly, keeping social distance, and remaining outside, in line with step 2 of the government roadmap. Keeping visits outdoors will ensure any risk is minimised as much as possible.

· Others involved in the visit should take steps leading up to the visit to minimise the risk to the care home resident and others in the care home, recognising that introducing COVID to a care home puts all those who live and work there at risk. For instance, they should minimise their potential exposure to COVID by limiting the number of people they meet for 2 weeks prior to the visit out.

· All out-of-the-home visits must be by appointment. Ad hoc or unannounced requests for such visits by named visitors will not be permitted.

· These named visitors should take a rapid lateral flow tests before each planned out-of-the-home visit. The visit is dependent on negative results of their tests. If the care home staff perform the test, they must wear suitable PPE. Children under the age of 11 years should not undertake testing at the care home.

· Visitors will be asked to wait outside the home for the results of their test.

· Currently all rapid lateral flow testing of visitors must be done in the care home as visitors are not allowed to self-test at home. This may be subject to change soon, but this first needs to be approved by the Medicines and Healthcare products Regulatory Authority (MHRA).

· The resident should take a rapid lateral flow test and receive a negative result immediately before they leave the home for the visit. If the test shows a positive result, the visit must not go ahead.

· The visitors must wear suitable PPE for the duration of the time they are in the building, and must follow all infection prevention and control measures. These requirements differ for children, depending on age. Children aged 11 years and over should wear the same PPE as adult visitors. Children under 3 years should not wear masks for safety reasons.

· Visitors or residents do not need to be vaccinated for an out-of-the-home visit to take place.

· All discussions with the resident and/or their family/friends regarding out-of-the-home visits should be documented in their Care Plan.

· The homes will only be able to welcome a certain number of out-of-the-home visitors each day. This is simply because visitors need to socially distance, and so staff are available to help them take their tests and complete the necessary paperwork.

· Named visitors should call ahead, to make an appointment, and to be advised on what PPE is required. They should arrive promptly at the agreed time, to ensure we have the time to follow all the necessary steps to facilitate the out-of-the-home visit, and to ensure visiting appointments are ‘shared out’ so everyone gets a chance to have one.

· The visitors should be given a clear description of what to expect, before they visit.

· All visitors MUST wash their hands or clean them with alcohol gel on entry and exit to the unit, and should wear a face covering or mask (which we will provide, but visitors can provide their own if preferred) all the time they are in the building.

· All visitors must undergo a temperature screening check if they enter the building. If the screen denies them access, the visitor should leave the building.

· All visitors will be asked to review, complete and sign a COVID-19 Care Home Visiting Form and a COVID-19 Screening Form.

· An Outings form should also be completed by staff and a copy should be filed in the resident’s care plan.

· Anyone who has been having symptoms of COVID-19 for less than 10 days, or anyone who tested positive for COVID-19 less than 10 days ago, and anyone who has had COVID-19 symptoms for more than 10 days, but is still experiencing a high temperature must not be involved in the visit outside the home.

· Anyone who has had contact with a person with suspected or confirmed COVID-19, during the past 14 days, must not come to the home or be involved in the visit outside the home.

· Visitors and residents must be advised to keep to social distancing rules during the visit outside-the-home. They must bear in mind that any physical contact with the resident during the visit increases risk of transmission. There should not be any close contact such as hugging or kissing.

· Visitors should be advised not to touch their own nose, mouth or eyes during the visit and to wash their hands or use a suitable hand sanitizer frequently.

· Visitors must observe social distancing from other residents, other visitors and staff at all times during their time at the home. Children must not be left unaccompanied whilst at the home.

· Window visits and visiting pod visits may still go ahead as before with other family or friends. Social distancing rules still apply to visitors during such visits, unless they are from the same household (or support bubble).

· The resident should not travel to the venue for the visit e.g. garden etc. using public transport.

· If a resident or a person involved in the visit becomes unwell with COVID symptoms during the visit, the home manager must be contacted prior to bringing the resident back to the home so appropriate actions can be taken. The resident will need to isolate in their room for 14 days.

· A risk assessment should be carried out to assess the rights and needs of individual residents, as well as any specific vulnerabilities which are outlined in their care plan, and to consider the role that visiting outside-the-home can play in this.

If there is an outbreak of COVID-19 at the Home

· The arrangements for visiting residents outside-the-home will be suspended. Visits inside the home will also be suspended unless the resident is receiving end of life care.

· If a resident has COVID-19 and is receiving end of life care, the resident may be visited by one person and personal protective equipment must be used by the visitor throughout the visit: gloves, apron, mask and eye protection (which we will provide, but visitors can provide their own if preferred), the visitor may need to be shown how to safely put on and take off PPE. They should be advised not to touch the resident and to stay at least 2 metres away from them. They should be advised not to touch their own nose, mouth or eyes during the visit and to wash their hands when leaving the room.

COVID-19 TESTING FOR VISITORS

· The home will not provide a waiting area whilst a result of the test result is achieved. Whilst the visitor awaits a result, they must wait elsewhere.

· Appointments for visitors should be made making sure there is sufficient time booked to test, wait for the results complete associated paperwork (e.g. the visiting forms etc.) and assist the visitor to put on PPE etc.

· Consent must be obtained from the visitor before the test is performed. Visitors should be asked to complete a consent form for the test to be taken and reported to the NHS. For children over 11 years, their parent or guardian should also sign the form. Children under 11 years should not undertake rapid lateral flow tests.

· These rapid lateral flow tests must be done on site and visitors cannot self-test at home.

· While rapid testing can reduce the risks around visiting it does not completely remove the risk of infection. It is important that the care home is clear to visitors and residents about the expectations placed upon visitors participating in tested visiting (in respect of PPE use, social distancing, hand hygiene, any physical contact, actions in the event of a positive test). It is crucial that visitors follow all such advice and instructions carefully – to minimise the risks for themselves and loved ones as much as possible.

· If the test is positive, the visitor must return home, avoiding public transport. They should isolate for the government prescribed period and complete a confirmatory polymerase chain reaction (PCR) test which can be given to them by the home. If this comes back positive, their household should also self-isolate and contacts may also need to self-isolate in line with current government guidance.

REVIEW

· Palms Row will keep the situation regarding visiting under review, and will update this Policy as required.