This policy revises the arrangements for visiting this care home from 8 March 2021, as a result of Government guidance linked to its roadmap for moving out of the whole country being in “lockdown”.
Ivy Lodge defines a visitor as someone who does not live or normally work on the premises as a paid staff member or accredited volunteer and who comes to the home for a short period of time to see residents or staff.
For the purposes of this policy visitors include people who:
- visit residents on a personal or social basis regularly or occasionally, eg relatives, friends and others who come to see an individual reside
- provide professional services to residents such as GPs, community nurses, pharmacists, occupational therapists, physiotherapists, ministers of religion, social workers, advocates, hairdressers, opticians, etc
- deliver, provide or supply goods and services that have been bought or commissioned by the home, staff or residents, including repairs and maintenance
- come to the home to see staff members for any reason
- Visit the home on a professional or business basis.
- This policy applies mainly to relatives and friends of residents and others who might need to have direct contact with residents. With other visitors, the home will continue to apply all required infection control measures, including health and safety risk assessments, the appropriate use of PPE and regular testing. In these ways the home is committed to minimising and mitigating the risks of infection into, through and from the home.
The home’s visiting policy will always be adapted to the changing conditions concerning the spread of Covid-19 and the associated Government policies and guidance. The current policy reflects Government guidance that takes effect from 8 March 2021.
The home understands that any longer-term continuation of these arrangements will depend on how well the pandemic is being brought under control and the success of the vaccination programme. The home understands that there could be a further easing of visiting restrictions from 12 April 2021.
The home welcomes the Government’s current position, which recognises that “visiting is a central part of care home life. It is crucially important for maintaining the health, wellbeing and quality of life of residents. Visiting is also vital for family and friends to maintain contact and lifelong relationships with their loved ones and contribute to their support and care”.
The care home recognises that visiting must be made safe to all concerned and continues to apply its infection control measures fully in line with this latest Government and public health guidance.
It acknowledges that, despite the vaccination roll out, care home residents are still amongst the most at risk by virtue of their age and frailty to being seriously and possibly fatally ill if they fall ill with Covid-19; especially as the effectiveness of the vaccination programme in preventing transmission of the virus with new variants appearing and in preventing reinfection is still unknown.
The home is committed to making its visiting policy available and well communicated to its residents and families, so that they understand fully the reasons for any restrictions and arrangements and changes that might need to be made in line with local and national developments regarding Covid-19.
Approaches Taken During Restrictions
During this period the home has arranged for suitable alternative means of relatives and others who would normally be visiting for keeping in contact with residents and the home through, for example, telephone, messaging, social media, Facetime, Skype and Zoom. These methods are well established and will continue as options even after the lifting of the current visiting restrictions.
The updated Care Provider Alliance Visitors Protocol has recommended that care homes should consider and apply, where appropriate, any of are the following.
- Indoor visits (one regular visitor): From 8 March 2021, residents will be allowed in line with the latest Government guidance a single named visitor indoors, who will be allowed where safe to have limited physical contact i.e. holding hands. Visits can be repeated regularly under carefully designed conditions to keep residents, staff and visitors safe. These arrangements will require Lateral Flow Testing before entry and the visitors should wear appropriate PPE during their visit.
- Window visits: These require safe ground floor window access for the resident and their visitors with relevant physical distancing and PPE measures in place.
- Garden visits: These involve providing independent access to the garden to avoid visitors moving through the care setting to the garden. Providers should consider how to facilitate garden visits in different weather conditions, how to ensure cleaning of areas and any items used between visits and keep everyone safe, whatever the weather.
- Use of designated indoor areas: The layout of the care home might make it possible for visits to take place in an identified location inside the care home provided for this purpose. The room or areas used should be well ventilated, allow for physical distancing, ease of access and limiting journeys through the home that risks increased contact with other people. A conservatory that can be effectively segregated from the rest of the premises might be suitable as a designated visiting area.
- In-room visits: These visits can take place in line with national guidance in relation to essential/end-of-life visits to ensure the person can die with dignity and comfort, taking into account their physical, emotional, social and spiritual support needs. The range of visits made available will be negotiated between the care providers, their residents, their staff and their visitors. It may be possible for residents and visitors to have visits in a variety of these forms, as circumstance allow.
The home has and will continue to consider all these ideas to its situation and adopt any that are suitable, practical and are responsive to individual needs and circumstances.
The home has also considered the practicality of suggestions put forward for safe visiting to take place in cold weather conditions, which can also be adapted for warmer weather. These have included the use of “pods” or “lodges” situated in the grounds or in a separate area of the home, use of floor to ceiling screens, awnings, gazebos and open sided marquees.
With any set of arrangements, the home will continue to have in place or be ready to put in place all essential safety measures to:
- keep physical distances between people of at least two metres (except with visiting arrangements supported by negative test results) ensure high quality infection prevention and control practices before, during and after each visit
- restrict the numbers of named visitors per resident to one at a time (who are preferably constant) until numbers can be increased to two; though by arrangement with the care home up to two visitors might be allowable with other types of visiting
- have separate single entry and exits for visitors with one-way systems and minimum contact with other than those involved in the individual visit
- ensure good ventilation in every visiting area
- supervise the arrangements to ensure all safety precautions are being followed.
Revised Policy (March 2021)
Ivy Lodge continues to adopt the current Government guidance (updated 8 March 2021) by following these principles.
- The care home welcomes the recognition that visits should be supported and enabled wherever it is safe to do so.
- The home accepts that it is responsible for setting its own visiting policy and arrangements in line with national and local public health guidance.
- It will do so based on a dynamic risk assessment taking into consideration the needs of individuals within their home and with regard to the advice of the local Director of Public Health (DPH) through their outbreak management team or group.
- It will:
- continue its policy of “outdoor” visits adapted to the situation as indicated by the risk assessments, including those made using temporary facilities such as gazebos, window visits and its use of technology to facilitate contact between residents and their families and friends
- introduce “indoor” visits by named visitors to pre-appointed areas that can be supported by prior LFT testing and/or visitors who have been vaccinated against Covid-19 (recommended in the Government guidance).
- introduce the policy of “essential care givers” (as defined in Government guidance) where in exceptional circumstances close contact personal care can be provided from a close relative/person which is critical for the resident’s immediate health and wellbeing (not only to end-of-life care). The “essential care givers” will be supported to follow the same testing arrangements and the same PPE and infection control arrangements as care home staff. (See Section on Testing Arrangements for Essential Care Givers.)
- continue with its current approach of taking a flexible approach to visiting required compassionate grounds where a resident is receiving end-of-life care. (See section on Essential Purpose Visiting.)
- The home will ensure that all visits are conducted in a risk-managed way that considers the needs of our service users and the practicalities arising from the physical features and layout of the home.
- It will continue to assess the rights and needs of individual residents, particularly those with specific vulnerabilities as outlined in their care plans and will consider the importance of visits in promoting their health and wellbeing.
- Residents will be fully involved in the appointment of their “named visitor” and the arrangements for their visits.
- It will continue to make appropriate best interest decisions with the help of all involved in their care in respect of residents who lack mental capacity and who might be subject to deprivation of liberty authorisations and involving them as fully as possible.
- It will follow all Government and local public health guidance in respect of the arrangements needed to ensure safe visiting of residents whenever this takes place.
- It will always ensure safety is never compromised and will adopt Government and local public health advice on any form of visiting.
Visiting Procedures, including Testing
The home will implement the following procedures when appropriate to do so:
- allow only the number of visitors at any time that are in line with Government and local public health guidance and will ensure they are tested on each visit and/or have been vaccinated
- ensure visitors are wearing the appropriate PPE and following standard infection control measures such as hand hygiene
- have a designated entrance or outside dry space for people to put on the necessary personal protective equipment (PPE) required for the testing procedures
- have a designated area for the testing to be carried out, which is away from the main visiting area, which can also be used while the tests are being processed
- ensure the designated area is well ventilated and complies with fire safety and other health and safety regulations and is robust enough to withstand repeated cleaning with chlorine-based agents
- ensure all physical distancing, face covering and hand hygiene requirements are followed prior to the testing results being available with hand sanitisers being readily available
- ensure all prospective visitors are made well aware of the requirement to be tested, the timescales involved, the need for their consent, what testing involves and the potential benefits to the visiting experience
- advise them of what would happen if they tested positive ie the visit would not go ahead, they would need a confirmatory PCR test, which the care home would carry out. If that was also positive they would need to follow Government guidance on self-isolating with other members of their households and the information fed into NHS test and trace
- have a designated visiting area that does not increase any risk to anyone else in the home and to which all safety measures can be applied.
Testing Arrangements for Essential Care Givers
The home will follow all Government guidance in relation to visitors defined as “essential care givers” as follows.
Visitors who might be engaged in personal care and support as designated “essential care-givers” will:
- take a rapid lateral flow test before every visit except in the circumstances below. This must include a minimum of two tests a week: one rapid lateral flow test on the same day as the PCR test, and one rapid lateral flow test three to four days later
- if the visitor is visiting less than twice a week, they will need to make arrangements with the care home to carry out the twice weekly testing. These rapid lateral flow tests must be done on site and visitors cannot self-test at home
- take a weekly PCR test and share the result with the home. Care homes should use their existing PCR stocks to test these visitors and these should be registered as “staff” tests using the care home unique organisation number (UON) and be returned via courier with other staff tests
- be subject to additional testing in line with care home staff should the care home be engaged in rapid response daily testing or outbreak testing
- visitors who have recently tested positive for Covid-19 should not be retested within 90 days unless they develop new symptoms. This means that some visitors will not need to be tested regularly because they will still fall into this 90-day window. These visitors should use the result of their positive PCR result to show that they are currently exempt from testing until the 90-day period is over
- once the 90-day period is over, visitors should then continue to be tested. They should still continue to follow all other relevant IPC measures throughout these 90 days, including maintaining good hand hygiene and wearing PPE.
Face Coverings and Physical Distancing
The home will follow current Government guidance about the use of face coverings to reduce risks when people meet in enclosed public spaces and will recommend that, subject to other risk factors, residents and visitors wear face coverings and continue to maintain physical distance.
The home in consultation with its public health partners will always exercise discretion in instances where on the one hand residents are frightened or affected adversely by having to or seeing their visitors in face coverings and on the other hand, visitors have reasonable grounds for not wearing them, which can be discussed at pre-visiting planning.
Where it has been agreed that face coverings should not be worn, but the visit is not supported by testing, all parties will be reminded of the importance of maintaining physical distancing and hand hygiene procedures, (which apply to everyone at all times).
Under the present circumstances the home recognises that all visits will have to be pre-booked and with limited availability some order of priority might need to be established. It will base its priorities on the following.
- The importance to the wellbeing of the individual to have a resumption or continuation of visits and their expressed wishes.
- The degree of harm that might occur without any visits.
- The risk factors that are involved including the vulnerability to infection for the person concerned.
- The degree of compassion that is involved, eg if the person is receiving end of life care or is likely to be receiving it in the near future.
- The importance of visiting to the person in the context of their overall care plans.
- The effectiveness of the current contact or visiting arrangements in place.
- The willingness of prospective visitors to go through the new testing procedures if and when adopted by the home.
The home will ensure that the visiting arrangements will be planned, including times, frequency, and duration, and agreed in consultation with residents and their families and with professionals involved in a person’s welfare.
Each resident will have a visiting plan, which will set out the arrangements for that individual together with an agreement outlining people’s responsibilities for the safe and successful conduct of the arranged visits.
Communicating with Residents, Families and Visitors
The home will follow Government guidance in respect of enabling visits to be conducted safety and successfully, including supporting visitors on how to prepare for a visit, including where testing is being used, and how to communicate if face coverings are required, for example:
- speaking clearly from a safe physical distance
- keeping eye contact
- not wearing hats or anything else that might conceal their face further
- wearing clothing or their hair in a way that a resident is more likely to recognise
The home accepts that the arrangements for each set of visits will vary and need to be highly individualised.
In making these arrangements the care home will observe the rights of residents who may lack the relevant mental capacity needed to make particular decisions about their needs for visits and visiting plans. It will make all such arrangements in line with individual needs by following best interests decision — making as set out in the mental capacity laws, and where appropriate in consultation with their advocates or those with power of attorney. However, it also recognises that people with dementia or without mental capacity for other reasons might also be the ones who will benefit most by the new visiting supported by testing approach from the closer contact that will be possible, and their needs given high priority.
Essential Purpose Visiting
The home considers that it is still important to maintain its essential visiting policy on in-home visits but with a flexible approach in line with Government guidance on visiting on compassionate grounds. If you must visit outside of the regular visiting arrangements for an essential purpose such as being with someone who is receiving end of life care we still ask you to check with the home beforehand to discuss the essential nature of the visit, its advisability and the safety issues in respect of residents and staff that should be addressed.
The home will encourage all visitors to take advantage of local SARS CoV-2 testing facilities to provide reassurance that they are safe to visit, and the rapid testing arrangements that are being introduced.
Visitors’ Risk Assessments
When visiting our care home as an agreed “essential or named visitor” we will still ask you to:
- check with us before visiting that everything is in order and that you do not have any symptoms for Covid-19
- check if you might have had any contact with anyone who might have been in contact with an infected person or someone carrying the virus and take a decision about visiting based on your assessment of any risks
- be extra careful about being in physical contact with the person you are visiting and other people whom you might meet by:
- avoiding close contact with people, particularly if they are unwell
- avoiding touching their eyes, nose, and mouth with unwashed hands
- keeping to designated areas of the building which we will inform you about
- carry out stringent hand hygiene practice by always washing your hands carefully before and after any contacts made — using the soap and hand sanitiser gels and paper towels provided
- help staff to carry out the procedures that have been put in place to keep everyone safe from the virus and its spread
- report and discuss with us any concerns you have about the health of the person whose welfare is your concern.
We are confident that with these precautions in place we will be able to keep our residents safe.
The home will update this visiting policy in the light of further developments, particularly if there are further cases of Covid-19 in the home or evidence of increased risk from community transmission that has been identified by local Public Health.
Staff Involvement and Training
All staff are made aware of the policy and of the changes made over time. They are also consulted in respect of individual risk assessments, decisions and arrangements, the new rapid testing approach and local test and trace programmes.