Wessex Care Visiting Protocol during Covid-19 Pandemic.
Last updated 20/08/2020
In line with the latest guidance from the Department of Health and Social Care and Public Health England and the Care Provider Alliance, we have now developed the following protocols to begin the long process of reintroducing visits within our care homes.
Due to the diverse and complex needs of those we care for, the logistical challenges posed by our individual homes as well as the ever-changing situation with COVID-19, these protocols will vary from home to home and person to person and may be subject to change, wholly or in part, without notice. That said, we will endeavour to maintain clear and consistent communication with all parties as we navigate the next steps of this ongoing journey.
As per this latest guidance, we are exploring a variety of different approaches to visits which we hope will enable us to accommodate the needs of everyone involved although, it must be understood that our priority is, and will always be, the wellbeing of our residents and staff and as such, we will not be able to acquiesce to the wishes of every individual and some degree of compromise will inevitably be required.
We are rightly proud of what we have achieved so far and we recognise that this has been very much a collective effort which has demanded so much from all involved and it will require a consistent and unified approach from all parties if we are going to move forward safely and successfully.
General Visiting Protocols
- All visits to be scheduled at least 24 hours in advance via Wessex Care HQ – unscheduled visits will NOT be permitted
- Visiting agreement to be completed and returned prior to the first visit.
- Visitors may only enter the building in exceptional circumstances and only with specific authorisation from Wessex Care HQ
- All visits will be supervised by a member of staff
- No children to visit unless under exceptional circumstances and only with specific authorisation from Wessex Care HQ
- All visitors to wear appropriate PPE at all times. The level of PPE required may vary depending on the type of visit.
- Hand hygiene/sanitizing must be observed at all times
- Social distancing to be maintained at all times
- No gifts to be passed directly to residents and only gifts which can be sanitized can be accepted – unfortunately this does mean no flowers (unless delivered directly from a florist).
- Visitor Obs to be taken and recorded on arrival – temperature, SATS, etc. and results recorded in Visitors Log. If temperature is recorded above 37.5C and/or SATs below 94% then the visit cannot proceed.
- Visitors to sign to confirm that they have not been unwell within past 14 days prior to the scheduled visit, and have not come into contact with anybody that has been unwell with COVID related symptoms within the last 14 days.
- Visitors to inform Wessex Care HQ immediately if they become unwell/present symptoms up to seven days after a visit.
- Visitors are not permitted to visit if they have travelled outside of the country or to a restricted area of the UK within the last 14 days.
- Visits to be limited to a ‘single constant visitor per resident’ unless specifically authorised by Wessex Care HQ.
- Wessex Care reserve the right to cancel any and all visits without notice if it is deemed necessary to protect residents and staff wellbeing.
- Visitors agree that Wessex Care temporarily retain contact information for all visitors (name, mobile phone number, email and postal address) to support ‘Track and Trace’.
- Although we would seek to give as much notice as possible, visits may be cancelled without notice if Wessex Care receives notice from the Director of Public Health that there is an increased risk of infection either in the locality of the care setting being visited or the locality from which a visitor is travelling.
- Visits will be for no longer than 20 minutes unless otherwise stated.
Window Visits - (Including and in addition to General Visiting Protocols)
- Duration of visits to be no more than 30 minutes.
- Visitors must not call out to their relative/loved one as this may cause significant distress to the individual and/or other residents.
- Visitors to remain behind the 2-metre barrier at all times.
- No PPE is required at this time for secure distances window visits (minimum of 2 meters) but do not attend if you or someone to spend any time with is unwell in any way. If in doubt check with the office before attending and if you attend you must wear a mask.
- Visitors must be aware that if, at the time of their scheduled visit, their relative/loved one does not wish to come to the window, we cannot enforce this. They may wait until the visit ends to see if this changes but the visit WILL end as scheduled.
- Visitors will not need to have temperature and SATS checked for Window visits at present.
Garden Visits - (Including and in addition to General Visiting Protocols)
- Garden visits will only take place in a designated visiting area and visitors must not leave this area during the visit.
- Duration of visits to be no more than 20 minutes (based on evidence suggesting that likelihood of transmission of COVID19 increases dramatically after this time).
- On arrival, visitors must apply a good quantity of alcohol gel and rub / wash their hands thoroughly. They must then don all appropriate PPE and will be escorted to the designated visiting area. PPE must include as a minimum an IIR Mask and face shield, supplied by Wessex Care.
- Visitors will be required to have temperature and SATS checked.
- Visitors must leave the garden directly once scheduled the visit has finished.
- All used PPE to be disposed of in the bins provided.
- All visitors to re-sanitise hands at the end of the visit.
'Indoor’ Garden Visits - (Including and in addition to General Visiting Protocols)
We are exploring the possibility of using temporary structures to enable us to continue garden visits after the end of summer when outdoor weather conditions might otherwise prevent us from doing so.
These visits will follow the same protocols as garden visits.
Indoor Visits - (Including and in addition to General Visiting Protocols
- Visits where visitors actually enter one of the homes will only take place in exceptional circumstances and only with specific authorisation from Wessex Care HQ.
- All personal belongings, hand bags, phones etc. must be left in the secure area provided as there will not be time to decontaminate such items.
- On arrival all visitors must wash their hands for at least 20 seconds and apply alcohol gel/hand sanitiser.
- Visitors will be required to have temperature and SATS checked.
- Visitors will be provided with Red level PPE which includes, gown, apron, gloves, IIR mask, potentially a face shield and shoe covers which they must wear at all times. Staff will be on hand to instruct on the correct procedure for putting on PPE.
- Long hair must be tied/covered up to avoid possible contamination of PPE.
- All visitors will be escorted to the designated visiting area.
- Visitors must not enter any other part of the building and should avoid contact with other residents and staff wherever possible.
- Visitors must leave the building directly once the scheduled visit has finished.
- All used PPE to be taken off as instructed and disposed of in the bins provided.
- All visitors to sanitise hands at the end of the visit.
Of course, it is clearly understood that there are many benefits associated with having in-person connection with family and friends and there is evidence to suggest that the health and wellbeing (both physical and emotional) of care home residents has been jeopardised by the lack of these connections during lockdown. What needs to be ascertained is the balance between the potential benefits to health of having visits and the risk posed by a potential COVID-19 infection. All residents will have an individual risk assessment drawn up which aims to help us strike that balance effectively.
To enable us to regulate the number of visitors coming to the homes, visits will be limited to 3 days per week with a maximum of 3 visits per day. There will be a minimum of 30 minutes between each visit to allow time for the team to sanitise the designated visiting area.
Visiting slots will be apportioned fairly between all residents and we will continue to encourage the use of video calls for those residents who regularly received more visitors or more frequent visits prior to lockdown.
DHSC and PHE guidance states that ‘prior to visits being allowed in care homes the Director of Public Health in every area should disseminate their view on the suitability of visiting in the local authority area’ but also that the ‘the decision on whether or not to allow visitors, and in what circumstances, is an operational decision and therefore ultimately for the provider and manager of each individual setting to make’.
Should the local area DPH advise of a potential outbreak in the vicinity of our settings, we will take the precautionary measure of postponing all visits immediately until the extent of the outbreak and possible threat to residents and staff can be ascertained.
Where visitors are arriving from outside of the locality, we will seek advice/information from the DPH in that area and make a decision on that particular visitor. When booking a visit, visitors must give the postcode of the area from which they are travelling. If this is identified as a high-risk area by the local Director of Public Health, the visit will be postponed.
Resident Risk Assessments for Visits
Every resident must be risk assessed to identify where the benefits of having familial contact outweighs the risk of contracting COVID-19 from a visitor.
It is important that we also consider the risks to the health of the wider population of each home (including staff) posed by the reintroduction of visits.
The section in the individual risk assessment which covers existing health conditions is based upon the COVID-19 Risk Assessment written by the BMA and follows their scoring guidelines.
Not all sections of the individual risk assessment are easily quantified and will require consideration based upon a number of factors including the individual’s visiting history, current and historical health, the individual’s mobility and the logistical realities of the care setting in which they live.
Wessex Care have adopted a Red, Amber, Green scale which will be applied to the outcomes of each individual resident’s risk assessment. Where a resident falls within the Red category, we would have to implement a mitigation strategy with the aim of bringing them into the Amber or Green category before visits would be authorised.
Further considerations and exceptional circumstances
Other considerations we will be taking into account in prioritising visits may include:
- Has the resident had frequent and regular visits prior to lockdown?
- Has the resident been using video calls to remain in contact – how effective have these been for them?
- If the resident receives all their care in bed, can they still access the garden/outdoor space?
This list is not exhaustive and will undoubtedly grow with time as we encounter new challenges presented by this evolving way of working.
Residents who are deemed to lack capacity.
If it is deemed that a resident lacks capacity and is therefore unable to make a decision regarding visits, then only the person that holds Power of Attorney for Health and Welfare can consent to visits for that resident. If there is no Power of Attorney for Health and Welfare then we will seek a Best Interests Decision which will include the key people involved in their care - family/friends, their Social Worker (if applicable), Head of Care/Manager and Key Worker, GP, advocate and will, of course, take the residents’ own comments and feelings into consideration.
Residents with limitations on mobility
Many of our residents are affected by mobility issues and these issues will have a bearing on the type of visits that might be possible. The individual resident risk assessment will consider their current level of mobility and a decision will be made which balances the benefits of having visits against the risks involved. The outcome of this might include reviewing the type of visit which is most appropriate given their individual circumstances.
Residents with underlying health issues
Many of our residents are living with underlying health issues which make them particularly susceptible to COVID-19 and makes it far more likely that contracting COVID-19 will result in serious illness or death. The individual risk assessment will consider their current level of health and the outcome will form the basis upon which any decision around visits will be made.
Residents and issues with masks/face-coverings
It has been observed that a very small number of people can have great difficulty in accepting staff or visitors wearing masks or face coverings. The severity, intensity and/or frequency of the behaviours of concern may place them, visitors or the supporting staff at risk of harm. If there is evidence to suggest that there is the potential for harm, Wessex Care reserves the right to cancel scheduled visits or to review the kind of visits available to a particular resident. If visors or clear face coverings are available, use of these may be considered as a means of mitigating the risk.
Exceptions to some of the protocols laid out in this policy may include:
Children may be included in window visits if there is a demonstrable benefit to the health of our residents by having children visiting them. Any children included in these visits would need to be accompanied at all times by a responsible adult and these arrangements would require specific authorisation from Wessex Care HQ.
We may consider allowing children to attend one open garden visit at KE, KW, CV and HW in cases where there is demonstrable benefit to the resident without compromising the health and wellbeing of either party. eg. A new baby being introduced to a great-grandparent. This would need prior authorisation from Wessex Care HQ.
We may have to consider the situation where a resident’s ‘single, constant visitor’ requires assistance to attend a visit (ie. If they use a wheelchair and require carer support). In these instances, the carer might be deemed to fall outside of the restrictions providing they too adhered to all the necessary protocols around hand hygiene, PPE and social distancing.
Special occasions – we may be able to arrange visits outside of agreed visiting days to take special occasions into account – significant birthdays, etc. These would have to be discussed on a case by case basis and authorised by Wessex Care HQ.
Matthew, Pauline, Christian, Jodie