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This publication is available at https://www.gov.uk/government/publications/arrangements-for-visiting-out-of-the-care-home/visits-out-of-care-homes
Applies to: England
This guidance applies to residential care homes and care home residents of all ages. There is separate guidance for supported living and extra care settings.
The measures described in this guidance relate to visits where the resident leaves the care home premises. Visits with friends and family that take place in the care home garden or other outdoor spaces on the premises are described in our care homes visiting guidance.
Opportunities for care home residents to make visits out of the home are an important part of care home life.
Even as vaccine coverage increases, there are still risks involved in visits out. It’s important that care homes, residents, family and friends take steps to manage and mitigate these risks.
This guidance applies from 16 August 2021 and replaces all previous guidance on visits outside of the care home.
Spending time out of the care home has always been an important part of life for many people living in residential care, and residents leave their care home for a range of reasons. These might include to attend work or education, attend medical appointments and to spend time with friends and family.
For some residents, regular visits out may have been assessed as being a necessary part of their care plan, such as accessing care and support at day services, participating in community groups and volunteering. This might include regular planned overnight visits to the nominated family home.
We recognise how important this is for residents’ health and wellbeing, their ability to remain at the heart of family and social networks, and, in some cases, to deliver the objectives of their care plan.
However, spending time with others outside the care home will increase the risk of exposure to COVID-19 for the resident and potentially to other residents and staff on their return. This is the case even as we see vaccine coverage increasing.
This guidance sets out advice on the approach that care homes should take to planning and supporting visits out of the home as safely as possible, where residents wish to make them. It explains the measures that should be taken – by the home, the resident and others taking part in the visit – to manage the risks that residents returning from visits bring infection back into the care home with them.
There are certain types of activity where the risks are inherently higher and the advice is that in these cases the resident should self-isolate for 14 days on their return to the care home. This is to ensure that, in the event they have unknowingly become infected while out of the home, they minimise the chances of passing that infection on to other residents and staff. These activities are:
overnight stays in hospital that are unplanned (an emergency admission to hospital is considered higher risk than an elective procedure)
visits assessed to be high-risk following an individual risk assessment (below)
travel to an amber list country
For planned hospital overnight stays (such as elective admissions), residents do not need to isolate upon return provided they meet the following criteria. Residents should:
be fully vaccinated
receive a negative PCR test following their return to the care home (and isolate until the result is received)
complete daily lateral flow tests for 10 days following their return
avoid contact with other highly vulnerable residents in the care home
If there is a nosocomial outbreak in the part of the hospital where the resident stayed, they should self-isolate for 14 days on their return regardless of whether their overnight hospital stay was planned (elective) or unplanned.
This remains under review, and it is our ambition that guidance on self-isolation following overnight stays in hospital will be amended as soon as the data and evidence show it is safe.
As care homes are high risk settings, residents are advised to limit international travel to and from amber list countries as much as possible, even if fully vaccinated. If residents do travel to an amber list country, they should isolate for 14 days even if they are fully vaccinated.
All other visits out of the care home that are not assessed as high risk should be supported, and not subject to advice to self-isolate on return to the care home, subject to an individual risk assessment (see section on individual risk assessments below). Where applicable, attention should also be given to any additional local guidance provided by the local director of public health (DPH) and director of adult social services (DASS).
Separate guidance is available on planning visits that residents may need to make to a hospital or other healthcare setting.
Care homes should always support visits out in exceptional circumstances, such as to visit a friend or relative at the end of their life.
Supporting outward visiting
Providers are best placed to define their overall policy for how outward visits are supported in the care home, and should exercise their judgement when putting this guidance into practice in a way that takes into account the assessed needs of their residents and what is possible within the facilities and resources of the care home.
The make-up of the care home community should be a key determinant of local arrangements for supporting outward visits. This is because residents are likely to have a range of needs, long-term conditions and other clinical vulnerabilities and levels of mobility.
Providers should consider both the benefits and potential risks involved in a visit out of the care home, in order to recommend measures to mitigate risks before, during and after the visit. Consideration should be given to the risk to other residents (who may be particularly vulnerable) and staff.
The local DPH and DASS both have an important role in supporting care homes to ensure outward visiting can happen safely. This support should assume that outward visiting should be possible unless there is evidence which suggests a more restrictive approach should be taken.
In particular, the DPH and DASS should not recommend an approach across the whole of the local authority area that does not recognise variation between different areas with the local authority, and which does not take account of the different circumstances in individual homes and the need for any specific COVID-related infection control measures at a given time.
Further information on the DPH and DASS role is provided in the guidance on care home visiting.
Individual risk assessments
No visit out of a care home during a pandemic is without risk, but there are steps we can take to reduce those risks. Care homes should discuss and agree arrangements with residents, residents’ named visitors, or their essential care giver in advance.
Decisions about steps to mitigate the risk of an individual resident’s visits out of a care home should be taken with the resident’s assessed needs and circumstances considered. The care home should balance the benefits of visits out of the care home against a consideration of the risks to others in the home, where necessary.
It is important that the resident and where appropriate their family are involved in discussions throughout this process. If undertaking a visit out is not possible without self-isolation on return because of the risk to the individual and other residents and staff, care providers should communicate the reasons for this decision clearly to the resident and where appropriate their family.
Individual risk assessments should take into account:
- the vaccination status of residents, visitors and staff, including the extent of second vaccinations
- any testing of those accompanying the resident or who they intend to meet on their visit out
- levels of infection in the community
- variants of concern in the community
- where the resident is going on a visit and what activities they will take part in while on the visit
- the mode of transport that residents intend to use
Where a care home is situated in a local community with high, or rapidly rising, levels of infection, or where there is evidence of variants of concern or variants under investigation, care home managers should seek additional local advice from their local authority DPH.
Regard should also be given to the ethical framework for adult social care, and the wellbeing duty in section 1 of the Care Act 2014, and all decisions should be taken in light of general legal obligations, such as those under the Equality Act 2010 and Human Rights Act 1998, as applicable.
Social workers can help providers to meet these duties by providing advice in individual cases, should that be required.
Providers must consider the rights of residents who may lack the relevant mental capacity needed to make a decision about visits out of care homes. These people are protected by the empowering framework of the Mental Capacity Act (MCA) 2005 and its safeguards.
If applicable, providers should also consider guidance on protecting people who are clinically extremely vulnerable from COVID-19.
Other steps to mitigate the risks around a visit out
The following measures can support safe visits out of care homes and minimise the risk of transmission of infection to care home residents and other people they live with in the care home. The following should be considered for all visits out of care homes:
- if appropriate, residents being accompanied by:
- a member of care home staff
- one or more of their named visitors, or
- their essential care giver
- residents maintaining distance from anyone who is not one of their named visitors, essential care givers, or care staff and, wherever possible, avoiding close physical contact with those who are supporting their visit to minimise the risk of infection
- residents avoiding crowded places
- residents avoiding using public transport where possible, especially at peak times; travelling in a family car or private taxi is an acceptable alternative
Where visits out are accompanied by a named visitor, the visitor should follow the relevant testing regime as referenced in the guidance on care home visiting and receive negative test results in the same way as if they were visiting in. Testing arrangements are outlined in more detail in the guidance on care home visiting.
Where possible, anyone else who the resident meets as part of an indoor visit should undertake a lateral flow device test and receive a negative result on the day of the visit. This can be confirmed by the named visitor. All tests should be reported to the unique organisation number (UON) of the care home.
Where residents are visiting a location with an existing testing regime, for example a workplace, day care centre or education setting, they should participate in the relevant testing regime for that organisation where 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-19 to a care home puts all those who live and work there at risk. This includes receiving a negative test and following good infection control practice including limiting close contact, hand hygiene, wearing face coverings and avoiding crowded places.
If the resident is being accompanied by a member of care home staff, a risk assessment should be carried out. This should assess the COVID transmission risk to the care worker arising from any activities during the visit to ensure that the necessary precautions are in place. This may, for example, include if the care worker is likely to undertake direct personal care, as per the how to work safely in care homes guidance, and therefore whether the care worker requires PPE (above the requirements for individuals in a public place). If necessary, the staff member should take the required additional PPE, as well as the means to safely store or dispose of it, along with a spare, replacement face covering with them when they leave the care home.
Vaccination is one of our best defences to combat infection risk. It significantly reduces the transmission of the virus, particularly following 2 doses.
It is strongly recommended that all visitors and residents take the opportunity to be vaccinated before conducting visits.
In the event of an outbreak in the care home
In the event of an outbreak, all movements out of a setting should be minimised as far as possible.
These restrictions should continue until the outbreak is confirmed as over, which will be at least 14 days after the last laboratory confirmed or clinically suspected cases were identified in a resident or member of staff in the home.
Detailed information on managing outbreaks, including determining how long visiting needs to be stopped for, can be found in the guidance on care home visiting.