[Withdrawn] Admission and care of residents in a care home during COVID-19

Updated 22 March 2022

This guidance was withdrawn on

The information in this guidance has been superseded by Infection prevention and control in adult social care: COVID-19 supplement.

Applies to England

Applies to: England (see information for Scotland, Wales and Northern Ireland)

Summary of changes

This summary outlines the changes to the ‘Admission and care of residents in a care home during COVID-19’ as of 24 February 2022.

Updated to reflect the removal of the legal requirement for people with COVID-19 to self-isolate in line with government’s approach to living with COVID.

Due to the higher risk nature of health and social care settings, the advice for residents and staff members working in these settings has not changed.

Information on what to do if a staff member tests positive for COVID-19 can be found in the management of staff and exposed patient guidance.


The Department of Health and Social Care (DHSC) has led on this guidance with input and advice from NHS England and NHS Improvement (NHSE/I), UK Health Security Agency (UKHSA) and the Care Quality Commission (CQC).

This guidance is of a general nature. Employers should consider the specific conditions of each workplace and follow all the applicable legislation, including the Health and Safety at Work etc. Act 1974.

Read also:

Who this guidance is for

The guidance is for use by:

  • care homes (proprietors, managers and staff)

  • local health protection teams (HPTs)

  • local authorities

  • clinical commissioning groups (CCGs)

  • registered providers of accommodation for people who need personal or nursing care, including registered residential care and nursing homes for people with learning disabilities, mental health and/or other disabilities

  • social workers

  • family members of care home residents

  • relevant health professionals

  • GP practices

  • community health service providers

1. Admission and isolation of residents

Care home managers have the absolute discretion to accept or decline a resident and whether to isolate that individual on admission. This section explains what to do when residents are discharged to a care home from another care facility or hospital. It also explains what to do when new residents are admitted to a care home from the community.

1.1 Admission of residents from a care facility

For the purpose of this guidance, a care home resident is ‘fully vaccinated’ when they have received their primary doses of vaccine and any eligible booster dose.

Newly admitted residents to a care home who are transferring from an interim care facility or transferring from another care home do not need to self-isolate upon arrival. Instead, they should:

  • take a PCR test before they’re admitted (within the previous 72 hours)
  • take a PCR test on the day of admission (day 0)

The individual risk assessments should take into account:

  • whether the person admitted is fully vaccinated – that is, they have received their primary doses and any eligible booster dose

  • local guidance from the director of public health about community transmission of variants of concern

  • the circumstances at the person’s home, prior to admission – whether the individual has been in contact with someone with COVID-19 symptoms during the previous 10 days, or if they have been required to self-isolate by NHS Test and Trace (if a close contact has occurred, admission may be delayed until after the relevant period of isolation, though admission should not be delayed if there are safeguarding and welfare concerns)

  • the circumstances at the care home or interim care facility from which they are transferring, prior to admission[footnote 1]

  • the levels of transmission in the community within which the previous care home or care facility is situated[footnote 2]

  • the COVID-19 outbreak management of the previous care home or care facility[footnote 3]

Regard should also be given to:

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.

If the risk assessment shows that an incoming resident should self-isolate, this should be for 10 days. See section 1.8 for further information.

1.2 Admission of residents discharged from hospital

Every individual in hospital who is ready for discharge to a care home must receive a COVID-19 PCR test result within 48 hours prior to discharge, except for those who have previously tested positive for COVID-19 and are within 90 days of their symptom onset or positive test date (if asymptomatic). The test result must be shared with the individual themselves, their key relatives or advocates, and the relevant care home provider in advance of the discharge taking place.

All individuals who test positive should be discharged to a designated setting in the first instance to complete their self-isolation period. The total isolation period can be shared across the hospital and a designated setting. Please see the designated settings guidance for further information. More detail on required isolation periods is set out in section 1.7.

Individuals who receive a negative test result within 48 hours prior to discharge should be discharged to a care home where they will not be asked to self-isolate, unless:

  • they were discharged following an emergency admission (see below)

  • there is possible contact with a known outbreak in the part of the hospital where they were treated

  • if they are a contact of a suspected or confirmed positive case

For further guidance on discharge, please refer to the hospital discharge service: policy and operating model and guidance for stepdown of infection control precautions and discharging COVID-19 patients. See also section 1.6 for information for individuals who cannot be tested.

Discharge following elective admissions

For planned hospital overnight stays of any length, residents should take a PCR test prior to discharge. If the result is negative, they do not need to self-isolate. If they test positive, they should go to a designated setting and/or follow the self-isolation requirements set out in section 1.7. Residents should also minimise contact with people at higher risk of severe COVID-19 illness.

Discharge following emergency admission

Residents discharged from hospital following an emergency (unplanned) hospital stay should self-isolate for 10 days upon return to the care home. More detail on required isolation periods is set out in section 1.7.

Emergency admissions are deemed higher risk due to the increased likelihood that contact with people of unknown COVID status may be encountered during the hospital stay, during periods of high community transmission.

This advice remains under review, and it is our ambition that guidance on self-isolation following emergency overnight stays in hospital will be amended as soon as the data and evidence show it is safe.

Discharge following an outbreak in the hospital

If there is an outbreak in the part of the hospital where the resident stayed, they should self-isolate for 10 days in their room regardless of whether their overnight hospital stay was planned (elective) or unplanned. This is to prevent possible introduction of infection into the care home. More detail on required isolation periods is set out in section 1.7.

1.3 Admission of residents who have tested positive for COVID-19 in the past 90 days

Anyone who has had a COVID-19 positive test (PCR or rapid lateral flow test) within the past 90 days[footnote 4] should not be tested again before being discharged from hospital or a care facility if they:

  • do not have severe immunosuppression

  • have completed their self-isolation period following the positive test result

They can be discharged into a care home if they:

  • meet the clinical improvement criteria included in the stepdown guidance

  • have no new symptoms

  • have no new COVID-19 exposure

If a patient develops new COVID-19 symptoms prior to discharge, a clinical assessment should be made to determine subsequent onward movement. Please refer to the stepdown guidance for more information.

If a person tested positive for COVID-19 more than 90 days ago, they should be tested again 48 hours prior to discharge. The result of this repeat test should be sent to the care home, For further guidance on discharge, please refer to the hospital discharge service guidance.

Exemption from routine testing for individuals who have previously tested positive within 90 days

If an individual has tested positive with a PCR or rapid lateral flow test, the testing they should undertake in the following 90 days may be different. Full guidance on what testing to undertake within 90 days of a positive PCR or lateral flow test result can be found in the COVID-19 management of staff and exposed patients or residents in health and social care settings guidance.

1.4 Admission of new residents from the community

Residents admitted to a care home from the community will not need to self-isolate. Instead, they should:

  • take a PCR test before they’re admitted (within the previous 72 hours)
  • take a PCR test on the day of admission (day 0)

The individual risk assessments should take into account:

  • whether the person admitted is fully vaccinated – that is, they have received their primary doses and any eligible booster dose

  • local guidance from the director of public health about community transmission of variants of concern

  • the circumstances at the person’s home, prior to admission – whether the individual has been in contact with someone with COVID-19 symptoms during the previous 10 days

If the risk assessment shows that an incoming resident should self-isolate, this should be for 10 days. It may be possible to reduce the period of self-isolation: see section 1.8 for further information.

If a resident is required to self-isolate upon admission from the community, this should take place within the care home. Self-isolation should not take place within the resident’s own home or be shared between the resident’s own home and care home. This is because care home managers are not able to monitor isolation periods within the resident’s own home. See section 1.7 for further information on self-isolation in care homes.

1.5 Urgent admissions from the community

For urgent admissions, the individual should self-isolate for 10 days. It may be possible to reduce the period of self-isolation: see section 1.7 for further information.

The care home manager should also find out whether they have had a PCR test and if so, when and what the result was.

If the individual has taken a PCR test within 72 hours of the urgent admission into the care home, the care home manager must share the result with the care home’s named clinical lead.

If a PCR test has not been taken or was taken more than 72 hours before urgent admission, the individual should be tested. The care home manager has the discretion to decide which form of testing (rapid lateral flow or PCR) they want to use.

If the test result is positive, the care home manager should inform the individual’s GP and then follow the same standard procedures for the admission of residents with COVID-19. This means:

  • that the resident should self-isolate for 10 days within their own room – it may be possible to reduce the period of self-isolation (see section 1.7 for further information)

  • informing the local HPT

  • closely monitoring the resident’s symptoms

If the test is negative, the care home manager should conduct a risk assessment to assess the need to continue self-isolation. The risk assessment should include information about risk and exposure prior to admission, and vaccination status.

1.6 Admission of residents who cannot be tested

If residents cannot undergo testing, and are a known contact of a positive case or have had high risk exposure (such as a high-risk visit out) they should be assumed to be potentially infectious as their COVID-19 status is unknown. Therefore, they should self-isolate for 10 days as a precaution. As designated settings are only for those who test positive for COVID-19, residents who cannot undergo testing should self-isolate within the care home, to minimise the risk of the spread of infection which could cause serious harm to people at higher risk of COVID-19.

1.7 Self-isolation in care homes

The rules on self-isolation in care homes has changed. The self-isolation period for residents is now 10 days. It is possible for residents to end their self-isolation earlier than 10 days, subject to a risk assessment and negative rapid lateral flow test results. Please see below for more information.

All residents should self-isolate for 10 days if:

  • they test positive for COVID-19, regardless of whether they are symptomatic or asymptomatic

  • they have symptoms of COVID-19 and are awaiting a PCR test result to confirm their COVID-19 status (if they receive a negative PCR test, they no longer need to self-isolate – however, they may have another illness, and clinical advice should be sought)

  • they are a contact of a person with COVID-19 and are required to self-isolate regardless of vaccination status – see section 1.8 for more information

  • they have been discharged following an unplanned overnight hospital stay

  • following a risk assessment, they are required to self-isolate due to one of the reasons outlined in section 1

Positive cases

Residents who test positive for COVID-19 – regardless of their vaccination status – should self-isolate and then take part in daily rapid lateral flow testing from day 5 (counting the day of the original positive test as day 0). They can end self-isolation after receiving 2 consecutive negative tests 24 hours apart, or after 10 days isolation. Residents who are unable to test should self-isolate for the full 10 days following a positive test.

However, isolation should only be stopped when clinical improvement criteria are met for the following:

  • clinical improvement with at least some respiratory recovery

  • absence of fever (less than 37.8°C) for 48 hours without the use of medication

  • no underlying severe immunosuppression

To further reduce the chance of passing COVID-19 on to others, if residents end their self-isolation period before 10 full days they should limit contact with anyone who is at higher risk of severe illness if infected with COVID-19. They should follow this advice until 10 full days from when the self-isolation period started.

The risk to others from infection beyond day 10 is highly likely to be mitigated by high vaccine coverage in residents (>90%) and reduced severity of Omicron. The vaccine status of care homes and variants in circulation should be included as a consideration in any risk assessed approach.

High-risk exposures

Vaccinated residents who have attended a high-risk setting should self-isolate and then take part in daily rapid lateral flow testing from day 4. After receiving 3 consecutive negative rapid lateral tests each 24 hours apart, or after 10 days, they can end their isolation. High-risk exposures include having been discharged from an unplanned overnight stay in hospital, or visiting a hospital experiencing nosocomial outbreaks.

Unvaccinated residents who have attended a high-risk setting should self-isolate and then take part in daily rapid lateral flow testing from day 6. After receiving 3 consecutive negative rapid lateral flow tests, or after 10 days, they can end their isolation.

Residents who are unable to test daily should self-isolate for the full 10 days after having attended a high-risk setting.

For residents who attend hospital for assessment, without being admitted, a risk assessment should be conducted to determine whether the visit is high risk. Please see section 2.4 of the visiting guidance for further information on risk assessments. If the visit is deemed high-risk, they should self-isolate for 10 days, however self-isolation can end earlier than day 10, in line with the information above. If the visit is deemed low risk, the resident does not need to self-isolate.

What residents can do during self-isolation

During their isolation period, residents should be supported to leave their room to go outdoors if the care home has outside space, without restarting their isolation period. Outdoors in this context means within the boundaries of the care home’s grounds and should not involve contact with any other resident. This is subject to carefully considered risk assessments that take into account the safety of the resident and other residents within the care home. Care homes can take steps to mitigate risks, for example, by having staff accompany residents when they go outdoors.

For outdoor visits to occur safely, care homes should ensure that:

  • the resident can safely transit through the care home without mixing with other residents

  • the route to get outdoors is well ventilated

  • while outdoors, the resident does not mix with other residents and maintains a distance of at least 2 metres

  • staff or essential care givers accompanying residents wear PPE as per requirements for indoors

  • there are sufficient staff on duty to safely manage outdoor visits

Residents in self-isolation should not use communal areas, including shared lavatories and bathrooms. Measures should be taken to manage symptoms and keep the resident as comfortable as possible. This may include medicines which will need to be prescribed and monitored by the resident’s GP.

Self-isolation for residents with flu

Residents who have confirmed or suspected flu should self-isolate until fully recovered and for at least 5 days after their symptoms started. Residents with other respiratory viral infections should isolate as per flu unless they are advised otherwise by their HPT.

Visits from essential care givers during self-isolation

Essential care givers can visit in periods of outbreak and when their friend/family member in a care home is isolating.

If a care home resident has tested positive for COVID-19, essential care giver visits can be made in exceptional circumstances (for example, severe distress or end of life) with appropriate IPC support. Consideration will also be given to the vulnerability and vaccination status of the essential care giver to facilitate such visits.

Essential care givers should be subject to the same testing requirements as staff and should follow appropriate guidance for using PPE in different care scenarios laid out in the guidance on how to work safely in care homes.

For further information on essential care givers, please see the guidance for visiting arrangements in care homes.

Reablement care during self-isolation

Individuals who are required to self-isolate on arrival to a care home from a hospital, whether they are returning residents or admitted as an interim placement, should be supported to engage in short-term therapy if it has been determined that they need it to aid their recovery and maximise their independence. This could include the provision of a paper copy of an exercise programme by the acute or community hospital with exercises for both upper and lower limbs. It is important to ensure these individuals are supported to regain and maintain their function during their isolation period.

Supporting people who lack mental capacity

Some residents may lack the relevant mental capacity needed to understand why they may need to self-isolate. These residents will fall under the Mental Capacity Act 2005.

Providers should review their legal obligations under the Mental Capacity Act 2005 in conjunction with (as applicable) the:

See section 4 for further information.

1.8 Self-isolation of residents following close contact with a confirmed COVID-19 case

Residents who are identified as a close contact of someone with COVID-19 should follow these testing regimes:

  • vaccinated residents can end their self-isolation if they receive 3 consecutive negative lateral flow tests taken on days 4, 5 and 6

  • unvaccinated residents can end their self-isolation if they receive 3 consecutive negative lateral flow tests taken on days 6, 7 and 8

  • any resident who is unable to test – regardless of their vaccination status – should self-isolate for 10 days

Residents who are identified as a close contact, should undergo testing in accordance with the day of exposure rather than the date they were notified of close contact.

During this period, they should continue to follow all outbreak measures in the event of an outbreak, even where they have tested negative.

1.9 Cohorting residents during their period of self-isolation

If a resident with a confirmed infection is required to self-isolate and they cannot be cared for in their own room it may be possible to safely care for them in a cohort with other similar residents.

It is important that only residents with the same confirmed infection are cohorted together, for example residents with confirmed COVID-19 must not be cohorted with residents with confirmed flu.

It is preferable to have separate staff for cohorted residents.

During outbreak situations Health Protection Teams may give additional advice regarding cohorting.

In all circumstance residents with suspected or confirmed infections should not be placed next to immunocompromised residents.

1.10 Self-isolation after international travel

Due to the vulnerability of others within the care home, residents returning to the care home following travel outside of the UK should minimise contact for the 10 day period with people at higher risk of severe disease if they were to be infected.

For individuals returning from a non-red list country, see guidance on travel to England from another country during coronavirus (COVID-19).

2. Testing

The safety of care home residents and staff is a priority, and testing is a crucial part of protecting them, by helping to prevent and control outbreaks.

For a summary of the type of testing available for staff, residents, visitors and visiting professionals in social care settings, see ‘COVID-19 testing available for adult social care in England: a summary’ on Coronavirus (COVID-19) testing for adult social care settings.

There is also additional information on how to order test kits as well as full guidance regarding care home testing.

If you cannot access resources online, please call the NHS Test and Trace helpline 119.

3. Vaccinations

3.1 COVID-19 vaccines

The COVID-19 vaccines are safe and effective. Large clinical trials have been undertaken for each of the COVID-19 vaccines approved in the UK, which found that they are highly efficacious at preventing symptomatic disease in the populations that were studied (see the COVID-19 vaccine weekly surveillance reports).

A booster vaccine provides additional and strong protection against symptomatic COVID infection, such as from the Omicron variant. Every eligible adult in England has now had the chance to get a lifesaving COVID-19 booster.

Primary care teams are delivering boosters directly to care home staff and residents within settings. While most eligible care home residents have already received their booster vaccine, protecting the most vulnerable is our top priority and DHSC is committed to maximise the numbers of people offered the booster. To accelerate the rate at which care home residents are being vaccinated, the vaccination programme will ensure that all homes will get the visits they need to ensure everybody has the chance to access vaccination.

Social care workers can book a vaccination slot online through the national booking service or attend a walk-in centre to receive their booster vaccine. All eligible frontline social care workers who have not already had their COVID-19 vaccine can also access their first and second doses via these routes. Providers have been given access to funding via the Infection Control Fund to pay staff their full wages to attend a vaccination facility for the purposes of being vaccinated. They can also help cover costs associated with reaching a vaccination facility.

3.2 Flu vaccines

The flu vaccination programme is now running. We would encourage people, if eligible, to get their flu vaccine, which protects people from serious complications from flu. See the NHS website for more information on the flu vaccination.

Frontline social care workers who are employed by registered residential or home care providers, voluntary managed hospice providers, as well as those employed through Direct Payment and/or Personal Health Budgets to deliver domiciliary care to people are eligible for a free flu vaccination this winter for those who are unable to get the vaccine through their employer. For further information, see the guidance on flu vaccinations for social care workers.

The annual flu letter sets out who is eligible for a free NHS flu vaccine.

You can have the NHS flu vaccine at:

  • your GP surgery

  • a pharmacy offering the service

  • a hospital appointment

4. General clinical support

This section covers access to general clinical support for care home residents during COVID-19, and guidance on how to care for people with individual needs.

When caring for residents, providers should pay regard to the:

Specific legal guidance for mental health, learning disability and autism, and specialised commissioning services supporting people of all ages during the coronavirus pandemic has also been provided by NHS England.

Providers should continue to follow existing guidance on caring for individual needs, such as the falls and fractures guidance. The CQC has continued to inspect throughout the pandemic. Providers should ensure they meet CQC standards.

Providers should also be aware of additional support available to them, such as diagnostic tools RESTORE2 and NEWS2, along with NHS clinical support, signposted in the section below.

4.1 Accessing general clinical support

If a resident requires support with general health needs:

  • flag each resident who requires review by the weekly ‘check in’ with the aligned primary care network (PCN) or GP practice (see section on NHS support)

  • if needed, and where possible, support residents to comply with local hospital arrangements prior to elective surgery and to self-isolate prior to admission for an elective care procedure.

  • consult the resident’s GP and community healthcare staff to seek advice

  • alternatively, contact NHS 111 for clinical advice

Details on the latest NHS clinical support offer is outlined in the adult social care winter plan, published on 3 November 2021.

Details on the PCN Enhanced Health in Care Homes (EHCH) Service Specification can be found in the Network Contract Directed Enhanced Service – Contract specification 2021 to 2022 – PCN Requirements and Entitlements document. Complementary EHCH requirements for relevant providers of community physical and mental health services have been included in the NHS Standard Contract. The Care Provider Alliance have produced a guide for care homes on EHCH.

4.2 Supporting existing residents who may require hospitalisation

If you think a resident may need to be transferred to hospital for urgent or essential treatment, for COVID-19 or non-COVID-19 related conditions, consider the following checklist. In a medical emergency the care home should dial 999.

Checklist to assess the appropriateness of hospitalisation

To assess the appropriateness of hospitalisation, the care home should:

  • follow usual practice to determine if hospitalisation is the best course of action for the resident

  • contact their local registered GP or the appropriate out of hours service for advice

  • consult the resident’s personalised care and support plan or advance care plan

  • discuss with the resident, their family members, health and welfare attorney or their GP as appropriate

  • be aware of and have referral routes into the 2 hour community crisis response service

If hospitalisation is required

If hospitalisation is required:

  • follow IPC guidelines for patient transport

  • inform the receiving hospital as early as possible if the incoming patient has COVID-19 symptoms and/or a positive COVID-19 test

If hospitalisation is not required

If hospitalisation is not required, follow IPC and isolation procedures and consult the resident’s GP for advice on clinical management, using remote monitoring, if appropriate. DHSC has issued guidance on infection prevention and control measures in care homes.

4.3 Care for individual needs

Mental Capacity Act

Some care home residents, including those admitted from hospitals and the community, may lack the relevant mental capacity to make decisions about arrangements for their care and treatment. This might include people with dementia or people with learning disabilities.

These groups of people fall under the empowering framework of the Mental Capacity Act 2005 (MCA) and are protected by its safeguards, including the Deprivation of Liberty Safeguards (DoLS).

If care home staff think a resident lacks the relevant mental capacity to make necessary decisions about their ongoing care and treatment, including testing, a capacity assessment should be carried out. This should be done before any decisions about their discharge from hospital and admission to a care home are made.

Please refer to The Social Care Institute of Excellence (SCIE) for guidance on implementing the Mental Capacity Act, specifically to support care homes in doing this.

Dementia and learning disability

People with dementia or a learning disability, autistic people and people experiencing serious mental ill health are likely to experience particular difficulties during the pandemic. This could include difficulty in understanding and following advice on self-isolation and increased anxiety. They may need additional support to recognise and respond to symptoms quickly, and in some cases may be at greater risk of developing serious illness from COVID-19. The government has worked with the SCIE to provide additional guidance for care staff supporting adults with learning disabilities and autistic adults.

Please also see guidance for people with a learning disability and/or autistic people and Dementia in care homes and COVID-19, which has been provided by the SCIE.

5. Caring for residents with COVID-19 and outbreak management

5.1 Keeping residents without symptoms safe and monitoring symptom development

Care home providers should follow relevant government guidance for everyone in their care home.

Care home residents (including older and younger residents with a learning disability, and autistic people) may not present with the typical COVID-19 symptoms of a cough or fever. They may also not be able to report a loss of taste or smell.

It is important to assess residents twice daily for:

  • the development of a high temperature (37.8°C or above)

  • a cough

It is also important to look for softer signs, including:

  • shortness of breath

  • if residents are less alert

  • if residents have a new onset of confusion

  • if residents are off food

  • if residents have reduced fluid intake, diarrhoea or vomiting

Care home providers and staff should consider COVID-19 as the possible cause of any worsening in physical or mental ability when there is no other known cause.

Through NHS ‘mutual aid’, the NHS will be supporting care home professionals to use well evaluated tools such as RESTORE2 and NEWS2 (supported in current British Geriatric Society (BGS) guidance).

Staff should immediately report residents with these symptoms or signs to the HPT, as outlined in sections 5.3 and 5.4.

5.2 Support caring for residents who test positive for COVID-19

Pulse oximeters will be available to care homes via their named clinical lead, or local CCG, as part of COVID oximetry at home. One oximeter per 10 beds with a minimum of 2 oximeters per home is recommended. Equipment which is used to support the monitoring of residents will need to meet infection control and decontamination standards and guidance.

The Care Provider Alliance has produced guidance on COVID oximetry at home. Health Education England and West of England AHSN have also produced training and support for care home staff using pulse oximetry.

Care homes should have a weekly check-in with the home’s PCN or multidisciplinary team, who can support staff to understand the RESTORE2 and NEWS2 scoring system as a way of monitoring residents with symptoms. Should a patient’s symptoms worsen, it is important to contact NHS 111 or the registered GP for a clinical assessment either by phone or face to face.

The resident’s GP should give further advice on escalation and ensuring decisions are made in the context of the resident’s advance care plan. In a medical emergency, the care home should dial 999.

If symptoms worsen during isolation or are no better after 7 days, contact NHS 111 or the named clinician for the care home. In case of a medical emergency, dial 999.

If a resident has tested positive with a PCR test, they should not be tested using a PCR for 90 days, unless they develop new symptoms during this time – in which case they should be retested immediately using PCR. This 90-day period is from the initial onset of symptoms or, if asymptomatic when tested, their positive test result.

5.3 Outbreak management

Reporting COVID-19 cases

An outbreak is defined as 2 or more confirmed cases of COVID-19, or clinically suspected cases of COVID-19, among people associated  with the same specific setting, with the onset of symptoms within 14 days. For more detailed guidance on the definitions of outbreaks please see the COVID-19: epidemiological definitions of outbreaks and clusters in particular settings guidance.

If an outbreak is suspected, the HPT (or community infection prevention and control team, local authority or CCG according to local protocols) should be informed. A risk assessment should be undertaken with the HPT or other local partner to see what measures are required to prevent or control an outbreak. These will include testing and may also include:

  • temporarily stopping or reducing communal activities

  • closure of the home to further admissions

  • changes to visiting: some forms of visiting, including from essential care givers, should continue if individual risk assessments are carried out – see guidance on visiting arrangements in care homes for further details

In specific situations, where the local or national risk assessment indicates that cases may be caused by a variant with vaccine escape potential or other concerns, additional measures  may be advised.

In the event of an outbreak in a care home, outbreak restrictions will be in place for different lengths of time, depending on the characteristics of the outbreak and the results of outbreak testing.

See Coronavirus (COVID-19) testing in adult care homes for full guidance on care home COVID-19 testing, including guidance on the outbreak testing process. The process will usually be as follows – your HPT (or community infection prevention and control team, local authority or CCG) will advise if a different approach is needed based on the specific circumstances of the outbreak.

For an outbreak, staff should continue to do rapid lateral flow tests before their shift each day. In addition, all staff and residents should be tested with rapid lateral flow and PCR tests on day 0 or 1 of a new outbreak, and once again between days 4 and 7. Outbreak restrictions should usually remain in place until the results of a round of whole home PCR recovery testing (no sooner than 10 days from the latest case) reveal no further cases. 

There may be circumstances in which the HPT (local authority, CCG or community infection control team) advise that the original cases were considered highly unlikely to be linked to transmission within the setting (a cluster) and outbreak restrictions may be stood down after 2 rounds of whole home PCR testing and daily staff rapid lateral flow tests reveal no further cases at around the 7-day point. 

If, however, further cases are identified in this period, and it is possible that these cases were acquired within the setting, then outbreak restrictions should be continued until negative results of a round of whole home PCR recovery testing are received. Recovery testing should take place no sooner than 10 days from the latest case. 

If the outbreak involves a particular variant which requires additional mitigations (this does not include Alpha, Delta or Omicron), outbreak recovery testing should take place once there have been 28 days with no new cases, rather than 10 days. The HPT will contact the care home if a variant is identified in the care home which requires these different measures.

Reporting flu cases

A flu outbreak is defined as at least one laboratory confirmed case of flu and one or more cases which meet the clinical case definition of a flu-like illness, among individuals (residents or staff) with an epidemiological link to the care home, arising within the same 48-hour period.

If an outbreak is suspected in a care home, this should be reported to the local HPT immediately. They will undertake an initial risk assessment, provide advice on outbreak management, and decide what testing is needed. Local HPTs will also inform their local partners of the situation.

Find your local health protection team in England

6. Care for people at the end of life and after death

Care at the end of life for residents, regardless of the cause of their deterioration, should be provided in line with the 5 Priorities for Care.

Each resident should receive personalised care, including an individualised care and support plan that outlines their individual needs and preferences. This includes explicit consideration of food and fluids, symptom management and psychological, social and spiritual support.

Residents should be asked, where possible, if they would like to be visited by loved ones and/or a faith leader. Care home staff should inform the resident’s family and those important to them about what is happening and offer the opportunity to visit.

More information on ensuring compassionate visiting for people at the end of life in care homes can be found in the guidance on care home visiting.

Any advance care decision, including do not attempt cardiopulmonary resuscitation (DNACPR) decisions, should be made on an individual basis. These decisions should be fully discussed with the individual and their family, and should be signed by the responsible clinician. It is unacceptable for advance care plans, including DNACPR decisions, to be applied in a blanket fashion to any group of people.

The CQC will urgently raise cases of inappropriate use of DNACPR with relevant bodies, including the General Medical Council, and take action where registered providers are responsible. See the guidance relating to DNACPR decisions.

After death, guidance on IPC precautions continue to apply. This is due to the ongoing risk of infectious transmission via contact, even though the risk is usually lower than from those living. Further information can be found in the guidance for care of the deceased with suspected or confirmed coronavirus (COVID-19).

7. Advice on keeping staff safe

7.1 Infection prevention and control (IPC) and personal protective equipment (PPE)

IPC measures should continue to be practised in care homes to reduce transmission of COVID-19 and other infections including flu. This includes regular cleaning, ventilation, limiting social contact and hand hygiene.

The government has worked with care sector representative bodies to produce tailored PPE guidance for care homes, in addition to illustrated guides for the correct order of putting on and taking off PPE.

When health and social care workers, essential care givers and other professionals visit care homes, they should wear appropriate PPE and follow all relevant IPC guidance. It is essential that PPE is used correctly and regardless of whether the person being cared for has symptoms of COVID-19, or whether they or the care worker have been vaccinated.

The government has committed to the provision of free COVID-19 PPE to the adult social care sector until March 2023, or until the guidance on PPE usage for COVID-19 is either withdrawn or substantially amended (whichever is sooner). CQC-registered providers can access this through the PPE portal and non CQC-registered providers via their local resilience forum (LRF) or local authority where LRFs have stood down regular distribution of PPE.

As it is possible for asymptomatic people to pass on COVID-19 to others, care home providers should continue to limit all staff movement between settings. See the guidance on restricting workforce movement between care homes and other care settings. Care homes are supported to do this through the extension to the Infection Control and Testing Fund.

7.2 Adult social care staff who test positive for or are a close contact of a COVID-19 case

Staff who test positive for COVID-19 or develop symptoms

For advice on staff who test positive for COVID-19 or develop symptoms, see the guidance on COVID-19 management of staff and exposed patients or residents in health and social care settings. This guidance also provides further information on returning to work.

Staff who are identified as a close contact of COVID-19

Staff who are a close contact of someone with COVID-19 should follow the advice in the management of staff and exposed patients or residents in health and social care settings guidance.

For a definition of a ‘close contact’, see annex A.

Consideration should be given to how to ensure staff can deliver safe care during the 10 days after being identified as a close contact of someone who has tested positive for COVID-19. This includes applying the measures known to reduce risk such as distancing, maximising ventilation, PPE, cohorting, and enhanced testing of COVID-contacts.

This should be built into care homes’ general risk assessments for responding to infectious diseases and ensuring safe staffing levels are maintained. Where possible, staff should be redeployed for 10 days following contact with a positive COVID-19 case to parts of the home or service where contact with people who are at higher risk of severe illness if infected with COVID-19 can be minimised. Recognising this may be challenging in adult social care settings.

7.3 Staff testing: symptomatic and asymptomatic testing

Staff should continue to take part in the regular asymptomatic testing regimes for their setting. For care home staff, this is outlined in COVID-19 care home testing guidance for regular and outbreak testing of staff and residents. Staff who test negative for COVID-19 and do not have symptoms at the time of the test can continue working.

A symptomatic individual who tests negative for COVID-19 may have another infectious illness like flu and actions to limit transmission may be needed.

7.4 Staff returning from international travel

Staff should take a cautious approach to international travel. For information on testing following international travel, including what to so if you test positive, see guidance on:

7.5 Mental health support for staff

See guidance to support and maintain the wellbeing of those working in adult social care. This provides advice and resources on maintaining mental wellbeing and how employers can take care of the wellbeing of their staff during and beyond the COVID-19 pandemic.

8. Advice for care home managers

8.1 Capacity Tracker

Care homes should report vacancies (bed capacity) in the Capacity Tracker. This data will be shared with local resilience forums (LRFs) in the daily national situation reports to support capacity planning and response.

Local authorities will also use this information to inform their care home support plans. Hospital discharge teams rely on this information being kept up to date to quickly find vacancies across the country.

If care home providers think there are imminent risks to the continuity of care, such as the potential closure of a service or insufficient staff to safely meet people’s needs, they should raise this with the local authority immediately.

8.2 Review sick leave policies and occupational health support

Care home managers should review sick leave policies and occupational health support for care home staff. They should also support unwell staff to stay at home. Support for employers can be found at working safely during coronavirus (COVID-19).

Staff may be ill due to reasons other than COVID-19 and may need to follow specific return to work procedures. For example, staff may be off due to diarrhoea and vomiting, in which case they should wait 48 hours before returning to work.

8.3. Provide appropriate training and support

Ensure staff are provided with appropriate training and support to continue providing care to all residents, including IPC training. Employers can access rapid online induction training for new staff, new volunteers and refresher modules for their workforce. The training includes key elements of the Care Certificate and is available free of charge where accessed directly through Skills for Care.

If required, managers should contact the directors of nursing in CCGs for IPC training support. Providers can also access support with the costs of training for their workforce through the Workforce Development Fund (WDF). More detail is available on Skills for Care’s Workforce Development Fund webpage.

8.4 Business continuity policy

All care homes should have a business continuity policy in place including a plan for surge capacity for staffing, which in turn should include using mutual aid, which is built into contingency and emergency incident plans at a local authority and a NHS level. In these circumstances, other homes may take the residents, or the NHS may provide additional support in the form of registered nurses. More information on developing contingency plans for adult social care services is available from the Care Provider Alliance.

9. National support available to implement this guidance

In January 2022, an additional £60 million was made available to local authorities through the Adult Social Care Omicron Support Fund, to help support the adult social care sector’s response to the Omicron variant. The Omicron Support Fund announced in October 2021 to prevent infections and support testing to the care sector. This grant is available until 31 March 2022 and can be used to support community care providers to take key infection prevention and control and testing measures, as set out in the grant conditions.

Providers can use the Infection Control and Testing Fund to pay full wages to staff who are asked to stay at home, in line with government guidance. This fund does not apply to those who cannot work due to non-compliance with the vaccine as a condition of deployment regulations (unless exemptions apply).

On 10 December 2021, DHSC announced an additional £300 million to support local authorities working with providers to further boost staffing and support existing care work through the winter. This new funding is in addition to the existing £162.5 million Workforce Recruitment and Retention Fund announced on 21 October.

On 3 November 2021, DHSC published the Adult social care: winter plan 2021 to 2022. This was developed in conjunction with the NHS and social care sector stakeholders. We have drawn on:

  • the recommendations of Sir David Pearson’s review of last year’s ASC winter plan
  • advice from SAGE and UKHSA
  • extensively, lessons learned so far in the pandemic

The winter plan sets out the actions national government will be taking to support the sector, along with the steps local authorities, the NHS and care providers should take to prevent and control both COVID-19 outbreaks and other respiratory viruses.

On 30 September 2021, DHSC also announced a £478 million funding package to continue the hospital discharge programme until 31 March 2022. This will grant staff the resources needed to support patients to leave hospital as quickly and as safely as possible with the support.

To help local authorities maintain all their work to deal with the impact of the pandemic, we have committed over £6 billion to councils through un-ringfenced grants to tackle the impact of COVID-19 on their services, including adult social care.

The Department of Levelling Up, Housing and Communities has provided further detail on the funding arrangements in the Coronavirus (COVID-19): emergency funding for local government in 2020 to 2021 and additional support in 2021 to 2022.

Annex A: definitions of COVID-19 cases and contacts

A close contact means:

  • having face-to-face contact with someone at a distance of less than one metre

  • spending more than 15 minutes within 2 metres of an individual

  • travelling in a car or other small vehicle with an individual, or in close proximity to an individual on an aeroplane

It is advised that social care providers also take a wider meaning of contact as below.

A ‘contact’ is a person who has been in close contact to someone who has tested positive for COVID-19. You can be a close contact any time from 2 days before the person who tested positive developed their symptoms, and up to 14 days after, as this is when they can pass the infection on to others. A risk assessment may be undertaken to determine this, but a contact means:

  • anyone who lives in the same household as another person who has COVID-19 symptoms or has tested positive for COVID-19

  • anyone who has had any of the following types of contact with someone who has tested positive for COVID-19:

    • face-to-face contact including being coughed on or having a face-to-face conversation within one metre

    • been within one metre for one minute or longer without face-to-face contact

    • sexual contacts

    • been within 2 metres of someone for more than 15 minutes (either as a one-off contact, or added up together over one day)

    • travelled in the same vehicle or a plane[footnote 5]

An interaction through a Perspex (or equivalent) screen with someone who has tested positive for COVID-19 is not usually considered to be a contact, as long as there has been no other contact such as those in the list above.

Breaches of PPE at work

In assessing whether a member of staff has had a breach of PPE, a risk assessment should be done in conjunction with local IPC policy. The following factors should be taken into consideration:

  • the length of exposure

  • the proximity of the resident

  • the activities that took place when the worker was in proximity (for example, aerosol generating procedures (AGPs), monitoring, personal care)

  • whether the member of staff’s eyes, nose or mouth were exposed

If the risk assessment concludes there has been a significant breach, or close contact without PPE, the worker should remain off work for 10 days from the day after exposure.

Examples that are unlikely to be considered breaches include if a health or social care worker was not wearing gloves for a short period of time or their gloves tore, and they washed their hands immediately, or if their apron tore while caring for a resident, and this was replaced promptly. The local health protection team or local IPC lead can support a risk assessment if required.

This advice applies to all individuals present in a care environment if they are following instructions from that institution.

  1. Where there is an outbreak in the other care facility, the transfer should only take place in exceptional circumstances. Should there be known infection in the other accommodation, a risk assessment should be undertaken and transfer should only occur if the risk of that person remaining in the other accommodation is greater than for them to move into the care home. If the decision is taken to continue with the transfer, the resident should self-isolate upon arrival. 

  2. The associated risk level of transmission within a community is dependent on a number of factors, including population levels of the given area. Care home managers should get in touch with their local health protection team when assessing if the number of cases within the community in which the care home is situated constitutes as ‘high risk’. 

  3. This may include assessing the previous setting’s susceptibility to COVID-19 outbreaks; the previous setting’s inadequate understanding of risk factors; non-adherence to setting guidance; management concerns such as staffing issues or lack of PPE; significant media or political interest; any other significant implication. 

  4. A person can test positive for COVID-19 for up to 90 days after first being infected, even though they might have recovered and might not be infectious to others any more. This is because PCR tests can sometimes still detect remnants of COVID-19 (SARS-Co-V-2 RNA) in a person’s system. 

  5. The Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020 defines close contact as having face-to-face contact with someone at a distance of less than one metre; spending more than 15 minutes within 2 metres of an individual; and travelling in a car or other small vehicle with an individual or in close proximity to an individual on an aeroplane.