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This publication is available at https://www.gov.uk/government/publications/supported-living-services-during-coronavirus-covid-19/covid-19-guidance-for-supported-living
Summary change note
This table outlines the changes made to the COVID-19: guidance for supported living as of 22 November 2021.
|Number||Guidance section||Overview of changes|
|1||Introduction||Updated to signpost to additional guidance that providers may find useful, including guidance on direct payments.|
|2||How to maintain service delivery||Updated ‘6. Avoid sharing staff between settings’ to clarify advice on how care providers can manage staff movement.|
|3||How to maintain service delivery||Updated ‘7. People formerly identified as clinically vulnerable’ to clarify that people formerly identified as clinically extremely vulnerable are no longer required to shield – instead they should seek advice from a health professional on whether additional precautions are necessary.|
|4||Vaccination programme||Updated to include additional information on flu vaccines.|
|5||Advice on flu||Updated to include additional information on flu.|
|6||General infection prevention and control||Updated to consolidate advice on general infection prevention control measures.|
|7||Discharge from hospital||Updated to clarify that supported living settings that are comparable to care homes should refer to the admissions guidance for advice on self-isolation following an emergency (unplanned) admission.|
|8||Visits in and out||Updated to provide advice on international travel in respect to red and non-red list countries or territories.|
This guidance is intended for supported living settings, but many of the principles are applicable to extra care housing. It may also be a useful resource for the wider supported housing sector, such as retirement or sheltered housing.
When applying this guidance, providers should consider the importance of local risk assessment in ensuring that any measures are proportionate and appropriate to those in the supported housing sector.
Purpose of the guidance
This guidance sets out:
- information to support local plans and preparations to manage risk, and support people in supported living settings throughout the response to coronavirus (COVID-19). Local procedures may need to be updated to reflect changes in government guidance and advice as the pandemic response changes
- information for local authorities and supported living providers on managing flu
- safe systems of working, including limiting close contact, respiratory and hand hygiene, enhanced cleaning and how infection prevention and control (IPC) measures, personal protective equipment (PPE) and the use of testing apply in supported living settings
Who this guidance is for
This guidance is intended to be used by:
- providers of supported living centres
- care and support workers
- other staff in supported living settings
- local authorities
- NHS commissioners and providers
- extra care providers
Although this guidance has been written for those working in supported living settings and those commissioning these services, those working in extra care housing and in the wider supported housing sector (including retirement or sheltered housing) may find aspects of this guidance useful. Many of the principles are applicable to extra care housing.
Providers and commissioners may find it useful to read this guidance in conjunction with:
- guidance on the admission and care of people in care homes
- COVID-19: guidance for hostel services for people experiencing homelessness and rough sleeping
- guidance issued by the UK Health Security Agency (UKHSA) for individuals, families and informal care workers for households with possible COVID-19 infection
- COVID-19 guidance on testing for adult social care
How to use the guidance
Managers of supported living facilities should use this guidance to:
- develop local procedures and work with the people being supported
- ensure individual plans are in place to protect people’s wellbeing and minimise risk. Where relevant, this should be with the consent of individuals, their families, GPs, support groups and care or support providers
Supported living providers, managers and staff must always be mindful of the needs and rights of those in a supported living setting. They should use this guidance alongside the wellbeing principles in the Care Act 2014, the Ethical Framework for Adult Social Care, and relevant equalities-related legal and policy frameworks. Article 2 (right to life), Article 8 (right to private and family life), Article 5 (right to liberty and security) and Article 14 (protection from discrimination) of the Human Rights Act (HRA) 1998 are of paramount importance. Therefore, any assessment of, or decision about, the needs of individuals in supported living must be just and proportionate, and with good reason. This is to ensure that individuals are treated with respect, and to uphold their human rights, personal choices, safety and dignity.
Note that this guidance is of a general nature and a supported living provider should consider the specific conditions of each individual place of work and comply with all applicable legislation.
It will also be useful to read this guidance alongside the materials listed in Annex A below.
How to maintain service delivery
To maintain service delivery, supported living providers and local authorities are advised to follow the steps described below.
1. Ensure that individuals are supported in drawing up contingency plans for care
Individuals in supported living should be supported to draw up a contingency plan – with their care providers and any unpaid carers – that can be enacted should they contract COVID-19 or other infections like flu, or if there is an impact on care delivery due to COVID-19 or another infection. Providers should consider how they could share this information with any healthcare professionals providing care in place of regular carers.
Supported living providers and local authorities should continue to work together to ensure that records of people in supported living are up to date. These records should include the levels of formal and informal care and support available to individuals.
2. Business continuity planning
Providers should maintain business continuity plans to help them to manage in emergency situations. These should be kept up-to-date and key details to record may include:
- who provides care for the people in supported living environments
- whether those delivering care are still able to provide care and are not self-isolating, whether paid staff or informal carers
- how and where care and support plans are located
- requirements for any specialist care or long-term conditions
- key contacts coordinating care from other community-based services including, but not limited to:
- mental health and dementia support services
- learning disability services
- third-sector voluntary social and community enterprises (VSCEs)
- drug and alcohol or social work teams
- family members
3. Key contingency details
Key contingency details should also include information about the care recipient’s modes of communication. These include technology, their likely reaction to changes in routine or unfamiliar carers, and ways to reduce potential stress. In cases where current circumstances make consistency impossible, providers should prepare people for the fact that it may be necessary for a different carer to support them.
It is particularly important to ensure risk management plans are updated for individuals in supported living who may find any change in routine challenging, for example people living with dementia and certain types of autism.
4. Mutual aid, care and support plans
Providers and local authorities should work together to facilitate mutual aid, care and support plans across their areas. This is to inform planning ahead of a possible outbreak. Useful resources can be found on the Local Government Association website.
5. Identify people who use direct payments or fund their own support
Providers and local authorities should also work together to identify people who:
- use direct payments or who fund their own support
- receive individual service funds
- receive NHS continuing healthcare and help them establish the levels of support available from other sources
It may be helpful for providers to share with local authorities the number of hours of care they provide to help with planning, but providers will want to satisfy themselves that it is lawful for them to share that information and get consent from the individual being supported where possible.
6. Avoid sharing staff between settings
Routine movement of care staff between shared living services and other health and social care settings should be avoided to reduce the potential spread of COVID-19 and other infections like flu from one setting to another. For more on how care providers may manage staff movement, view our guidance for care homes on restricting workforce movement.
Where appropriate, staff should follow guidance on how to work safely in domiciliary care, which provides information on the use of PPE.
Local primary and community health services providers may provide support through the deployment of volunteers and agency staff, where it is safe to do so, provided proper safeguarding measures are in place.
7. People formerly identified as clinically extremely vulnerable
Following expert clinical advice and the successful roll-out of the COVID-19 vaccine programme, people previously considered to be clinically extremely vulnerable (CEV) will not be advised to shield again.
If you were previously identified as CEV, you are advised to continue to follow coronavirus guidance on how to stay safe and help prevent the spread. Individuals should consider advice from their health professional on whether additional precautions are right for them.
8. Maintain oversight of people who are self-isolating
COVID-19-positive individuals in supported living settings must self-isolate for a 10-day period. This should increase to 14 days if deemed necessary following a local risk assessment by managers of supported living settings, as stated in the COVID-19: management of staff and exposed patients or residents in health and social care settings guidance. Refer also to any guidance that has been put in place by your local director of public health.
Circumstances where self-isolation may be necessary are set out in guidance for households with possible or confirmed coronavirus (COVID-19) infection.
The supported living provider should maintain oversight of people who are self-isolating, and note the arrangements that local authorities, Clinical Commissioning Groups (CCGs) and NHS 111 are putting in place to refer people self-isolating at home to volunteers who can offer practical and emotional support.
By following these steps, most people who live in supported living environments should have a continuity of care, support and help that adapts to their situation. For a small number of people, where their wellbeing is at risk, the managers of supported living environments may wish to contact social workers in their local authority to seek further advice and support.
Risk assessment, risk reduction and local implementation
Local managers should undertake a balanced risk assessment when considering the implementation of this guidance. The COVID-19: adult social care risk reduction framework may be useful guidance for this.
A suite of coronavirus guidance including responses to frequently asked questions has been published to support people in making decisions related to COVID-19 and many of these resources will be relevant to the supported living sector.
Local managers should use these documents to develop their own specific ways of working to protect people’s wellbeing and minimise risks.
Taking decisions for people with limited decision-making capability
Some individuals – for example, some people with dementia, learning disabilities or mental health conditions – may lack the relevant mental capacity to understand and make decisions based on advice about their own care (such as testing procedures or visiting arrangements).
It’s important that all steps are taken to communicate information to such people in a way that they are most likely to be able to understand. For example, people with learning disabilities, dementia, certain types of autism or mental health conditions may have difficulties with understanding complex instructions or forget them.
In these circumstances (where the person is aged 16 or over), staff should consider making a ‘best interests’ decision on their behalf. In doing this, staff should consult the principles of the Mental Capacity Act 2005 (MCA).
Any visiting arrangements should be made in agreement with the person being supported. If the person is assessed as not having capacity in relation to this decision, the provider should work within the appropriate MCA framework to establish whether the arrangements are in the person’s best interests.
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. Health professionals and social workers can help providers to meet these duties by providing advice in individual cases should that be required.
Staff in individual risk groups
Healthcare workers and those working in social care are at a higher risk of repeated exposure to infection. COVID-19 infection can be serious and may lead to long-term complications. These are more common in older staff or those with underlying clinical risk factors.
Factors including age, sex, ethnicity, certain underlying health conditions and pregnancy may be associated with an increased risk of or from COVID-19. Employers are encouraged but not required to ensure that an appropriate person, such as a line manager, carries out individual conversations with all staff who may be at greater risk, in line with the latest guidance on reducing risk in adult social care.
Staff from Black, Asian and Minority Ethnic (BAME) backgrounds may have increased concerns about COVID-19, and employers should handle these conversations sensitively. Employers should ensure that staff are supported and any necessary steps to reduce risk are considered on an individual and proportionate basis. The employee should consult their employer if they have any concerns and discuss issues raised with their line manager.
Many staff will be able to work normally. Guidance on how to work safely in domiciliary care is available if staff wish to follow additional measures.
We encourage all frontline social care workers who have not already had their COVID-19 vaccine to book a vaccination online or by contacting their GP. See more information on the COVID-19 vaccine and booster vaccinations.
Frontline social care workers who are unable to get the vaccine through their employer are eligible for a free flu vaccination this season. For further information, please see the guidance on flu vaccinations for social care workers.
Advice on flu
Providers should maintain good infection prevention and control measures to reduce the risk from flu as well as other infections.
All supported living providers should:
- recognise that the symptoms of COVID-19 and flu are similar
- encourage flu vaccination uptake for staff and residents
- consult the flu vaccination guidance for social care workers and report seasonal flu vaccination rates, alongside COVID-19 vaccination rates, for staff and residents in the Capacity Tracker
- consider that someone with symptoms could have COVID-19, flu or another infection and should know what to do in response to multiple symptomatic cases – see the ‘In the event of an outbreak’ section below
- advise visitors to stay away from supported living settings if they have any flu symptoms or any other symptoms of illness, such as a cough, temperature, loss of taste or smell, diarrhoea, or vomiting
- encourage (where possible) all visitors to a supported living setting who are eligible for the flu vaccine to take it ahead of visiting. The annual flu letter sets out who is eligible for a free NHS flu vaccine
General infection prevention and control
Infection prevention and control (IPC) measures are designed to prevent harm and reduce transmission of infection to visitors, residents, people who use supported living services, and health and social care staff and their co-workers.
Some supported living settings are more comparable to care homes, for example if the setting is a closed community with substantial facilities shared between multiple people or it is a setting where the majority of residents (more than 50%) receive the kind of personal care that is CQC-regulated (rather than help with cooking, cleaning and shopping). In these cases, please refer to guidance on admission and care of residents in a care home during COVID-19.
To reduce the risk of the spread of COVID-19 and other infections such as flu or norovirus into supported living settings, IPC measures should be followed. This includes:
- hygiene principles (hand hygiene, sneezing or coughing into a tissue, safe disposal of tissues, environmental cleaning regimes)
- limiting close contact
- appropriate use of PPE
- self-isolation (if a person becomes ill with COVID-19 symptoms)
Limiting close contact
Whenever possible, staff should limit close contact with the person or people they support. If this is not possible due to having to provide direct personal care, or if the person they support has behaviours and needs which make this difficult, then PPE may be needed as highlighted below.
Staff providing care for people with learning disabilities, certain types of autism, mental health conditions, or dementia, should make every effort to make sure that the people they support are aware of the key behaviours needed to follow good IPC, and should provide encouragement and reminders when not followed. Staff should consider how the person they are supporting is most likely to understand the information, and use the most appropriate communication techniques for that person.
This may include the use of social stories, information in pictorial form, engaging with friends and family members to support understanding, and having regular online contact with the person being supported, when it is not possible to see them face to face, to reinforce IPC messaging. Learning Disability England and UKHSA have created resources which may support this messaging.
Ventilation and respiratory hygiene
Providers should maintain well-ventilated communal areas. Good ventilation, together with limiting close contact and other IPC measures can help reduce the risk of spreading COVID-19 – see the Health and Safety Executive’s guidance.
Supported individuals should be encouraged to use tissues to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose. Used tissues should be disposed of promptly in a bin, followed by cleaning of hands with soap and water or alcohol-based hand rub – see best practice hand rub.
Supported individuals should be encouraged to keep their hands away from their eyes, mouth and nose. Some people may need assistance with containment of respiratory secretions. Those who are immobile will need alcohol-based hand rub for hand hygiene.
If they have symptoms of (or tested positive for) COVID-19, supported individuals should have a bag (if safe to do so) or other appropriate receptacle at hand for immediate disposal of waste potentially contaminated with the COVID-19 virus, such as tissues. These bags should be placed into another bag, tied securely and kept separate from other waste. Where the person has learning disabilities, it will be important to make sure they understand exactly what they need to do and why.
Good hand hygiene is essential to reduce the transmission of COVID-19 and other infections including flu and norovirus. Supported living staff should think carefully about ways that the person they support can be encouraged to participate in regular handwashing.
Where possible, promote hand hygiene (see best practice hand wash) and ensure that liquid soap and disposable paper towels are available at all sinks in shared areas.
Alcohol-based hand rub can be used, where safe to do so, if hands are not visibly dirty (see best practice hand rub). If it is being used, it should be accessible and replaced when supplies are empty.
If supported individuals receive visitors, visitors should be encouraged to follow good respiratory and hand hygiene, washing their hands on arrival, during their stay and on leaving (for more details, see the ‘Visits in and out’ section below).
Hand hygiene should be followed even if staff, residents and visitors have been vaccinated, will be wearing PPE, or have tested negative.
Personal protective equipment (PPE)
The risk of transmission should be minimised through safe working procedures, reducing contact and following standard IPC precautions including PPE as described in the how to work safely in domiciliary care guidance.
Please refer to the correct order of putting on and taking off PPE (donning and doffing).
You will need different PPE if you are carrying out aerosol generating procedures (AGPs). A list of AGPs and advice on appropriate PPE can be found in the how to work safely in domiciliary care guidance and specific advice on how to put on and take off PPE for AGPs is also available.
The government has committed to provide free PPE for the COVID-19 needs of the adult social care sector until the end of March 2022.
CQC-registered providers can access this through the PPE portal.
Non CQC-registered providers can obtain free PPE from local resilience forums (LRFs), or local authorities where LRFs have ceased regular distribution of PPE. Please check the list of local contacts for providers for details of PPE provision in your area.
In supported living environments (including communal areas), cleaning may be carried out by the person who lives there, their family, an external cleaner, or as a service provided as part of the accommodation. Where appropriate, the supported living manager should adapt guidance accordingly.
In supported living environments, laundry may be carried out by the person who lives there, their family, an external person, or as a service provided as part of the accommodation. Where appropriate the supported living manager should adapt guidance accordingly. If a laundry service is provided, it should follow the guidance below.
If someone carries out their own laundry duties then, with consent, it may be appropriate to place visible pictorial reminders, such as posters or other communication aides in line with the person’s individual communication method, around the supported living setting to reinforce messages about the handling of laundry.
Wash items in accordance with the manufacturer’s instructions. Use the warmest water setting and dry items completely.
Laundry that has been in contact with an unwell person can be washed with other people’s items. Laundry that has blood or bodily fluids on it (such as vomit or faeces) should be laundered separately from other items. Use a pre-wash cycle, where available, before washing on the warmest setting the fabric will tolerate.
Do not shake dirty laundry prior to washing as this may increase the likelihood that the virus is dispersed through the air.
Clean and disinfect anything used for transporting laundry with usual products, in line with the cleaning guidance above.
COVID-19 testing for supported living staff
See guidance on coronavirus (COVID-19) testing service for extra care and supported living settings for information on asymptomatic testing, including:
- the criteria for ordering staff, care recipient and visitor tests for supported living organisations
- the testing process in extra care and supported living settings
- how to order test kits
- how to register test kits
- information on the 90-day window after a positive test
A symptomatic individual who tests negative for COVID-19 may have another infectious illness like flu and actions to limit transmission may be needed.
Two or more individuals with symptoms could be an outbreak – contact your local health protection team and see the ‘In the event of an outbreak’ section below for more information.
COVID-19 testing for people being supported
Where people being supported are being tested, staff should obtain consent from the individual to conduct the test, consulting family members and their GP, as appropriate, and in line with the management and provider’s usual policies and procedures.
Testing is voluntary, but those who are eligible for tests are strongly encouraged to participate to reduce the risk of transmission within social care settings.
Discharge from hospital
For discharge into supported living settings that are comparable to care home settings, refer to guidance on the admission and care of residents in a care home during COVID-19 for advice on whether an individual may need to self-isolate following an elective or an emergency admission.
Alongside this, managers should undertake a dynamic risk assessment to ensure any measures are proportionate and appropriate, please see the section on risk assessments that should be undertaken by managers to help support discharge.
Self-isolation following hospital discharge
If self-isolation is required, this should begin from the day the individual moves into their supporting living setting. For people with learning disabilities, certain types of autism, mental health conditions, or dementia, it will be particularly important to make sure they and their families understand the following, before the transfer happens:
why self-isolation is needed
what this will look like
how long this will be for
It will be important to ask how they feel about this and what, if anything, could make it easier for them.
The Mental Capacity Act 2005 should be followed if the person being discharged, or anyone they share their home with, is unable to understand information about the discharge arrangements or the requirements of the isolation period. This also includes where decisions need to be made that impact on their living arrangements or support needs.
Visits in and out
From 19 July 2021, there have been no restrictions on the number of people individuals can meet. People living in supported living settings live in their own homes and visits should be supported and enabled unless there is a specific reason not to do so. Blanket bans on visits are not appropriate.
When planning a visit into or out of the setting, providers, and care and support workers, should work with individuals and their families to consider their needs and maximise their safety. This will enable people being supported to make decisions about visits out of the home, and how these visits can be made possible.
There are risks that need to be considered – even where people are vaccinated for flu and COVID-19 – but these are risks that can be appropriately managed by following IPC measures.
Therefore, in all cases, arrangements for visiting into and out of the setting should be supported by a dynamic risk assessment for the overall setting, as well as an individualised assessment of the benefits of visiting and the risks to particular people because of their care and support needs. The risk assessment should consider people’s rights, and decisions should balance the resident’s assessed needs against the consideration of risk of infection. The risk assessment will also need to reflect whether the setting is a ‘high risk’ setting (as designated by the local director of public health).
For visits taking place at the setting, the manager may also wish to consider:
using a communal garden area for visits, where it can be accessed without anyone going through a shared building
if visitors should limit close contact with other people who live there and staff
providing facilities for visitors to wash their hands or use hand sanitiser on entering and leaving the home, and reminding visitors of the importance of hand hygiene
opening windows and doors to ensure the setting is well-ventilated
encouraging visitors to wear face masks while in the setting
For visits taking place away from the setting, the manager should consider:
testing visitors who are collecting residents and transporting them to or from the setting, and encouraging any others they may be meeting to conduct a test on the day
offering support so people can find or go to outside spaces to see their relative in a safer environment
factors to minimise the risk for staff and other individuals in the supported living setting (including the layout of the premises and the nature of the support provided)
encouraging the use of face coverings where appropriate
the nature and context of the visit – for example, whether the visit would include overnight stays in the family home or visits to a public place
the support needs that the person may have during the visit, and whether they will need to be accompanied by a staff member, carer, family member or friend
arranging transport for the visit that helps avoid exposing the person to those outside the household they are visiting, for instance by travelling in a family car wherever possible
increased communal risks that may arise in shared areas when people return from off-site visits (including shared spaces indoors and outdoors, on-site grouped services and social activities)
the need for those returning from off-site visits to self-isolate if they test positive for COVID-19, which is a requirement. There is no expectation for someone to self-isolate after a visit has happened if this is not the case whether individuals have been fully vaccinated or not
From 16 August, individuals who are fully vaccinated will not be advised to self-isolate if they have been identified as a close contact of someone who has tested positive for COVID-19, either by the NHS Test and Trace service or their workplace. People in supported living settings will no longer be advised to self-isolate and can continue to receive visitors following a negative PCR test. Individuals identified as close contacts should also undertake regular testing in supported living settings that are comparable to care homes.
Please see the admissions guidance for further information on the testing regime.
For supported living settings that are comparable to a household, please refer to the stay at home guidance.
And in all cases, the manager should work with people being supported and their families to:
make sure that no one with COVID-19 symptoms participates in a visit and anyone with suspected symptoms is tested. If someone with symptoms tests negative for COVID-19, it is possible that they may have another infection such as flu and therefore they should not visit
make sure that no one visits when an individual is required to self-isolate, either due to having tested positive for COVID-19, not being fully vaccinated or having travelled to certain countries. The red list is kept under constant review and countries and territories can be added to the red list at any time. See the red list of countries and territories for more information
consider whether the individual should be advised to self-isolate for other reasons (that is, following an unplanned hospital stay of any length or other high risk activity)
remind all those involved in visits to follow good infection control measures
where possible, support visitors with preparations for a visit and give tips on how to communicate if face coverings are required
Testing of visitors
Testing is not a requirement for visiting and managers should not refuse visits to visitors who have not taken a test unless they are symptomatic. Visitors must not visit if they are required to self-isolate. We recommend visitors participate in testing to reduce the risk of introduction of infection through asymptomatically infected people, in particular for higher risk settings with shared living accommodation spaces which have a higher potential for outbreaks.
All providers who are currently eligible for staff testing are able to access rapid lateral flow tests for the purpose of supporting safer visits. Managers can place an order for tests using their unique organisation number (UON) from the test kit ordering portal. Each setting will receive 4 test kits per person per week, which can be used to support both visits in and visits out.
Setting managers have discretion to set up their own testing areas, further information can be found in the guidance on rapid lateral flow testing in adult social care settings.
Testing onsite at the setting is preferable for assurance purposes. Where testing will be fully or partly conducted on site, supporting living managers will need to set up a testing area as described in the guidance above. However, recognising that individuals now have access to testing through other routes and visitors may be travelling long distances to visit, managers can allow visitors to provide evidence of a recent negative test undertaken through other means, if the test has been taken that same day.
When considering the most appropriate testing route, managers should consider any additional risks that may arise from testing off-site, as well as the confidence and ability of visitors to carry out tests away from the care home. This may include factors such as:
visitors inaccurately conducting or reporting lateral flow testing themselves
the increased risk of visitors needing to take public transport to a testing site, particularly where it is far from the setting, or coming into contact with other people
visitors not having a mobile phone or email address to receive the result of their test
Where visitors will be self-testing, managers may wish to supervise the first few tests on site and provide support to ensure visitors are confident conducting the tests at home and they are being completed and reported satisfactorily.
Wherever the test is conducted, it should be done on the day of the visit. Once the visitor has registered the test, they will receive a confirmation of their result by text message (SMS) and email to show proof of result. Proof of a negative result may include an email or text from NHS Test and Trace or a date-stamped photo of the test cartridge itself. Managers do not need to retain records of proof.
All tests done at home should be registered to the UON of the supported living setting and managers should ensure visitors are aware of their UON and their responsibility to report the result. Being able to link visitors to a supported living setting enables public health teams to better support settings to reduce the transmission of COVID-19 and prevent outbreaks.
If the visitor tests positive they must immediately self-isolate. They should follow the stay at home guidance. If the test has been taken while away from their own home, when returning home they should avoid contact with others as far as possible, for example, avoid public transport and wear a mask.
Visitors should also complete a confirmatory PCR test within 2 days of a positive rapid lateral flow test. This should be provided to them by the setting if testing on site, or by ordering a test online or by calling 119.
Visitors who have recently tested positive for COVID-19 from a PCR test should not routinely 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 following their period of self-isolation.
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 social distancing, maintaining good hand hygiene and wearing PPE.
Testing for visits out
Setting managers may decide to use some of their additional rapid lateral flow testing allocation for testing of the person being supported. This can be used to facilitate safer activities. The use of tests is at the manager’s discretion and must be conducted with the consent of the person being supported. This should be in addition to regular PCR testing for all people in high-risk supported living and extra care settings.
In cases where a person living in supported living receives a positive result using a rapid lateral flow or PCR test, having been notified by NHS Test and Trace they must self-isolate immediately and take a confirmatory PCR test from the stocks of the setting or get a free test. Please also alert the local health protection team (HPT) and consider any outbreak measures in place.
Managers may wish to consider testing people living in high risk settings with rapid lateral flow tests if they are often leaving the premises to meet or visit people. This is similar to testing for people who are unable to work from home who can access twice weekly lateral flow testing from their local asymptomatic testing site. Twice weekly testing for people who live in supported living can be conducted on site, assisted by a staff member.
In the event of an outbreak
An outbreak is defined as 2 or more confirmed cases of COVID-19, or clinically suspected cases of COVID-19, among people in the same specific setting, with the onset of symptoms within 14 days. For more detailed guidance on the definitions of outbreaks see the COVID-19: epidemiological definitions of outbreaks and clusters in particular settings guidance.
A flu outbreak is defined as at least one laboratory confirmed case of influenza and one or more cases which meet the clinical case definition of an influenza like illness, among individuals (residents or staff) with an epidemiological link to the supported living setting, arising within the same 48-hour period.
If an outbreak is suspected in a supported living setting, 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 HPT for more information.
The HPTs at UKHSA have an essential role in responding to, and supporting, any infectious disease outbreaks in supported living settings. Local HPTs will provide tailored advice to ensure staff protect themselves and the people they support.
It might be the case that the local HPT will recommend temporary measures, which may include limiting visiting to essential visits only. These should continue until such time as it is understood that the outbreak has been brought under control.
If a supported living worker has COVID-19 symptoms or tests positive
General guidance for working safely during coronavirus is available. If a supported living worker develops COVID-19 symptoms, see NHS guidance on when to self-isolate and what to do and general advice on coronavirus is available. In addition:
if symptoms start at home (off-duty), they should not attend work and should notify their line manager immediately. They should follow the stay at home guidance and get a PCR test as soon as possible
if symptoms start at work, the staff member should immediately return home, follow the stay at home guidance and get a PCR test as soon as possible. Any face mask or PPE worn should be removed and disposed of carefully, as described in the domiciliary care resource, and hands must be washed. They should get a test as soon as possible
If a supported living worker tests positive using a rapid lateral flow test they must isolate immediately, and they should get a confirmatory PCR test as soon as possible and within 2 days of the positive rapid lateral flow test at the latest. They should follow the stay at home guidance.
If anyone working or living in a supported living setting tests positive with either a rapid lateral flow or PCR test, all staff should undertake rapid response daily lateral flow tests for 7 days following the positive case in line with the testing guidance.
If the PCR test is positive the staff member will also be contacted by Test and Trace and should follow their advice.
If a supported living worker is concerned they may have been exposed to COVID-19
If a worker or volunteer has come into close contact with a person who is confirmed or suspected of having COVID-19 while not wearing PPE, or had a breach in their PPE, whether within or outside the work setting, then the staff member should inform their line manager and follow guidance for the management of exposed healthcare workers.
From 16 August, if a fully vaccinated worker or volunteer is found by NHS Test and Trace to have had relevant, close contact with someone who has COVID-19, they will not be required to self-isolate and can continue to work if they have received:
a negative PCR test
daily negative lateral flow test for the duration of the period they would otherwise be required to isolate
Consideration should be given to how to ensure fully vaccinated 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 should be built into the supported living setting’s general risk assessment for responding to infectious diseases.
For more information on interpreting test results and actions required for both symptomatic and asymptomatic individuals, see the flowcharts illustrating the return to work process.
If someone in supported living has symptoms of COVID-19
If the person develops a COVID-19 infection, plans need to be developed so that the person is supported to have their health checked in case additional help and health interventions are needed.
It may be harder to recognise COVID-19 infection in people with dementia, certain types of autism and people with learning disabilities who may find it hard to communicate verbally or easily express the symptoms they are experiencing. This includes signs of a high temperature (37.8°C or above), a cough, or a change in sense of taste or smell, as well as for softer signs, that is, being short of breath, not being as alert, having a new onset of confusion, struggling with eating, having reduced fluid intake, diarrhoea or vomiting.
Annex B below sets out special considerations when taking swab samples from people who may find the process challenging. It is essential that processes are put in place to enable and ensure the healthcare of these people is effectively supported.
A rights-based approach should be delivered at all stages of care. This includes:
consideration of all possible diagnostic causes
access to healthcare
informing individuals of their rights and ability to challenge decisions
access to advocacy
use of the hospital passport
regularly consulting with family members and carers
If a person being supported develops symptoms, then these plans should be acted on to provide additional support and help them self-isolate, and ensure that visitors such as care and support workers and family members follow appropriate procedures such as handwashing, respiratory hygiene and, where appropriate, the use of PPE.
It will be important to be aware of the specific needs of people living with dementia in this regard. Those with learning disabilities and certain types of autism may also be affected. For example, they may not fully understand the significance of, and need for, isolation. They may also find it frightening to see a carer wearing PPE.
Some actions can be taken to reassure individuals, such as having the supported care worker’s name and picture clearly visible on clothing, using tone of voice and open body language to demonstrate warmth, and drawing pictures or using written words to communicate where appropriate.
Plans should include communicating with family and others who provide support to help understand the reasons for staying in isolation. The principles underpinning the Mental Capacity Act (2005) should be followed when it is felt a person being supported may lack capacity to make a decision.
People with mental health conditions, learning disabilities, and certain types of autism, may need support in keeping isolated from the people with whom they may share communal facilities. If isolation is not possible within the supported living service, then appropriate alternative community provision may need to be considered. This needs to be discussed with the individual and, where appropriate, family members.
Annex A: additional resources
The Social Care Institute for Excellence has produced guidance for care staff who support autistic people and people with learning disabilities.
The Social Care Institute for Excellence has also produced guidance for care staff caring for those with dementia.
The Alzheimer’s Society website has resources to promote awareness of the Herbert Protocol among local emergency services and the local community. The Herbert Protocol is a national scheme that encourages carers, family and friends to provide and put together useful information, which can be used in the event of a vulnerable person going missing.
Examples of factsheets developed by organisations include This is Me, which contains space for:
access to advanced care plans
cultural, spiritual, religious and family background
The Challenging Behaviour Foundation has produced an information sheet about people with severe learning disabilities and face masks. The resource provides useful information about helping people with severe learning disabilities to prepare for the experience of wearing, or seeing other people wearing, PPE.
Organisations such as Speakup have developed a series of resources such as hospital passports for autistic people or people with a learning disability to help on discharge to hospital, if this was necessary.
The Housing Learning and Improvement Network have produced various resources related to specialist housing and COVID-19. These include bereavement and emotional support materials.
The British Geriatrics Society has produced guidance on managing delirium in confirmed and suspected cases of COVID-19.
Further useful information can be found from Learning Disabilities England, Mencap and NHS easy read resources.
Annex B: taking swabs
Some people may find it difficult to understand what’s happening when samples are being taken. This could include people with learning disabilities, certain types of autism, mental health conditions, dementia or any other type of cognitive impairment.
The special considerations when taking samples from people who may find it difficult to understand what’s happening include:
be aware that the person has a cognitive impairment that may affect their ability to understand information about taking the swab
find out from those who know them best how and when to give the person information about taking the swab in a way that they are most likely to understand
having given the information, if it is concluded that the person does not have the mental capacity to understand it and consent to taking the swab, a decision should be made in their best interests following the principles of the Mental Capacity Act 2005. See coronavirus (COVID-19): looking after people who lack mental capacity
relevant information about the person’s needs, preferences and understanding should be taken into account and, where possible, a family member or carer who knows them well should be present or at least consulted with to inform the best interests decision
provide reassurance and use a calm and confident approach
explain the process step by step using appropriate language and their preferred communication methods. If appropriate, use visual aids to show what is happening
be prepared to take time when taking the sample and to try more than once if needed, possibly at different times of the day
if the person becomes distressed at any point, it may be necessary to abandon the attempt to take a sample