Guidance

Supporting safer visiting in care homes during infectious illness outbreaks

Principles to support decision making for those involved in safely planning and protecting visiting during outbreaks of infectious illness in adult social care.

From:
UK Health Security Agency
Published
15 April 2024

Applies to England

Introduction  

Contact with relatives and friends is fundamental to care home residents’ health and wellbeing. The right to respect for private and family life is a human right protected in law (Article 8 of the European Convention on Human Rights.

There should not normally be any restrictions to visits into or out of a care home. However, during an infectious disease outbreak, health protection teams may in exceptional circumstances advise that providers reduce the number of people entering and leaving a care home to reduce the spread of infection. This should only happen if facilitating a visit would pose a significant risk to the health or wellbeing of someone in the care home premises, which cannot be mitigated through other precautions.

Aim of this guidance

This document provides general principles to support advice and decision making for anyone involved in the provision of advice to adult social care homes. It provides a review of the issues which should be considered in safely planning and protecting visiting during outbreaks of infectious illness.

Who these principles are for

These principles have been written for health protection practitioners and community infection prevention and control professionals, who have responsibility for advising on supporting safe visiting. They may also be useful for care home managers and providers who have responsibility for implementing outbreak management measures in adult social care homes.

From 6 April 2024, a new Care Quality Commission (CQC) fundamental standard on visiting and accompanying (Regulation 9A) requires that care home residents must be facilitated to receive visits, and not discouraged from taking visits out of the care home. If necessary and proportionate, precautions should be put in place to enable visits to happen safely.

The amendment to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9A aims to make sure that:

  • people staying in a care home, hospital or hospice can receive visits from people they want to see
  • people living in a care home are not discouraged from making social visits outside the home
  • people attending hospital or hospice appointments who do not require an overnight stay are accompanied by a family member, friend or advocate if they want someone with them

Providers are not legally allowed to prevent residents from leaving the care home unless there is a lawful basis for restriction of that person’s movements, and in accordance with the Deprivation of Liberty Safeguards (DoLS). However, there might in exceptional circumstances be a need for proportionate precautions upon an individual’s return.

In the specific circumstances of an infectious disease outbreak requiring precautions, the advice on reducing visiting should always be time limited, proportionate to each specific outbreak and risk based.

The following national guidance is available which includes advice on care home visiting during outbreaks of infectious illness:

National guidance containing advice on care home visiting is not provided for all infectious illnesses. However, some common principles can be applied across multiple scenarios. Principles which health protection, public health and infection prevention and control professionals can refer to when providing advice to care homes in the management of outbreaks are summarised below.

Principles for advice on visiting during an outbreak of infectious illness in a care home

These principles should be used when there is no national guidance on visiting for a specific infectious illness.

All decisions made and advice provided should be documented. Even in exceptional circumstances, end of life visits should be facilitated and CQC inspectors must be allowed entry to the care home.

Visiting should be facilitated unless there are exceptional circumstances, and providers should put in place necessary and proportionate precautions to enable a visit to take place safely. If exceptional circumstances apply, visits from friends and family should be assessed on an individual basis as to whether they should occur. It may be appropriate to reduce or postpone visits if a visit would pose a significant risk to the health, safety, or wellbeing of someone on the care home premises, which cannot be mitigated through other measures.

Residents’ emotional wellbeing must be prioritised when any restrictions to visiting are considered as part of outbreak measures.

The aim of these principles is to:

  • protect the health of the residents, visitors, and staff in the care home, and enable those involved in visiting to take appropriate precautions to facilitate visits both in and out of the care home in a safe manner
  • enable residents, visitors and others involved in visiting to be actively involved in the decision-making process
  • reduce stress and anxiety for the resident and visitor by enabling visits
  • ensure advice is proportionate to the specific infection or situation
  • reduce the risk of infection being transmitted between residents and visitors in the care home

All visits into and out of the care home 

1. Residents and visitors should be informed that there is an outbreak of infectious disease.

Visits into the care home

2. The risk to the visitor should be explained to them and to the resident they are visiting (where appropriate), especially if visiting a symptomatic resident.

3. Visitors should be given information on hand hygiene, personal protective equipment and any other measures that may reduce the risk of onward transmission. This could be in the form of written information, signs, or other appropriate means of communication. These measures should also be explained to residents (where appropriate).

4. People should not visit if they have symptoms of any infectious illness or if they consider themselves to be infectious for any reason, unless there are exceptional circumstances, such as end-of-life care. They should stop visiting for any required exclusion period (for example, 48 hours after recovery for gastrointestinal infections).

Further information on specific infectious illnesses is available in the UK Health Security Agency (UKHSA) Infectious Diseases A to Z and the NHS Health A to Z.

5. Social gatherings such as parties that bring together groups who would not normally socialise together should usually be postponed until the outbreak is over.

6. Visitors should not normally visit multiple residents during outbreaks. When this is necessary – for example, a minister of faith or a healthcare professional – they should as far as possible visit individuals considered most likely to be infectious last (for example, individuals with recent onset of symptoms). Appropriate infection prevention and control procedures should be used for each individual visit.

7. Visitors providing services other than health or social care, such as hairdressers or entertainers should usually be postponed until the outbreak is over.

8. Visiting that is required on grounds of compassion or health and safety should continue, even where exceptional circumstances apply. Examples include:

  • when a resident is approaching the end of life (see Next Phase Community Health Service End of Life Core Service framework) – this does not require a specific terminal diagnosis
  • when there would be distress or harm resulting from not having a visitor
  • when there are safeguarding concerns by family, provider, regulator, commissioner or any advocate for an individual resident
  • visits from healthcare professionals which, if delayed, would be detrimental to the resident
  • visits from social workers which, if delayed, would be detrimental to the resident
  • visits for religious or spiritual reasons
  • essential maintenance staff, for example, heating or water supply
  • visits from the Care Quality Commission inspector

9. It may be appropriate to reduce or postpone specific visits if a visit poses a significant risk to the health, safety, or wellbeing of someone on the premises and this cannot be mitigated through other precautions. Consider as part of a risk assessment:

  • very young (especially babies) and very elderly visitors who may be at increased risk
  • the risk of harm to the resident
  • the risk of visitors re-introducing the infection into the care home, particularly in relation to infections more likely to be spread by children

10. In very exceptional circumstances, it may be necessary to consider stopping most visits (for reasons other than on the above grounds of compassion or health and safety) for a limited period. Examples include:

  • when there is risk of severe harm to visitors from the infection
  • where an outbreak is not under control and there is current and significant risk of serious harm to visitors, residents and/or the wider population

Visits out of the care home (by residents)

11. Residents should be supported to make proportionate changes to daily activities, taking into account any advice for the general public. This is particularly important when considering visits to other social care settings such as day centres or another care home, as there may be a risk of the outbreak spreading into another setting. A risk assessment should be taken on an individual basis.

12. Residents (or their advocates) should be supported to consider the risks and benefits of visits outside of the care home, including:

  • if the resident is likely to be infectious to others
  • if the resident is well enough to undertake the visit
  • the risk of harm to those they are visiting
  • the risk of harm to the resident (consider other infections circulating in the local population)

13. When planning visits outside the care home, the following should be considered as part of a risk assessment:

  • communication of risk with the person being visited (if appropriate)
  • transport arrangements
  • escort requirements
  • advising the resident (or their advocates) to avoid crowded places
  • advising the resident (or their advocates) to avoid poorly ventilated spaces (particularly if the resident has symptoms of a respiratory infection)
  • advising the resident (or their advocates) on hygiene measures such as cleaning hands frequently, tissues, wearing a face covering (as appropriate)

14. If a resident has a health appointment, the health provider should be contacted prior to the appointment to risk assess and determine if attendance is appropriate.

Contact

If you have any questions about this guidance contact ASCTeam@ukhsa.gov.uk

Published 15 April 2024
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