Visiting arrangements in care homes
As you will be aware, guidance for visiting arrangements in care homes during Coronavirus was recently published: GOV.UK's Update on policies for visiting arrangements in care homes page (opens in a new window). This guidance gives the Director of Public Health and Worcestershire County Council the responsibility to advise care homes on the suitability of visiting in the local authority area, taking into account infection rates and the wider risk environment.
Careful consideration of the wider COVID-19 situation in Worcestershire combined with detailed risk assessments by individual homes, will help support the development of visiting policies that balance the wellbeing benefits of visits against the risk of transmitting infection.
Each care home will need to produce their own risk assessment and visitor policy, and this should be made available to residents and families.
Current situation (8 September 2020)
Following the review of Worcestershire’s COVID-19 infection rates and the wider risk environment, we would like to advise you of a change to our current visiting advice. In response to the recent localised increase in the number of COVID-19 cases, we are now advising that visiting to care homes in Bromsgrove District should be restricted to essential visits only. See the Bromsgrove Ward Map (Bromsgrove District Council website, opens in a new window).
Care homes in other districts should restrict non-essential visitors from Bromsgrove District until further notice. However, care home staff members who reside in Bromsgrove District can continue to work in care homes and follow existing guidelines.
At present, we continue to advise that it remains appropriate for care homes to facilitate visits to their residents in all other districts (excluding Bromsgrove). It is essential that all visits continue to be conducted in compliance with national guidance and the framework described in the attached communication. We will continue to closely monitor the situation across Worcestershire and will contact you by email should there be a change in our advice.
For districts with no restriction, the decision on whether or not to allow visitors, and in what circumstances, is an operational decision and therefore ultimately for the provider and managers of each individual setting to make. Where visits are restricted care homes should employ alternative options to maintain social contact for their residents.
Framework and requirements
As outlined in the national guidance, policies for visiting arrangements and decisions should be based on a dynamic risk assessment and minimise risk wherever possible. This requires consideration of local epidemiology and circumstances of individual care home. The framework by which we will consider the suitability of visiting in care homes in Worcestershire is as follows:
Local COVID-19 infection rates
Worcestershire County Council Public Health team and Outbreak Control Group regularly review the COVID-19 epidemiology. To support visiting, the following criteria need to be met:
- Number of cases reported per 100,000 population remaining low*
- No significant increase in the number of cases per 100,000 in last 7 days*
- Continued low rates of positivity in local testing data
- No significant increase in local outbreak situations
- No other significant factors
*These factors will be considered in light of the broader context, for example, visiting may be permitted to continue where these rates increase rapidly if the increase is known to be associated with a discrete setting and not to impact on care homes.
If there is a significant change, care homes will be alerted by email from the Council.
Context of care homes
Alongside the local epidemiology, it is important for providers to conduct a dynamic risk assessment and minimise risk. Care homes are required to:
- Have no confirmed or suspected cases or an outbreak that is not yet declared over1
- Be fully compliant with national guidance on PPE use
- Be fully compliant with national and local guidance on Infection Prevention and Control measures
- Have a published COVID-19 Visiting Policy, which is informed by dynamic risk assessments and developed in accordance with national guidance
- Provide regular assurance around availability of workforce, PPE, and completion of Infection Prevention and Control training, by completing the national Capacity Tracker.
- Keep a temporary list of contact details of visitors in addition to staff and residents to facilitate NHS Test and Trace.
- Follow a good practice approach to regular staff testing and whole home testing, both routinely and in the context of any outbreak.
- Provide clear guidelines outlining procedures for safe visiting to visitors and residents.
- Request visitors from outside Worcestershire to declare whether they are from an area on the current Government Watch List (see weekly surveillance reports, published at GOV.UK's National COVID-19 surveillance reports page (opens in a new window)). Visitors from areas subject to additional lockdown measures (e.g. travel restrictions) should not be allowed to visit.
1) In the event of a new suspected or confirmed case, the care home should immediately return to essential visits only (e.g. end of life). This can be reviewed following discussion and risk assessment with the Infection Prevention Control team. In the event of an outbreak, visiting restrictions should continue until declared over by the definition of no new cases in the 28 days since the onset of symptoms in the most recent case.
To further support providers, the Care Provider Alliance have published a sector-led protocol for enabling visiting based on this model: The Care Provider Alliance - Visitors' protocol - CPA briefing for care providers (opens in a new window).
Future assessments and ongoing dynamic risk assessment
As stated above, we are regularly reviewing COVID-19 epidemiology in Worcestershire. Routine updates of this communication will be available on our Coronavirus (COVID-19) page every week.
The National Capacity Tracker will help inform the Director of Public Health’s judgement on whether it is safe to continue with visits, based on a live view of local conditions. Providers are therefore strongly encouraged to continue with regular reporting.
Where, for whatever reason and at any time, an individual or group of care homes is/are considered to need to restrict visiting, either temporarily or permanently, the Director of Public Health will communicate this advice in writing as quickly as possible. As far as possible, providers will be informed through usual communication channels.
We are working on publishing local epidemiology but before this is available, providers might find the following sites useful and interesting:
- Cases by date (GOV.UK website, opens in a new window) – available at local authority level
- Map of cases (ArcGIS website, opens in a new window) over recent 7 day period – available at sub-county level