Covid Visiting Policy

Visiting Policy (updated January 2022)

Introduction

This policy revises the arrangements for visiting Birchfield from 31^st January 2022.

Definitions

Birchfield’s definition of “visitor” is someone who does not live or normally work on the premises as a paid staff member or accredited volunteer and who comes to the home for a short period of time to see residents or staff.

For the purposes of this policy visitors include people who:

• visit residents on a personal or social basis regularly or occasionally, e.g. relatives, friends and others who come to see an individual resident
• provide professional services to residents such as GPs, community nurses, pharmacists, occupational therapists, physiotherapists, ministers of religion, social workers, advocates, hairdressers, opticians, etc
• deliver, provide or supply goods and services that have been bought or commissioned by Birchfield, staff or residents, including repairs and maintenance
• come to Birchfield to see staff members for any reason
• visit the home on a professional or business basis, e.g. external managers, inspectors and other personnel from the employing organisation or similar who may not be coming specifically to see individual residents, but who may have some contact with them depending on the nature and purpose of their visit.

This policy applies mainly to relatives and friends of residents and others who might need to have direct contact with residents. With other visitors, Birchfield will continue to apply all required infection control measures, including health and safety risk assessments, the appropriate use of PPE and regular testing. In these ways the home is committed to minimising and mitigating the risks of infection into, through and from the home.

Policy Statement

Birchfield’s visiting policy will always be adapted to the changing conditions concerning the spread of Covid-19 and the associated Government policies and guidance. The current policy reflects Government guidance that takes effect from 22 January 2022.

Birchfield understands that any longer-term continuation of these arrangements will depend on how well the pandemic is being brought under control and the success of the vaccination programme.

Birchfield welcomes the Government’s current position, which recognises that “visiting is an integral part of life at Birchfield. It is crucially important for maintaining the health, wellbeing and quality of life of residents. Visiting is also vital for family and friends to maintain contact and lifelong relationships with their loved ones and contribute to their support and care”.

Birchfield recognises that visiting must be made safe to all concerned and continues to apply its infection control measures fully in line with this latest Government and public health guidance.

It acknowledges that, despite the vaccination roll out, care home residents are still amongst the most at risk by virtue of their age and frailty to being seriously and possibly fatally ill if they fall ill with Covid-19; While vaccination is proving very effective, we are still seeing some cases of severe illness, hospitalisation and death of care home residents who have been vaccinated.

Birchfield is committed to making its visiting policy available and well communicated to its residents and families, so that they understand fully the reasons for any restrictions and arrangements and changes that might need to be made in line with local and national developments regarding Covid-19.

Approaches Taken During Restrictions

Birchfield recognises that the guidance on visiting has been issued in stages in line with the severity of the threat caused by the Covid-19 outbreak.

During the pandemic Birchfield has arranged for suitable alternative means of relatives and others who would normally be visiting for keeping in contact with residents and Birchfield through, for example, telephone, messaging, social media, Facetime, Skype, Zoom and pod visits. These methods are well established and will continue as options even after the lifting of the current visiting restrictions.

Updated Policy (January 2022)

Birchfield  continues to adopt the current Government guidance (updated 31 Jan 2022) by following the following principles.

1. Birchfield welcomes the recognition that visits should be supported and enabled wherever it is safe to do so.
2. Birchfield accepts that it is responsible for setting its own visiting policy and arrangements in line with national and local public health guidance.
3. We will do so based on a dynamic risk assessment taking into consideration the needs of individuals within their home and with regard to the advice of the local Director of Public Health (DPH) through their outbreak management team or group.
4. It will:
   • continue its policy of “outdoor” visits adapted to the situation as indicated by the risk assessments, including those made using temporary facilities such as pods and gazebos and window visits and its use of technology to facilitate contact between residents and their families and friends
   • continue “indoor” visits by named visitors to pre-appointed areas that can be supported by prior LFT testing and/or visitors who have been vaccinated against Covid-19 (recommended in the Government guidance).
   • continue the policy of “essential care givers” (as defined in Government guidance) where in exceptional circumstances close contact personal care can be provided from a close relative/person which is critical for the resident’s immediate health and wellbeing (not only to end-of-life care). The “essential care givers” will be supported to follow the same testing arrangements and the same PPE and infection control arrangements as care home staff. (See Section on Testing Arrangements for Essential Care Givers.)
   • continue with its current approach of taking a flexible approach to visiting is required on compassionate grounds where a resident is receiving end-of-life care. (See section on Essential Purpose Visiting.)
5. Birchfield will ensure that all visits are conducted in a risk-managed way that considers the needs of our service users and the practicalities arising from the physical features and layout of the home.
6. It will continue to assess the rights and needs of individual residents, particularly those with specific vulnerabilities as outlined in their care plans and will consider the importance of visits in promoting their health and wellbeing.
7. It will continue to make appropriate best interest decisions with the help of all involved in their care in respect of residents who lack mental capacity and who might be subject to deprivation of liberty authorisations and involving them as fully as possible.
8. It will follow all Government and local public health guidance in respect of the arrangements needed to ensure safe visiting of residents whenever this takes place.
9. It will always ensure safety is never compromised and will adopt Government and local public health advice on any form of visiting.

Implementation

Birchfield recognises that its current visiting policy and arrangements will be very much subject to local circumstances and will have to be adjusted to meet any changes in these. These changes include:

• the circumstances of Birchfield in terms of, for example, its location, resident needs, current staffing situation and its experiences with the Covid-19 outbreak
• the local circumstances of the Covid-19 epidemic, including past and current incidence and transmission risks, and the prevalence of any SARS CoV-2 variants.

Any arrangements made by Birchfield will apply only when safe to do so, with the approval of the local Public Health Authority.

Its decisions will continue to be based on balancing the benefits to its residents (and reducing harm because of lack of visits) against the risks of increasing Covid-19 infections and their consequences to a vulnerable group of people.

Birchfield recognises that decisions to allow visiting and under what circumstances will be made in line with local intelligence from testing on the community and of residents and staff, transmission risks in the local community, including from SARS CoV-2 variants, and other information provided by Birchfield, for example, through its Capacity Tracker updating.

When setting up any new visiting arrangements such as a dedicated indoor area, we will ensure that it which can be accessed and used safely without risk to and from the other parts of the home. Any such arrangement will follow all public health guidance on:

• the numbers of visitors that can be allowed at any one time or over a period of time
• the number of visitors allowed at any one time
• how Birchfield should support visitors to reduce the risks of them transmitting any infectivity to Birchfield and of being infected from their visits to Birchfield, including prior testing, the wearing of face coverings, hand hygiene, etc
• the infection control measures required for the use of the visiting area, including the wearing of face-coverings and for access and exit
• the infection control measures to be taken by staff during visiting, including appropriate use of PPE.

Visiting Procedures, including Testing

Birchfield will implement the following procedures:

• allow only the number of visitors at any time that are in line with Government and local public health guidance and will ensure they are tested on each visit and/or have been vaccinated
• ensure visitors are wearing the appropriate PPE and following standard infection control measures such as hand hygiene
• have a designated entrance or outside dry space for people to put on the necessary personal protective equipment (PPE) required for the testing procedures
• have a designated area for the testing to be carried out, which is away from the main visiting area, which can also be used while the tests are being processed
• ensure the designated area is well ventilated and complies with fire safety and other health and safety regulations and is robust enough to withstand repeated cleaning with chlorine-based agents
• ensure all physical distancing, face covering and hand hygiene requirements are followed prior to the testing results being available with hand sanitisers being readily available
• ensure all prospective visitors are made well aware of the requirement to be tested, (a negative test, either at the home or by providing evidence of a negative test on the day of visit) the timescales involved, the need for their consent, what testing involves and the potential benefits to the visiting experience
• advise them of what would happen if they tested positive ie the visit would not go ahead, they would need a confirmatory PCR test.If that was also positive they would need to follow Government guidance on self-isolating with other members of their households and the information fed into NHS test and trace
• have a designated visiting area that does not increase any risk to anyone else in the home and to which all safety measures can be applied.

Testing Arrangements for Essential Care Givers

Birchfield will follow all Government guidance in relation to visitors defined as “essential care givers” as follows.

Visitors who might be engaged in personal care and support as designated “essential care-givers” will:

• take a rapid lateral flow test in line with staff government guidelines for staff. This must include a minimum of three lateral flow tests a week plus a PCR test: one rapid lateral flow test on the same day as the PCR test, and two lateral flow tests every two/three days later
• as above, take a weekly PCR test and share the result with the home. Care homes should use their existing PCR stocks to test these visitors and these should be registered as “staff” tests using Birchfield unique organisation number (UON) and be returned via courier with other staff tests
• be subject to additional testing in line with care home staff should Birchfield be engaged in rapid response daily testing or outbreak testing
• visitors who have recently tested positive for Covid-19 should not 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
• 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 maintaining good hand hygiene and wearing PPE.

Face Coverings and Physical Distancing

Birchfield will follow current Government guidance about the use of face coverings to reduce risks when people meet in enclosed public spaces and will recommend that, subject to other risk factors, residents and visitors wear face coverings and continue to maintain physical distance.

Visiting Schedules

Under the present circumstances Birchfield recognises that all visits will have to be pre-booked.

Birchfield will ensure that the visiting arrangements will be planned, including times, frequency, and duration, and agreed in consultation with residents and their families and with professionals involved in a person’s welfare.

Each resident will have a visiting plan, which will set out the arrangements for that individual together with an agreement outlining people’s responsibilities for the safe and successful conduct of the arranged visits.

All visitors will be asked to provide, using our visitor’s questionnaire, their contact details, etc. in line with the Government’s test and trace guidance. This information will be held for 21 days after each visit before being destroyed in line with data protection laws.

In the event of an outbreak, window and pod visits do not necessarily need to be stopped. A risk assessment on window visits during an outbreak should be undertaken to take account of specific circumstances of the care home. It should consider the impact of the outbreak and capability to facilitate window or other visits without breaching zoning or cohorting of residents and staff, which is part of infection control management. Health protection teams, local authority directors of public health, clinical commissioning group infection control leads and other partners provide advice to care homes to help them with such a dynamic risk assessment. Specific measures may change over the course of any outbreak depending on success of containing any outbreak.

There may be local policy and outbreak management arrangements, which will be important to follow. These restrictions should continue until the outbreak is confirmed as over. Outbreak measure may only be in place for 7 days (depending on PCR turnaround times) if the first and second round of outbreak testing confirm there is no evidence of further transmission within the care home. Otherwise, outbreak recovery testing should be undertaken when there have been 14 days with no new cases.

Care home visits for close contacts with someone who is COVID-positive

From 16 August 2021, those who have been fully vaccinated no longer needed to self-isolate if they were identified as having been in close contact with someone who had tested positive for COVID-19. This means that:

• visitors who are not legally required to self-isolate are advised against visiting the care home (for 10 days) if they have been identified as a close contact of someone with COVID 19, unless absolutely necessary, even if they have been fully vaccinated. Where visits do occur, visitors should have received a negative LFD result earlier in the day of their visit.
• where there is an outbreak in the care home, usual outbreak procedures should be followed as outlined in section 1.4

Communicating with Residents, Families and Visitors

Birchfield will follow Government guidance in respect of enabling visits to be conducted safety and successfully, including supporting visitors on how to prepare for a visit, including where testing is being used, and how to communicate if face coverings are required, for example:

• speaking clearly from a safe physical distance
• keeping eye contact
• not wearing hats or anything else that might conceal their face further
• wearing clothing or their hair in a way that a resident is more likely to recognise
• providing reassurance to visitors, including that some people with dementia might struggle at first to remember or recognise them

Birchfield accepts that the arrangements for each set of visits will vary and need to be highly individualised.

Mental Capacity

In making these arrangements Birchfield will observe the rights of residents who may lack the relevant mental capacity needed to make particular decisions about their needs for visits and visiting plans. It will make all such arrangements in line with individual needs by following best interest decision-making as set out in the mental capacity laws, and where appropriate in consultation with their advocates or those with power of attorney.

However, it also recognises that people with dementia or without mental capacity for other reasons might also be the ones who will benefit most by the new visiting supported by testing approach from the closer contact that will be possible, and their needs given high priority.

Visitors’ Risk Assessments

When visiting Birchfield as an agreed “essential or named visitor” we will still ask you to:

• check with us before visiting that everything is in order and that you do not have any symptoms for Covid-19
• check if you might have had any contact with anyone who might have been in contact with an infected person or someone carrying the virus and take a decision about visiting based on your assessment of any risks
• sign a short disclaimer to this effect
• be extra careful about being in physical contact with the person you are visiting and other people whom you might meet by:
  • avoiding close contact with people, particularly if they are unwell
  • avoiding touching their eyes, nose, and mouth with unwashed hands
  • keeping to designated areas of the building which we will inform you about
• carry out stringent hand hygiene practice by always washing your hands carefully before and after any contacts made — using the soap and hand sanitiser gels and paper towels provided
• help staff to carry out the procedures that have been put in place to keep everyone safe from the virus and its spread
• report and discuss with us any concerns you have about the health of the person whose welfare is your concern.

We are confident that with these precautions in place we will be able to keep our residents safe.

Birchfield will update this visiting policy in the light of further developments, particularly if there are further cases of Covid-19 in the home or evidence of increased risk from community transmission that has been identified by local Public Health.

Staff Involvement and Training

All staff are made aware of the policy and of the changes made over time. They are also consulted in respect of individual risk assessments, decisions and arrangements, the new rapid testing approach and local test and trace programmes.

References

Covid-19 Visitors Protocol (revised September 2021), Care Providers Alliance, available on the Care Providers Alliance website

Guidance on Care Home Visiting (updated 31 January 2022), available on GOV.UK website (applies to England)

Last reviewed 1 February 2022