2. Anticipation and prevention of COVID-19
For many older people living with frailty, their presentation when unwell may be very different to younger people. They may not have a cough and a temperature but may have a decline in function, falls or increased confusion as a symptom that they are unwell. Families will often be able to provide information on changes of health, behaviour or mood. The most important thing is simply to be vigilant that someone who is frail may experience health challenges in a different way and being aware of that may provide an opportunity to flag up when someone needs medical or nursing assessment.
2.2 Care and support arrangements
Clients who access care and support may be considered at risk even if they are under 70 due to underlying health conditions including anyone given the flu vaccination each year on medical grounds. Therefore social distancing measures should be applied to reduce social contact to all but essential contacts from staff and family/ friends. For family / friends it is recommended that up to two people from same household visit at a time and where possible maintain a distance of approximately two metres apart.
Any visitors, whether staff or family/friends, should stay away if they have any respiratory symptoms. Staff and other visitors should follow hand washing advice before and after providing personal care or doing meal preparation. (See hand washing advice in Appendix 2 of HPS COVID-19: Information and Guidance for Social or Community Care & Residential Settings
2.3 Documentation of anticipatory planning
Clients at risk should have anticipatory care planning discussions conducted with the most suitable member of staff, linking in with the wider health and social care team eg in primary care where appropriate. In many cases, the staff providing social care support regularly update care plans, and may be able to start anticipatory care planning conversations. Decisions need to be documented and communicated with the GP practice so that they can be recorded in the client’s Key Information Summary (KIS), which is maintained by the GP. A shorter, simpler ACP has been adapted by Healthcare Improvement Scotland which will be available soon. Ideally this conversation should involve families and include preferences around future arrangements for care and support including preferences for end of life care.
People for whom it is appropriate should have in place other documentation and provision such as ‘Do Not Resuscitate’ or Just-in-Case Medication prescribed.
Due to frailty or complex comorbidities, it may be appropriate to place some individuals on the palliative care register within the GP practice.