4. Admissions, discharges and transfers involving social or community care and residential settings
As stated above the care home sector is a vital part of the health and social care system. It is imperative that the care homes continue to take admissions if it is clinically safe to do so in order to prevent flows out from acute hospital being hindered and where appropriate expedited.
The HPS guidance on social care settings includes updated advice on measures to be put in place prior to an admission to a care home from the community or hospital setting to ensure that individuals across the entire facility are managed appropriately and safely. This advice summarised below.
4.1 Admissions from the community to care home facilities
HPS guidance states, prior to admissions the care home facility should:
- source information on NHS Inform for current symptom and isolation advice, using the symptom and isolation checker
- discuss with local senior facility healthcare staff and or a designated senior decision maker in the community prior to planned admission, including consideration of current isolation advice for that individual or the household from which they are being admitted.
HPS guidance also states that people being admitted from home / the community do not need to be tested for COVID-19 and should be managed based on symptoms.
4.2 Admissions/transfer from hospital to care home facilities
HPS updated guidance states that if the individual is deemed clinically well and suitable for discharge from hospital, they can be admitted to the facility after:
- appropriate clinical plan.
- risk assessment of their facility environment and provision of advice about self-isolation as appropriate (See NHS Inform for details).
- there are arrangements in place to get return them to the facility
Decisions about any follow-up will be on a case by case basis.
If a patient being discharged from hospital is known to have had contact with other COVID-19 cases and is not displaying symptoms, secondary care staff must inform the receiving facility of the exposure and the receiving facility should ensure the exposed individual is isolated for 14 days following exposure to minimise the risk of a subsequent outbreak within the receiving facility.
Individuals being discharged from hospital do not routinely need confirmation of a negative COVID test. Facilities will be advised of recommended infection prevention and control measures on discharge. It is recommended that this includes a documented clinical risk assessment for COVID-19. Annex A contains a new admissions/ transfer form to provide a means for safely admitting a new resident and identifying that where possible they have been deemed clinically safe for transfer.
4.3 Advice on care home admissions where there are COVID-19 cases in homes
The updated advice from HPS states that social or community care and residential settings may remain open to admissions in the following situations:
- where a single case of laboratory confirmed COVD-19 has been identified and all appropriate infection prevention and control procedures are in place
- where more than 1 laboratory confirmed case has been identified and following risk assessment and discussion with the local Health Protection Team (HPT), it is possible to manage cases and ensure all appropriate infection prevention and control measures are in place
Where there is evidence of a cluster or outbreak of COVID-19, senior facility staff should discuss this with the local HPT. An outbreak is defined as two or more clinical or laboratory confirmed cases of COVID-19 in a 24 hr period which have occurred as a result of cross transmission. In this situation the facility should close to admissions day care facilities and visitors. Any derivation from this should be done following a risk assessment with HPT as there may be exceptional circumstance where for example the schematic layout of the facility may allow for partial closure.
4.4 Transfer from social or community care and residential settings to hospital
If a transfer from a Social or Community Care and Residential Settings to hospital is required, the ambulance service should be informed if the individual is a suspected or confirmed COVID-19. Staff in the receiving ward/department should be notified of this in advance of any transfer.