- 10 Dec 2021
Minimising the risk of COVID-19 transmission over the winter period
We want to first of all thank you and all your valued colleagues for your continued resilience and ongoing commitment to supporting people during the pandemic. We recognise how challenging this has been, while managing the ongoing risk of COVID-19 transmission, guidance updates and extreme pressures on resource, and understand that many of your staff may be feeling particularly fatigued after over 20 months of the pandemic. We want to reiterate our thanks and appreciation to you all for supporting each other and working together as we continue to navigate through the pandemic.
Additional protective measures for adult care homes
As you may be aware there is community transmission of Omicron within Scotland, therefore, we must continue to do everything we can to minimise the risk of spreading the infection. We are therefore, urging everyone to do their part and use the tools and guidance we currently have in place to minimise the risk of COVID-19.
The additional protective measures for adult care homes outlined below aim to balance the current Covid-19 risk and the need to keep people safe in line with clinical advice provided about the risks of Omicron variant of SARS-CoV-2 at this time, and what actions may help reduce the risk of infection or spread of infection. However they are based on the principle that, where it is safe to do so, people living in care homes should continue be supported to see and spend time with those important to them as outlined in Open with Care visiting guidance. Care home staff have worked hard to increase opportunities for people to more safely connect with others, recognising that this is essential to the wellbeing of both residents and their families/friends.
The additional measures also recognise the importance of ensuring all existing Infection Prevention Control (IPC) measures are in place; all visitors should undertake a Lateral Flow Device (LFD) test before attending; vaccinations and boosters are to be encouraged; and no-one with symptoms or identified as a close contact meet with residents in and out with the care home.
Infection prevention and control (IPC)
As you know IPC measures, when implemented correctly, are a key safeguard against COVID-19 and other transmittable infections. When IPC measures are relaxed, such as when masks are taken off to use the phone, or people stand closer together, especially in break-rooms, social or work gatherings or whilst car-sharing, the virus is given the opportunity to spread, which can lead to outbreaks. As the winter progresses and we manage the risk of highly infectious variants, it remains crucial that all health and social care staff pay critical attention to and remain compliant with IPC measures. We know the efforts you and your colleagues are taking to follow IPC guidance to keep people safe. However we ask that you consider any areas where this may have relaxed, and that you stringently follow the guidance contained in the Winter Respiratory IPC Addendum. This includes:
- all staff ensure fluid resistant surgical masks (FRSM) are worn correctly over the nose and mouth at all times unless in situations as detailed in the above guidance
- everyone follows hand hygiene practices including hand washing with liquid soap and use of hand sanitiser when removing face masks, touching surfaces and touch contact with individuals when providing care
- ensuring rooms are ventilated as much and as frequently as possible by opening windows if temperature/weather conditions allow. Where weather conditions do not allow for windows being opened, considering if other mitigations can be applied within the area to reduce risk for e.g. where it is safe to do so, doors may be opened
- keeping physically distant from one another, the people you are caring for or supporting, unless providing direct care/support, and their friends and family
- avoiding car-sharing whenever possible
- managers and leaders ensure good compliance with IPC measures through robust risk assessment and governance
In addition to these protective measures for staff, all visitors to care homes should wear a Fluid Resistant Surgical mask (FRSM) as per Open with Care guidance.
We encourage you all to kindly remind each other of these measures. To support these conversations we have produced posters and social media tools called 'kind to remind'. You can download these tools at: Dropbox – Posters (print) – Simplify your life.
COVID vaccinations, boosters and treatments
Vaccinations and boosters
In addition to IPC measures, COVID-19 vaccination has played a vital role in minimising the impact of the virus and the likelihood of severe illness and hospitalisation. We thank all who have completed their two doses of the vaccination and have come forward for their booster.
Levels of protection provided by the vaccination reduce over time, it is therefore incredibly important that when eligible, we all take up offer of the booster. The COVID-19 vaccine booster dose will help extend the protection gained from the first two doses and give longer term protection. Importantly, it is also known to substantially increase protection from Omicron. You can now get the booster dose and it will help reduce the risk of you needing to go to hospital due to coronavirus this winter.
We ask that all staff protect themselves, those they care and support and the wider public by getting their booster. In particular, vaccination remains a key feature of good ante-natal care for health and social care workers.
We also ask that care homes continue to encourage and support their staff to take up the booster. You have an important role to play and we need your help. You are a vital source of trusted information and reassurance to help your colleagues make informed decisions about taking up the vaccine offer.
Further information on booking your appointment, including the contact details for the vaccine helpline are available at NHS Inform.
Additionally, drop in appointments should be available in most NHS boards. We recommend you follow your local NHS board Facebook and social media pages to be kept up to date on where the drop in clinics are.
Whilst getting your coronavirus (COVID-19) vaccination remains the best way to protect yourself from the virus, there are additional treatment options for selected groups of people with coronavirus who are thought to be at greater risk. These additional treatments need to be given soon after symptom onset and receiving a positive PCR test result to be most effective. A letter was issued 31 December 2021 providing information, for awareness, on these new treatment options and which selected groups of people with coronavirus may benefit.
Continued testing remains critical even when fully vaccinated as people can still catch COVID-19 and spread the infection when vaccinated. Early identification of cases is even more important with the new Omicron variant. Omicron has a higher rate of transmission than other variants. This is of particular concern for people living in care homes as they can be more vulnerable to infection. In addition to this communal living settings are at higher risk of outbreaks. We are therefore asking care home staff, visitors, visiting professionals and residents to increase the number of times they take an LFD test per week. Updated guidance on testing is detailed below.
Care homes should use kits supplied to the care home by NSS to support additional staff, visitor and resident testing as detailed in this guidance . NSS is working to ensure that care home continue to have sufficient supplies. Care homes are advised to use up existing stocks of kits of both Innova and Orient Genes before requesting additional supplies. If there is an immediate issue with stock levels then NSS can be contacted on 0800 008 6587. Note: if additional buffer solution is needed for Innova tests then this can also be requested via the helpline. Alternatively, tests can be collected at your local pharmacy or test centre.
Prioritised booking slots are available at test sites for all essential workers, including health and care workers. This can be accessed by clicking to confirm you are an essential worker when booking a test online.
There is a full list of those in scope if you are unsure if this applies to you.
This is in addition to the local arrangements that are in place for weekly PCR testing for social care staff. Uptake of PCR testing for care home staff is outstanding and we thank staff for continuing to participate in this programme. Due to prevalence in the community, we now expect all care home staff to undertake daily(working days) LFD testing, in addition to their weekly PCR test. Care home staff may also consider testing on non-working days if they are socialising in line with guidance from the First Minister. LFD testing helps us to identify asymptomatic positive cases in-between PCR testing which can be used to confirm and identify if the Omicron variant is present.
We ask that staff log their LFD test result for workplace testing on the COVID Testing Portal. Recording test results (positive, negative and void) helps us monitor prevalence of the virus and importantly the impact of the virus on the workforce.
Visitor testing including visiting professionals
Anyone who visits an adult care home or meets a care home resident outwith the care home – family/friends (including children) and visiting professionals should undertake an LFD test before every visit (one per day. Previously this was twice weekly for regular visitors). The exception to this is in exceptional circumstances e.g. end of life/distress, however all IPC measures to be followed.
As indicated in previous guidance, care homes have the discretion of supporting visitor testing at the care home or recommending visitors test before they come to the care home through community testing routes.
Testing of all visitors is recommended but it is not mandatory. If someone refuses to test, then staff should discuss this with them to understand the reasons why. If they still refuse, it is recommended that the individual visits as long as Infection Prevention and Control measures are followed. There will be circumstances where essential visitors may need to visit in urgent situations so it would be important to support such visits.
Care home residents testing
Residents are also recommended to undertake an LFD test before leaving the care home to meet with individuals indoors, and after returning from visits out (if the visit does not involve an overnight stay the test should be taken the next day), unless this will cause harm or distress. Residents are also recommended to test every other day for up to 14 days. Testing is recommended, it is not mandatory and should not be encouraged if this will cause harm or distress to the resident.
The approach to testing for residents following outings should be flexible and guided by the level of risk posed. For example if the resident is meeting family or friends inside or for an overnight stay testing every other day for 14 days is recommended. For residents that go out on a short walk outside of the care home with limited contact with others testing on return for 14 day is unlikely to be necessary. Residents who regularly attend day clubs, activities and go on outings with family or friends, eg once a week or more, are recommended to test 2-3 times per week in line with the advice for the general public.
Testing of residents before and on return from the care home is not mandatory and should only be done with consent. If a resident is unable or unwilling to do a test then they should not be prevented from leaving the care home to see others. Residents and those they are meeting are strongly recommended to follow infection prevention and control measures including hand washing, wearing face coverings, increasing ventilation and where possible, distancing from individuals not in your household.
The decision on who should do the test for a resident, will be best made by the care home with the resident. However this could be the resident if they are able and willing, care home staff or a family member if able and willing.
Tests for residents should be recorded on the NSS portal. The portal will be updated to have a category for “care home – resident” but until this time it is advised that the category “care homes – visitor” is used.
Care home staff, visiting professionals, visitors and residents
It is important note that testing is one form of protection - other protections such as handwashing, physical distancing, face coverings / masks, symptom vigilance and vaccination are important in reducing the spread of COVID-19. Symptom vigilance amongst residents and their friends and family when planning outings away from the care home or visits is essential.
Self-isolation periods for social care staff
Care home workers continue to provide care and support to individuals whom are often more vulnerable and of higher risk of COVID-19 infection, therefore there continues to be additional safeguards in place for care home settings.
A letter with updated self-isolation guidance was sent to the health and social care sector on 6 January 2022 . All health and social care providers/ employers and their staff should follow the updated policy Framework as detailed in the letter and the updated DL for Covid-19 self-isolation. This guidance applies to all staff whom test positive or are identified as contacts from 6 January 2022. The main changes to self-isolation for staff is that Covid positive cases can now exist self-isolation and return to work from day 7 of their self –isolation under the following circumstances:
- they have two negative LFD tests taken 24 hours apart from day 6
- they continue to take an LFD test each day for the remainder of the 10 day period
- they do not have and have not had a fever during the previous 48 hours
As detailed in previous self-isolation exemptions for health and social care staff, staff whom are identified as contacts of a Covid-19 case can exist isolation with a negative PCR test if they are fully vaccinated and meet the conditions as detailed in the Policy Framework. This has been summarised on Test and Protect guidance page.
Further information including all conditions for existing self-isolation, staff testing positive on or after their 10 days are detailed in the self-isolation Policy Framework.
Finally, we want to reiterate the important impact meaningful contact and socialising with family and friends has on individual’s mental health and wellbeing. We ask that care homes use the protective measures summarised in this letter to continue to facilitate and support residents to meet in person with their family and friends. As detailed in previous communications the expectation is that visiting should have increased from the minimum of twice weekly, to more routine normalised visiting with up to two households at any one time per resident, unless an outbreak is suspected or has been declared.
The guidance announced by the First Minister on 14 December 2021, for the general public was as follows:
When socialising at home or in indoor public places individuals should limit the number of households represented in your group to a maximum of three households at any time, with everyone encouraged to take a lateral flow test before meeting.
The following guidance was issued to the sector on 15 December to inform on the measures that should be taken to support visiting in and out of adult care homes.
The First Minister’s announcement on 21 December about additional restrictions in some sectors does not change the guidance on visiting.
- adult care homes should continue to support indoor visits. However in line with the recommendation for the general public to limit the number of households meeting indoors to three, we recommend that there should be no more than two households meeting with a resident at one time inside the care home
- anyone who visits an adult care home – family/ friends (including children) and visiting professionals should undertake an LFD test before every visit (previously this was twice weekly for regular visitors). Exception in exceptional circumstances eg end of life / distress but all IPC measures to be followed. Further details on visitor testing is available under the testing section of this guidance.
- as before there should be no restrictions placed on frequency of visiting. This will be guided by care home arrangements, which take into account the ability of the home to manage the number of people attending at any one time to ensure safe visiting practices can be maintained
- the duration of visits should not be limited if safe visiting practices can be maintained
- all visitors to care homes should wear a Fluid Resistant Surgical mask (FRSM) as per Open with Care guidance
- for adult care homes with a COVID-19 outbreak, care homes can support residents to choose a named visitor who may visit the resident in their private room if the local Health Protection Team has agreed this can happen. See guidance: Coronavirus (COVID-19): named visitor during outbreaks - letter and guidance for care home sector
Visits out of the care home
Adult Care homes who do not have a COVID-19 outbreak, should continue to support residents to undertake outings from the care home, but the following is advised:
- residents are recommended to undertake an LFD test before leaving the care home and after returning from visits out, (test every other day for up to 14 days), unless this would cause harm or distress. The frequency of testing should be based on a risk assessment as detailed in the testing section of this guidance.
- If the resident returns with symptoms, they must isolate as detailed in the Public Health Scotland care home guidance and get a PCR test
- ask anyone meeting residents out with the care home to undertake regular LFD testing, and receive a negative LFD test on the day of the visit. Testing is on the day is strongly recommended however it not mandatory. Residents should not be prevented from leaving if individuals refuse to, or are not capable of testing.
- encourage everyone – residents and those they are visiting - to have had their COVID-19 vaccinations including booster if eligible
- residents are recommended to avoid mixing with a large number of people indoors
- encourage everyone to follow good hand hygiene handwashing, face coverings and physical distancing wherever possible
- on return to the care home, as per the PHS Covid-19 adult care home guidance, residents should be assessed using the respiratory screening checklist as per the ARHAI Scotland Winter Respiratory Addendum . This should be completed by either the resident or care staff.
- further details on resident testing for outings, including applying a risk assessment flexible approach, is provided under the testing section of this guidance page
- if a resident returns with symptoms, they must isolate as detailed in the Public Health Scotland care home guidance and get a PCR test
- it is important note that testing is one form of protection - other protections such as handwashing, physical distancing, face coverings / masks, symptom vigilance and vaccination are important in reducing the spread of COVID-19. Symptom vigilance amongst residents and their friends and family when planning outings away from the care home is essential
Activities within the care home/communal areas
Adult care homes who do not have an outbreak should continue to support residents to participate in activities within the care home – these are an essential part of care home life and are vital to wellbeing. However, the following steps are recommended:
- as before large groups of visitors such as choirs and carol singers are currently not recommended inside the care home (existing advice), the Public Health Scotland Covid-19 Adult Care Home guidance. External visiting groups may perform outdoors in the care home grounds where residents can observe from a window inside the care home (e.g. window choirs). The care home manager should risk assess the feasibility of such visits by external visiting groups
- staff should continue to wear fluid resistant surgical masks (FRSM) and maintain 1m + physical distance from residents, each other and visitors (existing advice) unless providing personal care or for any other reason
- increase ventilation where possible, continue to maintain temperature comfort and follow the IPC measures as detailed guidance contained in the Winter Respiratory IPC Addendum
As indicated throughout the recent letters to the sector we currently consider testing, symptom vigilance correct use of personal protective equipment (PPE) and fluid resistant surgical masks (FRSMs) or face coverings (as appropriate), hand hygiene, increased ventilation and the IPC measures as detailed in the winter respiratory guidance to be effective at minimising the risk of Covid transmission.
Gifts do not need to be wiped down or isolated.
Advice for staff on activities and encounters
With positive cases of the Omicron variant continuing to rise in Scotland, staff are asked to be especially careful at this time of year.
For your own protection, as well as that of your friends and family, colleagues and those you support, you will want to think about limiting social encounters in line with guidance for the general public. Attending social events, such a large gatherings, could increase your own risk of being infected or of bringing infection to the home. The risk of either catching the virus or passing it on to others remains very high given the high transmissibility of the Omicron variant of SARS-CoV-2. If you do meet people socially or attend social events, as outlined by the First Minister, please LFD test and encourage those you are meeting to also test before you meet.
Wherever possible, vehicle sharing should be avoided with anyone outside of household or support bubbles. Where this can’t be avoided the advice in the winter respiratory addendum should be followed. As required by the law, in line with the general public, unless exempt, staff must also wear face coverings if they are travelling on public transport.
We also continue to encourage staff and residents to get their booster vaccination as soon as possible as it will extend the protection gained from the first two doses and help reduce the risk of you needing to go to hospital due to coronavirus this winter.
The changing nature of the pandemic can mean that the law can quickly change. It is important that individual care home providers continue to check and comply with all legal obligations on them to be sure the care home is a safe place to visit and with any health and safety or other obligations in respect of it being a safe workplace. This guidance does not supersede or provide any advice on those matters. Independent advice should be sought on compliance with any of these matters if needed.
What we will continue to do to support you through the winter period
We will continue to support you by working with our partners in Public Health Scotland, ARHAI and the Care Inspectorate, to keep you informed and update guidance in line with evidence and science, with involvement of sector representatives.
Throughout the winter period we will also continue to support you through sustainability payments resources through the wellbeing hub and access to PPE, when you and your colleagues need it.
Staff Support Fund
We would also like to take this opportunity to remind colleagues that the staff support fund for social care remains in place Coronavirus (COVID-19): social care staff support fund guidance - gov.scot (www.gov.scot) this includes support for a number of areas including:
- backfill/over time to cover when a member of staff is off with COVID/self-isolating in line with public health advice
- top up payment for staff who are put upon statutory sick pay when being asked to self-isolate in line with public health advice
- backfill to allow other staff to attend vaccine centre to get vaccination/booster
We would like once again to thank you and your staff for your continued efforts to follow and promote these measures.
- this guidance does not supersede or provide advice on matters that are governed by Part 1 of the Health and Safety at Work Act 1974, and any legislation or guidance made under, or about, that Act, occupiers liability or other legal obligations on health and social providers to ensure that premises are generally safe for patients, residents, visitors and staff. It is important that health and social care providers seek independent advice on those matters, and if necessary, what the impact of Covid-19 may be, to ensure they are complying with any such legislation or obligations