Coronavirus (COVID-19) Open with Care - supporting meaningful contact for care home residents at and after Level 0: letter to sector

Advice on increasing contact and activities with residents and day care services in care homes at Level 0 in a letter from the Chief Nursing Officer, the National Clinical Director, the Chief Medical Officer and the Director for Mental Health and Social Care.

Dear Colleague

Improving care home residents’ contact and connection – on moving to and past Level 0

As Scotland moves to Level 0 we are writing to update you on recommended relaxations within care homes from the same date. These can be implemented from Level 0 coming into effect, areas already in Level 0 can implement immediately.

We also outline plans towards 9 August, when it is anticipated that Strategic Framework Levels and many COVID-19 regulations will cease.

Meaningful contact within the care home – with friends and relatives

We want to reiterate our thanks for your work so far in supporting residents to reconnect with family and friends within the care home. We encourage you to continue to increase opportunities for good quality and meaningful contact, in line with existing Open with Care guidance, supporting friends and relatives to connect with residents flexibly. 

Nationally, the latest Safety Huddle Tool data indicates that 62% of homes are currently offering 2 designated visitors per week.  Remaining at this minimum starting point is not within the spirit of Open with Care.  If you are still routinely supporting 2 visits per week, we would ask you to urgently review this to increase your offer. Open with Care allows you the scope to more flexibly  support the wellbeing needs of your residents in line with their needs and preferences, as outlined in their care plans around family contact and activities within the care home.  Practical considerations to further increasing contact with loved ones will be supported by updates to the testing strategy (see below).  (Continued)

We are asking local oversight teams to review latest local Turas data and reach out to support all care homes in their area still only supporting 2 visits per week.  As the rest of society benefits from the easing of restrictions it is important that we maximise the flexibilities for our care home residents supported by the layers of protection set out in this letter.

The following changes aim to support this:

1. Physical distancing regulations are changing - from 19 July, Level 0 general population COVID-19 restrictions will change for physical distancing, outdoors and indoors.  We recommend that you implement parallel relaxations to distancing for residents’ contact with loved ones, in the care home and its grounds, i.e.:

  1. inside the care home physical distancing reduces to 1m (with touch and hand holding still being supported, in line with existing guidance).
  2. outdoors in the care home grounds, physical distancing is removed in all groups of 15 people or less (mask wearing is no longer recommended as necessary outdoors). 

2. ‘Designated visitor’ status - Feedback from the sector and relatives has indicated that this is increasingly unnecessary, as daily and group visits become the norm. We therefore recommend that this title is now no longer used.

3. Visitor testing - visitors will now, subject to your discretion, be able to undertake an LFD test in their own home immediately prior to visiting by accessing LFD tests via community testing routes.  We wrote to the sector on 13 July outling updates to the testing strategy.  Visitor testing at home is not a mandatory requirement; decisions should take into account the circumstances of your care home and your visitors. Not all visitors will be comfortable or able to test themselves, so you may wish to continue to support visitor testing at the care home for some or all of your visitors (see communication from 13 July).

Essential visits should continue in line with current recommendations, i.e. to prevent or respond to a decline in residents’ wellbeing (including distress or communication) and where there is a concern the resident may be approaching end of life.

Local and national oversight will continue to monitor and support progress with normalising and embedding good quality contact for residents.

Meaningful contact within the care home – communal activities

From Level 0, we recommend that you update physical distancing policy and practice for communal activities, in line with the wider changes, in the care home and its grounds.  This will support improved, daily connection between residents in the care home as well as through organised communal/group activities. Wider Level 0 physical distancing advice differs depending on whether people are from the same household or not. For care homes we recommend a similar approach to support you to maximise residents’ contact.

1. Outdoors

  • Mask wearing is no longer recommended as necessary outdoors.
  • For activities between residents and staff, physical distancing is removed 
  • For activities including people from outside the care home, physical distancing is removed where group size equates to 15 people or under. Any larger outdoor groups  (16 people or more) that include people from outside the care home should retain physical distancing of 1m. 

2. Indoors

  • For all communal activities indoors, physical distancing reduces to 1m. 

In line with guidance issued on 14 April on visiting professionals into care homes, communal activities should continue to increase and normalise within the care home. Today’s letter replaces 14 April advice on physical distancing for communal activities.

Looking ahead we hope to see care homes continue to strengthen connection with communities such that groups can visit as before. Advice will follow on this in coming weeks. For now, we recommend that organised groups of children and young people do not visit the care home because of the increased risks of large groups of unvaccinated people attending.  For clarity, children and young people can visit residents where they are friends or relatives and in manageable group sizes.

Outings and activities away from the care home – residents

General population restrictions will relax further at Level 0, for example increases to group size limits in public and private spaces. You can find further information on these changes.  We are bringing this to your attention so that you can factor the new conditions into planning with residents around outings and activities away from the care home, and support them to be aware of the updated advice and continued need for precautions.

Existing Open with Care – Outings away from the care home – additional guidance remains unchanged.

Resuming wider care home activities – day services

Where day services operate on a care home site, we recommend that from Level 0 these services are supported to resume, and once the necessary planning and preparations have been done. Further guidance will be issued shortly (in advance of 19th July) to support the re-opening of these services.

Wider advice

The Open with Care - Supplementary Information has been updated and published online, dated today.

Public Health Scotland recently updated their COVID-19 - information and guidance for care home settings (adults and older people) on 24 June 2021.  This provides advice on issues such as self-isolation of residents and essential outings away from the care home (such as hospital visits).

Looking ahead - removal of Strategic Framework Levels – 9 August

Subject to certain conditions being met, the current intention is that Scotland will move away from the Strategic Framework Levels system from 9 August.  We are currently working with the sector to develop care homes guidance on accommodating these wider changes, which will likely be in effect from this date. 

This guidance will focus on supporting all residents to have more meaningful lives, and care homes once again becoming more energised places, with more community in-reach and communal activities for example.  This vision is outlined in the Open with Care Progress report in June and supports the National Health and Care Standards being met in care homes.  

We are working with sector representatives to develop guidance for you around managing COVID-19 risks when the Levels system no longer applies and will provide you with advance notice to allow time to implement any changes. We recognise the need to firstly support residents to have as normal a life as possible and in broad terms we will likely look to minimise burden on residents while sustaining layers of protections for staff and visitors initially. Examples include physical distancing or mask wearing.

We appreciate that there are anxieties and unknowns around these changes and we wish to reassure you that we are live to developing advice that is clear and provides a level of stability, as far as possible, in day to day working in coming months.

The recent increases in community COVID-19 rates in Scotland are not currently translating into care homes to the extent seen in previous waves of the virus. Nevertheless it remains essential to continue to rigorously sustain and maintain current advice around the layers of protections again COVID-19, as well as wider symptom awareness.

We hope this information is helpful.  Thank you once again for your continued efforts and please also pass on our sincere thanks to your staff.


Amanda Croft
Chief Nursing Officer    

Gregor Smith
Chief Medical Officer 

Donna Bell 
Director, Mental Health and Social Care

Jason Leitch
National Clinical Director

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