Publication - Correspondence

Coronavirus (COVID-19): named visitor during outbreaks - letter and guidance for care home sector

Published: 15 Sep 2021

Advice recommending that care home residents be supported to have a named visitor during COVID-19 controlled outbreaks.

Published:
15 Sep 2021
Coronavirus (COVID-19): named visitor during outbreaks - letter and guidance for care home sector

In this document:

Guidance: Open with Care - named visitor to enable people in care homes to maintain contact with loved ones during COVID outbreaks

Interim Scottish Government advice, aligned to Open with Care, now recommends a framework whereby adult care homes can support residents to choose a named visitor who may visit indoors during a managed COVID-19 outbreak, where visiting can be safely supported. This interim guidance will be fully incorporated into Public Health Scotland Covid-19 information and guidance for care home settings  in the coming weeks.

This will ensure whenever possible that people can continue to benefit from regular contact with a named visitor when wider restrictions on routine visits may be in place.

This guidance provides information for adult care home providers, oversight teams and families on how named visitors can see loved ones safely.

Background

The principle of allowing limited visiting in a managed COVID-19 outbreak situation takes account of the fact that social contact (with a family member, friend or representative) can be therapeutic to a resident’s health, wellbeing and quality of life.  For many residents, family members play an important part in their care, through sharing and understanding a resident’s background and beliefs, and by helping to maintain family and friendship connections.

Having a named person to visit during a managed COVID-19 outbreak avoids residents experiencing prolonged periods of isolation from their loved ones.  Such a person can engage with a resident in their room, support the resident to eat and drink, or be a reassuring presence. The role of a named visitor is in addition to essential visiting which is not limited to one individual visitor and should continue to take place as per previous guidance, for situations including end of life and distress.

A COVID-19 outbreak is defined as two or more linked cases of disease within a defined setting over a period of 14 days.

A managed outbreak

During a managed COVID-19 outbreak, the priority will be to investigate the extent of the outbreak and bring it under control. Visiting during an outbreak requires to be continually risk assessed. This assessment will include consideration of the scale of the outbreak, continuing spread,  impact on the care home, staffing, and adoption, reinforcement or training needs of IPC measures.

An initial assessment of an outbreak can often take a few days and sometimes over the course of a ‘controlled’ outbreak, it can become ‘uncontrolled’ again.

Where the care home manager and the health protection team (HPT) consider that the outbreak is suitably controlled and managed, the following guidance outlines the recommended approach for supporting visiting  in this situation. It recognises the need to balance the risk of harm from isolation with the risks associated with contracting and transmitting COVID-19.

Named visitor

  • every resident (or their representative) can nominate one person who can visit them in their room during a managed COVID  outbreak.
  • the named visitor can visit in most circumstances. Visitor eligibility for this includes:
    • the visitor is asymptomatic and not known to be COVID-positive
    • the visitor has not been identified as a close contact of a COVID-19 case in the previous 14 days
    • the visitor is fully vaccinated (defined as having received both doses of an MHRA approved vaccination, with 14 days having elapsed since the final dose
    • the visitor adheres to COVID-19 precautions such as LFD testing and wearing an FRSM mask (and other PPE if advised), and physical distancing (as advised in the Scottish COVID-19 Infection Prevention and Control Addendum).
    • the visitor is made aware and understands the risks involved in visiting during an outbreak for themselves, the resident and the other residents and staff of the care home as a setting of communal living
  • there is no restriction on who residents choose to nominate.
    • care home providers should support residents to nominate their named visitor. They should involve family members, friends and advocates as appropriate.
    • providers should keep an updated record of each resident’s named visitor
    • during a managed outbreak, the named visitor should ideally remain the same person and visiting is restricted to the resident in their own room
    • in the event the named visitor cannot visit for a period during the outbreak (e.g. they are-self-isolating, on leave, ill), the care home should discuss and facilitate an alternative individual that can visit
    • a named visitor can visit a COVID-19 positive resident who may require some comfort in what can be a stressful time. This would involve a very managed visit to be supported and would depend on the circumstances of the resident and the care home
  • named visitors may, with agreement of the resident (or representative) and the care home manager, provide day to day basic care to support residents’ health and wellbeing. This is complementary to the care from staff and might for example include encouragement to eat and drink
  • implementing the approach of named visitor is in addition to the policy of essential visits for end of life or distress which should be supported at all times
  • as care homes have a range of additional tasks to care for and protect all residents during an outbreak, relatives and care home staff are asked to work together to support named visitors on factors such as the time and length of visits
  • the local Health and Social Partnership Oversight Team working alongside the local HPT have a role in supporting care homes to implement the approach and in monitoring implementation of the named visitor initiative
  • visits may need to be temporarily suspended to all but essential visits to enable the outbreak to be brought under control – this will be determined by the local HPT in discussion with the Care Home management
  • Scottish Government sustainability funding is in place until March 2022 to cover additional costs that may be incurred by social care providers as a direct result of the COVID-19 pandemic. This includes additional staff to support care homes with facilitating safe visiting during the pandemic

Summary of recommendations for resident contact in COVID-19 outbreak conditions

The following table summarises the types of resident contact recommended to be supported in different conditions.

‘Routine contact’ means continued support to meaningful contact as outlined in Open with Care and supporting advice (e.g. daily or group visits).

Essential visiting which is not limited to one individual visitor and should continue to take place as per previous guidance, for situations including end of life and distress

Scenario and visiting (Yes/No)

No outbreak/ declared over

Single resident in pre-cautionary isolation

Single resident isolating (COVID-19 positive)

Controlled  Outbreak

Outbreak assessment phase or ongoing phase

Routine visiting

Yes

No

No

No

No

Named visitor

No

Yes

Yes

Yes

No

Essential visiting, if relevant

Yes

Yes

Yes

Yes

Yes

Note about this guidance

This guidance note is part of the Open with Care – Supporting Meaningful Contact in Care Homes series and is subject to the same caveats and disclaimers such the need for care homes providers to ensure that they 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.

Letter to care home sector

Open with Care: named visitor to enable people in care homes to maintain contact with loved ones during  managed COVID outbreaks

We would like firstly to reiterate our thanks to you for your concerted work throughout the pandemic and specifically, to maintain residents’ meaningful contact with loved ones in and away from the care home.  

We continue to work with care home residents and their relatives, the care home sector,  Directors of Public Health and with Public Health Scotland, to balance the risk of harm from COVID-19 with the risk of harm from continued restrictions to meaningful contact and activities with loved ones, using the best available evidence.

To mitigate against risks of harm to residents from prolonged isolation, we have worked with clinical and professional colleagues, and relatives to develop new advice which recommends that residents be supported to have a named visitor during COVID-19 managed and controlled outbreaks in care homes. Continued support and advice from local oversight arrangements to assist with implementation is available through local oversight arrangements, including local health protection teams who have a statutory role in leading on the management of outbreaks in care homes under the Public Health Etc (Scotland) Act 2008.

The accompanying guidance note supports this and we recommend you now work towards putting the necessary arrangements in place, consulting with residents and their families to support this change to happen in a risk assessed way. We recognise the importance of a short period for you to make the necessary arrangements, including consultation with residents and families, to do this.  Advice from the local health protection team will be crucial in informing your decision on supporting a named visitor during a controlled and managed outbreak.

You should continue to consult Public Health Scotland Covid-19 information and guidance for care home settings

Advice for families on this approach, including the importance of working with you as you work to put arrangements in place, will shortly be available at www.nhsinform.scot/openwithcare.     

We will, over the coming weeks, continue to engage with the sector to support implementation of this updated guidance through member organisations and existing networks. This will include a series of workshops for care homes on adopting the approach.

We are also further exploring opportunities to capture and share learning in the coming weeks.     

Thank you once again to you and your teams for your continued efforts.

Minister for Mental Wellbeing and Social Care
Chief Medical Officer
National Clinical Director
Director, Mental Health and Social Care

Deputy Chief Nursing Officer

Print version

A PDF version of the guidance and letter to download/print is also available.