Open with Care - supporting meaningful contact in care homes: guidance

A1 Annex 1 Partner contributions

In order to open up safely everyone has a part to play.

Key partner roles in supporting safe visiting include the following recommendations and reflect their input. As each area's arrangements are different, these recommendations are illustrative and do not aim to be prescriptive or comprehensive. Content below aligns to and builds on the Framework for Multi-agency, Multi-professional Oversight - Guidance for scrutiny and assurance partners.

Loved ones (relatives and friends)

• Stay away if they have symptoms or have been in contact with someone infected and have been instructed to isolate, with expert advice and support if an essential visit is necessary for circumstances approaching end of life.
• Where they need to travel within Scotland to visit a person in a care home, they check that any travel complies with the law in Scotland (and any applicable guidance) and independent advice should be taken where needed.
• Where they need to travel in and out of Scotland to visit a person in a care home, they should check that any travel complies with any law in Scotland, or the law in England, or where relevant, other parts of the United Kingdom or other country of origin (and any relevant guidance) and independent advice should be taken where needed.
• Adhere to IPC and PPE measures on entering the home.
• Please take an LFD test. Whilst testing of designated visitors without COVID-19 symptoms is not obligatory, it is a critical safety measure to protect your loved one. It is important to be aware that care homes may be asked or required by third parties to refuse entry, if a test is not taken.
• Discuss any concerns they have about visiting with the care home staff.
• Follow the care home's instructions and aim to work with staff in a collaborative and constructive way.

Care Home Providers

• Where possible, separate larger care homes into discrete and independent sections ('bubbles'), with independent staffing rotas and no crossover of staff. This can limit the risks of infection's spread.
• Continue to stay up to date with relevant changes to the law and advice.
• Should take into account the Scottish Care Home visiting guidance, in relation to any care homes in Scotland and based on the characteristics of each individual care home (such as staffing availability, COVID-19 outbreak status and use of IPC measures including personal protective equipment (PPE)), especially where a provider also has care homes in other parts of the UK.
• Provide testing facilities for indoor visiting.
• Offer all staff regular testing in line with guidance.
• Support and endorse local homes to facilitate and maximise opportunities for residents to meet with families and loved ones.
• Where there is a duty to do so, take account of equality needs and the ECHR in developing visiting policies, and in particular Article 8, which provides a right to respect for private and family life.
• Take account of relevant guidance in developing their visiting policies and ensure they are weighing up the interests of all residents on a care home by care home basis (safety of all residents and positive impact from well-being from family visits on individual residents), and putting in place the least restrictive measures possible within their care home.
• Where a care home has an outbreak, continue to generously and sympathetically support essential visits.
• Notify all residents and designated visitors where changes to visiting are agreed on a care home by care home basis.
• Continue to ensure awareness and support to essential visiting at all times.

Care Homes

• Keep visiting policy and risk assessments up to date, reflecting the specific characteristics of the care home and changing situation (such outbreaks of infection).
• Undertake individual risk assessments to assess the rights and needs of individual residents, as well as any specific vulnerabilities outlined in the resident's care plan, and consider the role that visiting can play.
• Identify the need for tailored / bespoke arrangements that address the complexity of someone's individual needs and preferences, and where appropriate, taking into consideration any equality issues. For example, using Zoom or Skype calls as an alternative to face to face meetings might not work for all.
• Continue to align to existing advice and guidance around protections to maximise the safety of loved ones visiting the home, including on infection prevention and control and personal protective equipment, offering testing to asymptomatic visitors, safe staffing levels, visitor screening/booking.
• Put in place a monitoring system to check visitors' compliance with IPC precautions.
• Educate, assist and monitor visitors adherence to IPC and PPE precautions.
• Where there is uncertainty, seek support and advice with local oversight arrangements and health protection teams as appropriate.
• Encourage and monitor staff uptake of both testing and vaccination.
• Provide clear and regular communication with residents and families.
• Check that staff, residents and their loved ones are aware of the care home's complaints process where residents or loved ones may wish to raise over visiting decisions, also ensuring awareness of recourse to relevant regulatory oversight bodies such as the Care Inspectorate, where appropriate.

Provider representative/membership organisations

• Support the sector to implement the resumption of visiting
• Provide opportunities for awareness raising of guidelines
• Provide timely feedback on the experience of implementation and evidence any sector concerns to Scottish Government and other partners to support resolution of issues.

Local Oversight Arrangements

(Local oversight arrangements are collaboratively led by the NHS Director of Public Health, Executive Nurse lead, Medical Director, Chief Social Work Officer, HSCP Chief Officer.)

• Continue to provide clinical and professional oversight for care homes, providing expert input and support on issues to support this guidance compassionately and flexibly.
• Support care homes so that, where possible, the needs, preferences and rights of residents and their loved ones are being met, taking into account the ECHR and, where appropriate, the health and social care standards.
• Monitor care homes' adoption of Open with Care, TURAS safety huddle tool and other intelligence, acting to support and remedy care home practices.
• Put in place communication arrangements to notify all stakeholders of changes to local circumstances. Stakeholders include care homes, residents, relatives and friends, professionals and third / independent sector visitors.

Directors of Public Health (DPHs)

• Maintain oversight of the overall local position and provide professional assessment of where visiting cannot safely be supported and risk mitigation.
• Where there is an actual or suspected local outbreak, work with local partners and Incident Management Teams to support decision making around visiting and associated communications to the care home sector and the public.

Chief Social Work Officers

• Promote the health and wellbeing of people living in adult care homes by basing the provision of care and support for people, including arrangements for meaningful contact, on the person's assessed needs and current circumstances. This should be undertaken through the processes of reviewing and monitoring care, and through engagement with the person and their family.
• As part of oversight arrangements, monitor the adoption of visiting policies in care homes to check that the needs and rights of residents are being met.
• Promote the involvement of families and carers/a person who can speak on their behalf, or advocacy services where required, so that the views of people receiving services are being heard.
• Engage with colleagues across the Health and Social Care Partnership to ensure that there is support for families, loved ones and care home residents who are keen to have meaningful contact
• In line with existing responsibilities for adult support and protection, consider the risk of harm to residents from lack of continuing meaningful contact with loved ones.

Care Inspectorate

• Support care homes to adopt visiting plans safely (within care plans), compassionately and flexibly, and taking account of individual needs of residents. Webinars will be run with services to support visiting and a section created on the Care Inspectorate HUB with information to support the reintroduction of visiting for services and share good practice from within the sector to build confidence.
• Continue to include questions about visiting when inspecting, using the health and social care standards
• Gather information from care homes and reporting in all inspection reports, under the most recent Quality Frameworks applicable to care homes, for example Section 7.1 (Wellbeing) - see Annex 2 - Supporting Documents section for document web link
• Continue to provide advice and support to homes so visiting can be resumed safely, compassionately and flexibly. Where the home is not confident to resume visiting, providers may seek further support and input from local oversight arrangements e.g. building confidence to resume visiting.
• Continue to risk assess complaints through the Care Inspectorate's established complaints process.
• Continue to monitor that people have in place person centred care plans that include meaningful contact with loved ones and how this can reasonably be supported by staff.

Scottish Government

• Continue to review and, if needed, update legislation and national advice, e.g. on lockdown restrictions, as the pandemic progresses.
• Provide national advice and guidance around supporting meaningful contact as safely as possible, taking into account emerging scientific evidence from the pandemic, issues of equality and human rights.
• Monitor the adoption of visiting guidance using Safety Huddle Tool returns and other data (e.g. sector feedback).
• Engage with care homes and partners around the implementation of the guidance by way of a series of online webinars to raise awareness and address questions and any concerns in February and March 2021.
• Where it is possible, continue to provide funding for reasonable additional costs incurred as a result of the pandemic including staffing and non-staffing costs associated with facilitating safe visiting. This is in line with the financial support for social care providers guidance, published in December 2020; Coronavirus (COVID-19): financial support arrangements for social care providers - gov.scot (www.gov.scot)
• Provide funding and support for the provision of personal protective equipment (PPE) (extended to June 2021 and under ongoing review) and care home testing.
• Where possible, providing training and support on infection prevention and control as well as the appropriate use of PPE and of testing.