Open with Care – supporting people in adult care homes to have meaningful contact with others: progress report

Reflections and recommendations

Huge progress has been made since February with resuming residents' meaningful contact and activities in and away from the home. There has been a consistent and sustained increase in support to indoor visiting. By late March, over 90 per cent of care homes supported contact for residents indoors and this increase has continued, to 97 per cent as at 14 June. At the same time, the number of confirmed COVID-19 outbreaks in care homes has fallen.

This progress is to be commended and reflects the significant efforts by care homes and partners to help it to happen. Continued progress to normalise residents' meaningful contact is important and timely. It is an important first of several steps to support all residents to have not just good quality contact with loved ones, but also to have meaningful lives - throughout the remainder of pandemic and beyond.

A number of recommendations are made to supporting the meaningful contact that people would like. These have been developed with input from the Open with Care Oversight Group.

Recommendations

Continued national and local action will support meaningful contact to become the norm. This action should focus on:

• a. Care homes improving, maximising and embedding meaningful contact.
• b. Local system support and monitoring to maximise contact.
• c. Strengthening awareness and adoption of Open with Care.

a. Care Homes improving, maximising and embedding meaningful contact

The need to balance the risks of harm from COVID-19 and from ongoing isolation or restrictions continues. With the multiple layers of protection in place care homes should always promote and sustain meaningful contact, including essential visits. The wellbeing of the individual is central to all decision making about visiting and people going out of the home. On this basis, blanket decisions to restrict or prevent visiting or people leaving the home should be resisted and considered as a last resort.

The starting point for the reintroduction of indoor visiting in March 2021 was at least two indoor visits per week. Care homes should now move rapidly, with support from local oversight arrangements where necessary, to increase the frequency, duration and number of indoor and other visits with the fewest appropriate restrictions. Local oversight arrangements have a crucial role in supporting care homes to confidently and assuredly make these decisions, and in challenging care homes where progress cannot be evidenced.

Care home providers should continue to implement Open with Care, reviewing their visiting policies and practices to ensure they promote meaningful contact.

This involves continued action to improve, increase and embed support to person centred contact. Specific areas are around increasing the frequency and number of visits, where residents so wish, and reducing restrictive or inflexible approaches, in areas such as time, touch and trust.

Scottish Government is actively pursuing the option of increasing flexibility and local discretion around location of visitor testing, including testing at home, to remove any barriers to increasing the frequency or number of people visiting.

b. Local system support and monitoring to maximise contact

Continued local support to care homes remains crucial. Local oversight, including the Care Inspectorate, will continue to have a key role in building confidence and continuing improvements to practice. The oversight groups and Care Inspectorate will continue to do this by:

• Supporting care homes to fully implement the content and ethos of Open with Care, increasing the frequency, duration and number of visitors, where residents so wish.
• Empowering care homes through mentoring and wraparound support.
• Providing intensive support, where there is greater hesitancy.
• Working with care homes to align visiting policy and practice, taking appropriate action if and as necessary.
• Using Turas returns to inform regular conversations and support with care homes around visiting policies and practice and appropriate increases to the flexibility, frequency and quality of visits, alongside continued and holistic support to essential visits.
• Continuing to support and strengthen local learning and improvement, and sharing examples of good practice.
• The Care Inspectorate continues to advise and support family/friends, where there are visiting concerns.

National monitoring of progress will also continue, on both increasing indoor contact and activities away from the care home. As part of this the national Open with Care Short Life Oversight Group will meet further over the coming months as changes are fully implemented and to consider any remaining issues and actions.

c. Strengthening awareness and adoption of Open with Care

It remains a key priority that all partners communicate and publicise visiting guidance and resources accessibly, including dedicated information for residents, family and friends. This is to support increased awareness and confidence, for care homes as well as residents, family and friends, around resuming contact and activities and the COVID-19 protections in place.

The Care Inspectorate, Social Work Scotland and other partners will shortly be issuing a joint statement to services on the implementation of guidance and opening up of care homes, including advice on where to access support if there are any concerns around implementing Open with Care.

National work is underway on additional information support for residents and relatives. Scottish Government will publish easy read guidance on visiting in and away from the care home. The Care Inspectorate will work to support communication with relatives and to reach a wider audience. They have also updated their information on NHS Inform to ensure relatives know they can come for advice and that the Care Inspectorate will not share their details with the service without their consent. Current public-facing advice is available on www.nhsinform/openwithcare.

Visiting guidance is now longer term and intended to be the norm. This provides stability and scope for tailored local delivery, taking account of individual needs and preferences, and wider conditions. Any further advice is anticipated to build and develop Open with Care rather than change or reverse it. Greater confidence, knowledge and understanding of the guidance needs to be promoted, including the scope for local decisions while maintaining compliance with Open with Care principles.

The Care Inspectorate will provide a series of webinars around implementation and practical advice and guidance around visiting well. These will illustrate how the Health and Social Care standards can be met through Open with Care, incorporating learning from the pandemic. They will also provide clear guidance for services on what must be in place to ensure people have meaningful contact with loved ones taking account of human rights and the Health and Social Care Standards.