Changes to care home visiting guidance 'coming soon'

[Baker17]

I have just had a meeting with my husband’s social worker, the chess team and a supervisor from his home. The chess team have been called several times because of issues with my husband since the lockdown, these are all new issues and the chess team said that it’s because of not seeing me. The social worker also agreed with this. The supervisor was very black and white with no leeway which even though the meeting was on Teams was very apparent that we were all getting frustrated with her. Anyway I read out some areas of the guidelines and the social worker has gone away to see her legal department as she said there were some cases being brought in the COP. The chess team have asked for several areas of the report to be looked at by the management in order to make visits available and each resident to to be individually assessed.
The latest issue is that my husband is refusing his medication, this is essential because it’s for his heart. The home had phoned the doctor and he said they couldn’t force him. I phoned the doctor and he said to quote “ he’ll have a heart attack” just what I wanted to hear, anyway the home has been told to go back to the doctor and ask to find a way of getting his medication restarted.
I feel like the home don’t want to be bothered with setting up visits. The supervisor said that if I visited in his room it would have be deep cleaned afterwards ( it can be accessed without going into the main body of the home). The chess team said that the room hadn’t been deep cleaned after their visit and contractors are in the home daily along with chiropodist and other health care people so I can’t imagine this ‘deep cleaning’ be possible after all these people visit.
The upshot is the social worker and chess team have gone away to get more evidence to support my right to visit inside and the home have also been tasked to come up with solution to make this happen. There’s to be another meeting the week after next to hopefully plan visiting.

 

[Louise7]

Of course we have had more welcome news since your post about being allowed in care homes but it does concern me that it does seem to still indicate about social distancing as far as I understand it and my mother needs a hug or for me to just touch her hand.

The updated guidance does seem to suggest that in certain cases, and subject to a risk assessment by the care home, there can be 'close contact' between a visitor and resident:

visitors should wear PPE appropriate to the need of their visit. If a visitor is making close personal contact with a resident they may need to wear PPE which goes beyond a face covering

visitors should be encouraged to keep personal interaction with the resident to a minimum, for example avoid skin-to-skin contact (handshake, hug) and follow the latest social-distancing advice for as much of the visit as possible

Under the Coronavirus Act 2020 and associated government guidance, all action taken must comply with the Human Rights Act 1998 and a blanket lockdown in care homes without specific support for enabling family carers to visit could be viewed as a violation of Article 8 ECHR (the right to respect for private and family life, home and correspondence). There is also concern that preventing contact between residents with dementia and their family risks causing distress and, potentially, a risk to life which threatens their rights under Article 2 ECHR the right to a family life.

All public bodies, including government, local authorities and care home providers, have a legal duty to comply with human rights obligations which, in failing to facilitate forms of contact with family carers, they are failing to do.

What if a few of us made a stand by taking court action? Any thoughts?

My thoughts are that as there is not a 'blanket ban' in place in relation to family visits I don't see how a court case against the government for human rights breaches would succeed. The updated guidance makes it ultimately the responsibility of care home managers to make 'operational' decisions in relation to visiting policy at their home(s). If they have risk assessments in place, based on local risks factors such as levels of infection, whether there are any covid cases in the home etc , then I think it would be difficult to challenge something that is in place to protect all of the residents, staff and visitors. You could try putting a case to the home manager explaining the impact that their visiting restrictions are having on your relative and request an individual risk assessment for them. The guidance states that individual risk assessments should consider the following:

the health and wellbeing risks arising from the needs of the cohort of residents in that setting. This will include both whether their needs make them particularly vulnerable to COVID-19 and whether their needs make visits particularly important (for example, people with dementia, a learning disability or autistic people may be permitted visitors when restricting visitors could cause some of the residents to be distressed)

the benefits to a person’s wellbeing by having a particular visitor or visitors

the extent of the harm that will be experienced by the resident from a lack of visitation or whether the individual is at the end of their life

the provisions and needs outlined in the person’s care plan

the level and type of care provided by external visitors and the ability of care home staff to replicate this care

In making these decisions, the care provider should actively involve the resident, their relatives or friends, any advocates, commissioners and appropriate members of the multi-disciplinary team and, where appropriate, volunteers.

It might be worth a try requesting an individual risk assessment (similar to the approach in @Baker17 's post) to see what response you get from the care home manager?

 

[mydiamondmum]

Thank you Louise7, that has clarified things somewhat which as I understand means that it is basically down to the care home.

I think I may arrange for an IMCA to help me with this.

The other thing is, after fighting so hard to get my mother move to a care home near to me, the last thing I want to do is upset the care home or have a bad relationship with them.

I know like so many people in the same situation we are just desperate to hug our loved ones and let them know that they are loved where as visiting with all the PPE on when they no longer have mental capacity to explain why.

This covid thing is just such a horrible thing for all of us, and I suppose right now we just don't have the answers and can only cling on to hope.

 

[Sirena]

@Louise7 yes I agree, there isn't a 'ban' on visiting as such so there is no challenge on that account. The problem is that this -

people with dementia, a learning disability or autistic people may be permitted visitors when restricting visitors could cause some of the residents to be distressed

is all way too late, isn't it. We are four months down the line, if residents were distressed by lack of visitors they have had four months of it, and may well have 'come out the other side', forgotten the existence of their relative, and deteriorated significantly partly due to lack of contact.

I don't understand why garden visits were not permitted much earlier. If you are going to insist on PPE and 2m distancing outdoors, the risks are negligible. Then at least the resident might actually remember the relative. Starting visits that way after 4 months is unlikely to help either resident or relative.

Not to mention the fact that The Dept of Health twitter feed is full of 'anyone can get tested, plenty of capacity, just ask' and yet my mother's CH cannot get the tests required to enable (limited) visiting.

 

[mydiamondmum]

Sirena, I fully agree with your post and what I can't get my head round is that apart from even the key workers who need to be very close and touch my mother for personal care, there is also the receptionists who sit next to her to hold the ipad when we have a skype call. They of course have the temperature test and blood oxygen test when they go in just as I did for the unsuccessful garden visit but I can not sit next to her which would at least give her the comfort of closeness. It does not make sense to me.

 

[granny shoe]

Following Matt Hancock's announcement on 10th July I was so looking forward to getting the new guidance on visiting care homes. I thought that each resident would be allowed one visitor who would be given key worker status. However the new guidance doesn't take us any further forward and only talks about garden visits. It still says that where possible we should be using Facetime etc rather than visiting in person ! I've contacted my husband's social worker and asked for a review of his care as he has deteriorated so much.

 

[Quizbunny]

This is such a difficult area to address. Mums CH have been wonderful during lockdown, arranging lots of activities and themed events which they have photographed and video’d and sent out for us to see. They have now announced the start of being open to visits and have detailed how they will work. An appointment is made for a 30 minute visit where up to 2 visitors will don gloves and masks and go straight into the garden and into a gazebo. Mum would then be escorted into the gazebo by a carer who will stay and ensure that we stay 2 meters apart at all times. Problem is mum does not ever want to go into the garden and would probably need to be dragged out. She also would not know who the PPE’d people were and would likely be extremely arsey.

The problem I have is that as we would be sitting 2 meters apart in the garden why the need for us to wear the masks. From the photos and videos I have seen the carers never seem to wear masks and they are just as likely, more likely actually as I rarely go out, to take the virus into the home. I dont want to get into a disagreement with the manager over this as they have kept mum and the other 13 residents safe through everything, but I also don’t want to cause mum distress and I know that this would. I have decided not to visit at this time and I shall just have to hope that things improve.

 

[granny shoe]

This is such a difficult area to address. Mums CH have been wonderful during lockdown, arranging lots of activities and themed events which they have photographed and video’d and sent out for us to see. They have now announced the start of being open to visits and have detailed how they will work. An appointment is made for a 30 minute visit where up to 2 visitors will don gloves and masks and go straight into the garden and into a gazebo. Mum would then be escorted into the gazebo by a carer who will stay and ensure that we stay 2 meters apart at all times. Problem is mum does not ever want to go into the garden and would probably need to be dragged out. She also would not know who the PPE’d people were and would likely be extremely arsey.

The problem I have is that as we would be sitting 2 meters apart in the garden why the need for us to wear the masks. From the photos and videos I have seen the carers never seem to wear masks and they are just as likely, more likely actually as I rarely go out, to take the virus into the home. I dont want to get into a disagreement with the manager over this as they have kept mum and the other 13 residents safe through everything, but I also don’t want to cause mum distress and I know that this would. I have decided not to visit at this time and I shall just have to hope that things improve.

Agree that best not to upset your Mum. From other posts it seems that a lot of care home residents and their families are finding the garden visits distressing. I don't think that my husband gets anything out of them and I always go home crying.

 

[mydiamondmum]

Quizbunny, my visit with my mother last weeks which was similar to the way you describe was horrible and distressing for her, she was so confused about going into the garden are and me sitting away from her, it was horrible and I won't put her though that again....

I would urge you to contact your MP as I did today and ask them to write to Matt Hancock on your behalf and urge him to grant designated family members key worker status so that we can give them the support they need

 

[granny shoe]

Thanks for that thought My diamond mum. I wrote to my MP on Tuesday to ask where the long awaited guidance on care home visiting was. I'll follow it up with an email about key worker status.

 

[Baker17]

I’ve just had a call from my husband’s care home to say all visits, even window ones are cancelled until further notice due to a Covid spike in our area. It’s at currently 28 per 100,000.
Not the best news I’ve ever had?

 

[lemonbalm]

Sorry to hear that @Baker17 . It feels as though we're not making much progress on the visiting front. I suppose they have to be super cautious. I hope you can get to visit again soon. Look after yourself.

 

[Baker17]

Sorry to hear that @Baker17 . It feels as though we're not making much progress on the visiting front. I suppose they have to be super cautious. I hope you can get to visit again soon. Look after yourself.

@lemombalm thanks for your reply I’ve e mailed the Assistant Director of peoples services to ask why window visits aren’t allowed as I could do this without coming into contact with any staff or residents.

 

[lemonbalm]

@lemombalm thanks for your reply I’ve e mailed the Assistant Director of peoples services to ask why window visits aren’t allowed as I could do this without coming into contact with any staff or residents.

Good luck. I'll keep my fingers crossed for you. There is so much finger crossing at the moment, I'm surprised any of us can type. Keep yourself safe too.

 

[Sarasa]

My mother's care home were just going to allow garden visits when they had another case of Covid 19. I was in two minds whether to attempt to visit for all the reasons everyone has mentioned anyway. What I have done is write to my MP to say how disappointed I am in the latest guidelines. They pretty much sound what the care home has been saying in every communication every since the hope they could open for visits was first mentioned.

 

[northumbrian_k]

Speaking for myself and on behalf of my wife I can say that from what I have seen she has not suffered or been stressed unduly - if at all - by not seeing me for several months. For some weeks now I have been able to visit her in the garden, without PPE and so long as social distancing is maintained. The announcement this week has made no practical difference. We used to go into the garden at times when visiting was normal (pre virus). That and the fact that my expectations were low may have contributed to the feeling that visits like today's have turned out much better than I expected. I sympathise with anyone who feels that their person, or they themselves, is finding the current restrictions particularly difficult. But I understand why the restrictions are in place and my personal responsibility in keeping my wife's home virus free.

 

[Sirena]

For those asking why visitors cannot touch the resident when the carers obviously do so, I assume it is because they want to limit close contact to the people who do the daily care. However any staff making close contact should be wearing a mask and gloves - I know they are at my mother's CH. Staff have to don a mask even when they are merely walking through an area where there are residents.

I agree @Quizbunny that I do not understand why a mask is required if the visitor is 2m away, and outside. The government has said masks are only required indoors when 2m distancing may not be possible.

 

[Baker17]

Speaking for myself and on behalf of my wife I can say that from what I have seen she has not suffered or been stressed unduly - if at all - by not seeing me for several months. For some weeks now I have been able to visit her in the garden, without PPE and so long as social distancing is maintained. The announcement this week has made no practical difference. We used to go into the garden at times when visiting was normal (pre virus). That and the fact that my expectations were low may have contributed to the feeling that visits like today's have turned out much better than I expected. I sympathise with anyone who feels that their person, or they themselves, is finding the current restrictions particularly difficult. But I understand why the restrictions are in place and my personal responsibility in keeping my wife's home virus free.

I was interested that you said no PPE was needed for a garden visit. I asked if I could wear a face visor so as my husband might recognise me, it was met with resounding NO he will be breathing the same air as you. Unfortunately my husband doesn’t understand social distancing and has always greeted me with a big hug so it would distress him to be kept away from me. The chess team have become involved with my husband because of his decline since lockdown.
I wish I was in your situation but sadly I’m not as all homes seem to have used the “guidelines” and adapted them to the individual homes some better than others. Enjoy your visits.

 

[mydiamondmum]

For those asking why visitors cannot touch the resident when the carers obviously do so, I assume it is because they want to limit close contact to the people who do the daily care.

Sirena, my argument is that a loving touch from a close relative is just as important if not more to health,welfare and wellbeing of the resident

 

[Louise7]

I agree @Quizbunny that I do not understand why a mask is required if the visitor is 2m away, and outside. The government has said masks are only required indoors when 2m distancing may not be possible.

The guidance is more stringent for care homes & hospitals due to residents/patients being more at risk if they catch the virus. Care home staff and visitors have to wear masks/face coverings at all times even if able to maintain 2m social distancing. There isn’t a distinction between inside or outdoors, presumably because the garden is still ‘in’ the care home:

https://assets.publishing.service.g...w_to_work_safely_in_care_homes_v5_20_July.pdf

It does seem that individual care homes are doing different things though, as per @northumbrian_k 's post, but within the new visiting guidance the decisions are down to the individual care home manager so there will not be a consistent approach.

The new visiting guidance does include scope for a visitor to wear a visor rather than a face mask/covering in ‘exceptional’ circumstances but there has to be an individual risk assessment in place first: in exceptional circumstances, a very small number of people may have great difficulty in accepting staff or visitors wearing masks or face coverings. The severity, intensity and/or frequency of the behaviours of concern may place them, visitors or the supporting staff at risk of harm. A comprehensive risk assessment for each of these people identifying the specific risks for them and others should be undertaken for the person’s care, and this same risk assessment should be applied for people visiting the person. If visors or clear face coverings are available, they can be considered as part of the risk assessment. Under no circumstances should this assessment be applied to a whole care setting.

Even if relatives could be designated as ‘key workers’ they would still have to wear a mask.