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Visiting: the dilemma faced by care homes

Care homes are facing increasing anger as they continue to follow a policy that prohibits visiting of residents, by their relatives. A parliamentary human rights committee has called on ministers to legislate against blanket bans on care home visits in England that relatives claim are causing deaths through loneliness and isolation.

Harriet Harman, the chair of the cross-party joint human rights committee of MPs and peers, has asked the health secretary, Matt Hancock, to require care homes to allow face-to-face visits – including without screens – unless an individual safety assessment judges it unsafe.

It comes amid rising anger among relatives as many care homes remain shut to all but end-of-life visits in an attempt to keep out new fast-spreading Covid variants. This is despite government guidance that they should set visiting policy “on the basis of a dynamic risk assessment taking into consideration the needs of individuals within their home”. Relatives claim that a designated visitor, regularly tested, adds no more risk than a care worker and provides vital support.

Dynamic risk assessment

The Department of Health and Social Care in their latest guidance published 11 January 2021 requires providers to develop a dynamic risk assessment to help them decide how to provide the visiting opportunities outlined in this guidance, in a way that takes account of the individual needs of their residents, and the physical and other features unique to the care home.

This dynamic risk assessment should consider relevant factors relating to the rights and wellbeing of the residents. It may be appropriate or necessary for providers to apply different rules for different residents or categories of resident, based on an assessment of risk of contracting COVID-19 in relation to such residents, as well as the potential benefits of visits to them.

How other countries are dealing with the issue

In a letter to Hancock, Harman said: “We urge you to look at how other countries are tackling this, such as Canada, where in Ontario they have changed the law to allow access to care homes for a relative who is a designated caregiver, provided they test negative before each visit.”

Diane Mayhew, a co-founder of the Rights for Residents campaign group, which is backing the move, said that with some care homes even banning window visits relatives are in mental anguish and that there is no risk-free solution.

“They are posting (on Facebook) they can’t sleep, they are not eating properly, and they are thinking about the guilt they feel,” she said.

A government spokesperson said: “We know visits to care homes are crucial in supporting the health and wellbeing of residents, which is why we have updated guidance to ensure visits can continue to take place safely during periods of national lockdown.

“The government is looking to ensure that a wider range of visiting arrangements are made available for care home residents when it is safe to do so.”

Finding the right balance

DHSC are emphasising visiting as a central part of care home life. It is crucially important for maintaining health and wellbeing and quality of life for residents. Visiting is also vital for family and friends to maintain contact and life-long relationships with their loved ones and contribute to their support and care (often as essential carers).

At the same time the Government recognises that by welcoming people into care homes from the community inevitably brings infection risk. But that is a risk that care homes can mitigate. It is a risk that should be balanced against the importance of visiting and the benefits it brings to care home residents and their families.

DHSC state that visiting should be supported and enabled wherever it is possible to do so safely – in line with the guidance and within a care home environment that takes proportionate steps to manage risks.

This means finding the right balance between the benefits of visiting on wellbeing and quality of life, and the risk of transmission of COVID-19 to social care staff and clinically vulnerable residents.

Summary

Many families are distraught about not being able to visit their loved ones which is causing immeasurable mental health issues and loss in quality of life. There are few of us who have not criticised this government for the restrictions they have imposed on us and the control they have over our lives. Providers must not be seen to be adopting a similar position.

Care home providers need to find a way through dynamic assessment, testing of visitors before they enter a home and organisation of the environment that will safely enable relatives to visit and restore their resident’s quality of life.

Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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