The United Kingdom’s Adult Social Care Directorate (Department of Health and Social Care) published guidance on admission and care of residents during COVID-19 on the 2nd of April 2020.
Key points:
- Expectation that care homes will admit people discharged from hospital
- Residents and staff isolation guidance continues to be based on symptoms, not on potential contact with people with COVID-19 (see this post for discussion of early evidence on asymptomatic transmission in care homes)
Admission of residents
- Care for individuals with no COVID-19 symptoms or who had tested positive for COVID-19 but are no longer showing symptoms and have completed isolation period, to be provided as normal.
- Hospital Discharge Service and staff to clarify with care homes the status of an individual during the process of transfer. Negative tests are not required prior to transfer/admissions into the care home.
Caring for residents, depending on their COVID-19 status
Care homes admitting a resident who has been discharged with a positive COVID-19 test should be provided with date and result of test, date of onset of symptoms, care plan for discharge.
For the care of asymptomatic residents, care homes should follow social distancing measures for everyone in the care home and the shielding guidance for the extremely vulnerable group. Care home should implement daily monitoring for COVID19 symptoms among residents and care home staff and report immediately to NHS 111 residents with fever or respiratory symptoms.
Residents with COVID-19 symptoms should be isolated promptly in a separate room with a separate bathroom where possible. Staff should immediately instigate full infection control measures.
Staff caring for people with dementia and cognitive impairment should be alert for the presents of other signs of infection such as delirium. There are also guidelines for staff supporting people with learning disabilities and autism.
It is expected that, as testing capacity grows, the government will offer more comprehensive testing to care homes.
Reporting of COVID-19 cases
The local Health Protection Team (HPT) should be informed of two or more suspected cases within a care home, and they will provide advice and support along with local authority to help the care home manage the outbreak.
Providing care after death
The infection control precautions continue to apply whilst an individual who has died remains in the care home and further guidance is provided.
Advice for staff
- Guidance on personal protective equipment that should be worn when caring for possible or confirmed COVID-19 cases. (there is a link to recommended PPE to provide care, however no specific guidance appears to have been developed for use in care homes?)
- Care home staff who come into contact with a COVID-19 resident while not wearing PPE can remain at work, but individual risk assessments should be conducted.
- Only staff who have COVID-19 symptoms are asked to not attend work and self-isolate.
Supporting existing residents that may require hospital care
There is a checklist for staff to consider if they think a resident may need to transferred to hospital for urgent and essential treatment, this involves assessing the resident’s Advance Care Plan/Treatment Escalation Plan and discussion with resident and/or their family or Lasting Power of Attorney to determine if hospitalisation is best course of action.
Support to implement the guidance
A number of resources are provided to help implement the guidance, including:
- checklist of COVID-19 symptoms, definition of COVID-19 cases and contacts,
- advice on isolation and cohorting,
- receiving residents discharged from hospitals,
- infection and control measures,
- information on how to obtain PPE supplies,
- decontamination and cleaning processes,
- advice on communications
- use of a Capacity Tracker to support effective discharge planning and continue care outside of hospitals