Updated guidance on visiting
In March, we were all worried by the distress and confusion caused to people in care settings when their much-loved visitors suddenly stopped coming. We reminded each other that we must not let this huge breach of residents’ right to a family life become the ‘new normal.’
Now back in lockdown, it feels as if in the summer the country missed the chance to work on loosening restrictions on residents’ enjoyment of what the law calls ‘a private and family life.’ Even in areas where infection rates became very low in the summer, a substantial number of care homes never did dare to allow indoor visits, and also banned residents from having trips out of the care home with relatives, even for a socially distanced walk.
It is undeniable that rights allowed at that time to all other citizens – socially distanced enjoyment of simple pleasures, such as eating with loved ones, or going out for a walk – were often routinely denied to residents of care homes. Unsurprisingly, challenges to these blanket restrictions are increasing, from relatives, care provider organisations, advocates and human rights professionals.
Providers rising to the challenge
It has been, and remains, very hard for providers of residential care to find ways to protect residents and staff from coronavirus brought in from outside while somehow enabling people to continue seeing those they love.
New government guidance on visiting care homes during lockdown stresses that
Receiving visitors is an important part of care home life. Maintaining some opportunities for visiting to take place is critical for supporting the health and wellbeing of residents and their relationships with friends and family.
It highlights the holistic health benefits for people with dementia or other conditions, saying that providers should consider
whether their residents’ 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)… 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.
Minsters have said, on public media, that this guidance is a ‘work in progress.’ I’m glad of this, since some of its suggestions, such as floor-to-ceiling Perspex barriers with microphones, do put me in mind of high security prisons – and others, such as having visitors somehow talk to residents from inside their cars, or making garden visits work in a British winter by using an open-sided gazebo, seem wildly over-optimistic.
Residents learning new skills
The news is definitely not all bad. Many residents of care services understand and appreciate the efforts made to ensure that they stay safe from COVID-19; they enjoy the challenge of being supported by staff to use unfamiliar communication systems such as internet video calling. As one resident aged 92 said,
I miss being with my family but at last I’m able to understand what my younger relatives are on about, and I impress them by calling them on the laptop. I even remember to come off mute, quite as often as they do!
And younger people with learning disabilities are supported, and encouraged, to create virtual groups with friends to chat among themselves – and are not above reminding care staff where necessary that these are private calls and to ‘butt out.’
Providers rising to the challenge
Many providers of care to people living with dementia, learning disabilities or acquired brain injury (ABI) began looking for inventive ways, right from the start, to maximise residents’ contact with those who were central to their happiness and well-being.
The most successful managers ensure that their risk assessments are completely unique for each individual. They take steps to identify those relatives who are shielding themselves from all contacts, either because of their own age or health conditions or simply in the hope of being able to visit; they also identify the one, or maybe two, visitors who come regularly, as recommended by earlier guidance, and even provide simple PPE for them and include them as ‘honorary staff’ for testing. These visitors know they are valued for the irreplaceable care and comfort they give to the person they love and know so well; they understand the need to wear PPE, record their visits and report their health status. It’s a compromise and does not come close to the open-door welcoming atmosphere that care homes have worked so hard to create in the past. But it’s a compromise that works for staff, visitors and residents, especially those who have been most distressed at the lack of visits.
‘Come up and see me, make me smile!’
With respect to Steve Harley and Cockney Rebel, this is what visiting is all about: making both the visitor, and the person they are visiting, smile. The current guidance has some very useful tips towards achieving the best we can during lockdown and periods of high infection rates. We echo their advice to do all you can to keep a good relationship going with your local director of public health (DPH) and clinical commissioning group (CCG) as well as commissioners of services. Use all the testing of staff and residents that is offered; up to date, local knowledge is crucial for making decisions for the individuals in your care. Remember that holistic well-being is impossible without smiles.
Things will improve
These are bleak and stressful times for everyone as winter tightens its grip, and especially for staff doing their best to protect some of the most vulnerable citizens: residents in adult social care. But we seem on the cusp of getting a COVID-19 vaccine that will be prioritised for care staff and residents; testing may soon be easier, cheaper and less invasive. We hope for clearer government guidance that acknowledges ways to balance human rights properly with safety during a pandemic. Until then, applause for all the care home staff who are doing their best to get it right.