Questions and answers for visiting care homes

Please note the advice on self-isolation for close contacts has changed. This website is currently updating. Please see here for more information.

General

The Department of Health issued updated visiting guidance for Care Homes on May 4 2021 ‘Visiting with Care – A Pathway’

www.health-ni.gov.uk/sites/default/files/publications/health/doh-visiting-with-care-a-pathway.pdf

The Pathway was developed by the Public Health Agency, working with representatives from the statutory sector, representatives from various relatives’ groups and independent healthcare providers.  It sets out an agreed new approach to supporting safe and proportionate increased visiting in care homes. This includes updated arrangements for the safe management of care home residents receiving visitors, as well as residents being able to visit other households, community facilities and take part in excursions.

The Pathway sets out a graduated approach to ease the visiting restrictions in all Care Homes in Northern Ireland. The application of the Pathway depends upon:

  1. No active outbreak in the care home.
  2. A dynamic risk assessment of the care home to make decisions on the day-today running of visiting.
  3. The provision of a range of visiting options will be in line with the Pathway.

There are four stages in the Pathway and caution is needed so that we can continue to progress safely throughout the four stages.

Guidance took effect on May 7 2021 starting at stage 1 “Cautious First Steps”. It is anticipated there will be 4 weekly cycles of review by Public Health Officials to study a range of data and to inform the recommendation to move to the next stages. The data considered includes evidence on transmission, outbreaks, mortality and vaccination.

Where a care home has concerns around putting the visiting guidance into practice, they can raise issues in a number of ways including contacting the local Trust or contacting the PHA Duty Room.

Table of Contents

  1. 1. How many visitors are allowed in the home at one time?
  2. 2. Do all visitors need to book in advance?
  3. 3. Can visitors attend during mealtimes?
  4. 4. Can Children and young people visit?
  5. 5: What about visiting services such as hairdressers etc.?
  6. 6: Can I visit during the 14-day isolation period for new admissions to care homes?
  7. 7: When can residents leave the care home?
  8. 8. What happens if there is an outbreak in the home?
  9. 9. What about residents who don’t have any visitors?
  10. Location and length of visit
  11. 10. Can I visit in the residents’ bedroom?
  12. 11. Can I visit outdoors within the care home grounds?
  13. 12. How long is a visit?  
  14. 13. Can visitors go to communal areas and participate in activities with the resident?
  15. 14. Do we need to continue with the use of screens and pods?
  16. IPC Compliance
  17. 15. Can a visitor use our toilet facilities?
  18. 16. Can visitors access refreshments
  19. 17. What should visitors wear?
  20. 18. Can we hold hands?  
  21. 19. Can I bring items into the home?
  22. 20. Are there any additional disinfection for COVID-19 infection prevention and control?
  23. 21. What if my visitors have difficulty in understanding IPC advice?
  24. Personal protective equipment (PPE)
  25. 22. Do visitors need to wear PPE?
  26. 23. What about visitors with medical exemptions for face masks?
  27. 24. Can visitors wear clear masks?
  28. Screening
  29. 25. What screening needs to take place when visitors arrive at the home?
  30. Vaccination
  31. 26. Do visitors need to provide proof of vaccination?
  32. 27. Can I visit a resident who has not been vaccinated?
  33. Other
  34. 28. Are there any resources for families?
  35. 29. How can we maintain social distancing and also hold hands?
  36. 30. Is testing available for visitors?
  37. 31. Can I bring my relative into my own home when we are on a trip out of the home?
  38. 32. Do staff and residents still need to be tested?
  39. 33. As restrictions ease for the general public, will they apply to residents?

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1. How many visitors are allowed in the home at one time?

The total number of visitors that the home can support at one time is not limited, as long as staff can support with the practical elements of supporting this safely, e.g. welcoming, and screening.

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2. Do all visitors need to book in advance?

Visits need to be booked in advance so that the volume of people visiting the care home can be manged to enable social distancing in communal areas and walkways. Visits will be available seven days a week as well as evening visiting.

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3. Can visitors attend during mealtimes?

It would be preferable if visitors would avoid mealtimes to enable residents to be supported with eating and drinking. This does not include Care Partners who may be attending to support their individual resident at meal times.

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4. Can Children and young people visit?

Children and young people can visit and will be included in the total number of visitors for the arranged visit. The responsibility will rest with the adult for supervision of the children, ensuring they adhere to all IPC measures as appropriate.

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5: What about visiting services such as hairdressers etc.?

Visiting professionals and service providers such as hairdressers can resume visiting residents. They are not included in the number of visitors for a resident.

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6: Can I visit during the 14-day isolation period for new admissions to care homes?

Health Protection Duty Room will provide advice on specific individual circumstances.

The period of 14 days self-isolation should be observed wherever possible, so visitors would not normally be considered in this period. However, essential visits should be supported sympathetically if they are needed, recognising that the resident will be in an unfamiliar setting and there may be instances where contact with loved ones may be needed, e.g. to alleviate distress.

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7: When can residents leave the care home?

Residents may resume trips out of the home; trips must be in line with Northern Ireland Executive COVID-19 restrictions in place at the time of the trip out (see

www.nidirect.gov.uk/articles/coronavirus-covid-19-regulations-guidance-what-restrictions-mean-you). This should be supported with individual risk assessment and collaboration with the resident and loved ones.

Advice on safer car sharing should be provided: www.publichealth.hscni.net/publications/advice-car-sharing-english-and-translations

Specific advice is provided at Appendix A of the Visiting with Care Guidance  www.health-ni.gov.uk/sites/default/files/publications/health/doh-visiting-with-care-a-pathway.pdf

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8. What happens if there is an outbreak in the home?

In the event of an outbreak in a care home, the home should immediately stop indoor and outward visiting. To note that End of Life visiting and Care Partner arrangements may continue in discussion with the home manager.

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9. What about residents who don’t have any visitors?

There will be people who do not routinely receive visitors either because their family / friends are not close by or they do not have any friends or family .  It will be important for care homes, working with local partners, to consider how best to support meaningful contact for those for whom it may be beneficial. There are a range of ways this can be supported from school children sending cards through to visits from befrienders / volunteers who can be identified as designated visitors. Arrangements that were in place before COVID.19 may be resumed.

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Location and length of visit

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10. Can I visit in the residents’ bedroom?

Residents should be supported to be with loved ones in their own room.

The visit should take place in an area of the room that is clutter free, and visitors are asked to restrict the number of items they handle. Touch points should be cleaned after the visit, there is no need to clean floors following a visit.

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11. Can I visit outdoors within the care home grounds?

Outdoor visits can continue and are included as part of the total visits per week and in line with the number of visitors permitted at each visit. The care home will need to manage outdoor visits in line with general restrictions.

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12. How long is a visit?  

Up to one hour is recommended but care homes should be flexible to meet the individual needs. The ambition of the Visiting with Care- Pathway guidance is to maximise meaningful contact so care homes are asked to be person-centred.

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13. Can visitors go to communal areas and participate in activities with the resident?

Whilst we encourage residents to use communal facilities such as dining rooms and lounges in reduced numbers with physical distancing, we are not at the stage of encouraging visitors to use communal areas where there is more than one resident present.

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14. Do we need to continue with the use of screens and pods?

This is no longer a requirement.

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IPC Compliance

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15. Can a visitor use our toilet facilities?

Care homes are asked, wherever possible, to enable visitors access to dedicated toilet facilities (for visitor use only), and ensure frequent enhanced cleaning is in place (at least hourly) for all surfaces and using a chlorine releasing agent 1000 ppm (bleach). This should include the toilet, sink and frequently touched surfaces like door handles and light switches, but not including floors.

We strongly recommended dedicated toilet facilities, being mindful that some visitors may have personal needs (or disabilities). If it is not possible to have a dedicated toilet for visitors, advise visitors of this before they come to the home. If there is not a designated toilet for visitors and there is an emergency, visitors should use the staff toilet. It should be cleaned as above.

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16. Can visitors access refreshments

Unfortunately, we are not able at this point to recommend that visitors can safely touch or take their mask off to eat or drink. Residents may eat or drink while the visit is taking place.

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17. What should visitors wear?

Visitors with long sleeves should be asked to roll their sleeves up to help support hand hygiene. If their sleeves are too tight to be rolled up, they should still be allowed to visit but advised that, for next time, they should ideally be wearing short sleeves.

Visitors do not need to change clothes upon entry to the home. All visitors should wash their hands on entry to the home and use hand sanitiser on clean hands.

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18. Can we hold hands?  

Touch, including hand holding is permissible in ‘Cautious First Steps’ and brief hugging in ‘Gradual Easing’ with the recommended IPC and hand hygiene.

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19. Can I bring items into the home?

Visitors should be allowed to bring in gifts and residents’ belongings. If the item(s) can be wiped clean, such as books, then do so.

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20. Are there any additional disinfection for COVID-19 infection prevention and control?

Enhanced cleaning is in place across all care homes with increased frequency and The cleaning that is required to be undertaken by care homes is specified in the Regional Infection, Prevention and Control manual www.niinfectioncontrolmanual.net/cleaning-disinfection   

There is no need for care homes to go beyond this. Any further questions on cleaning procedure or products used should be directed to the PHA Duty Room.

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21. What if my visitors have difficulty in understanding IPC advice?

Some visitors to the care home may not be able follow IPC advice for various reasons. For example, it may be difficult to explain the need to social distance to a visitor with learning disabilities or dementia. This takes time for everyone involved so might need to be built in before or during your visiting time.

In some cases it may be appropriate for the visitor to be accompanied by a loved one or carer, this person will be included in the total visitor numbers.

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Personal protective equipment (PPE)

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22. Do visitors need to wear PPE?

Visitors will be asked to wear a fluid resistant surgical mask (FRSM) and these will be provided by the care home to the person visiting. Gloves are not required; however visitors are reminded to restrict their handling of items in the resident’s room. At this present time, aprons still need to be worn. To note the resident and visitor will be able to hold hands for a short period of time. All visitors must have access to handwashing facilities on entrance to the home and should make frequent use of hand sanitiser. Regular testing continues to identify people who are COVID positive cases but who do not have symptoms and we must therefore continue to wear PPE.

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23. What about visitors with medical exemptions for face masks?

Care homes should not stop someone who is medically exempt from wearing a face mask from visiting. In these cases, the visitor should be made aware of the risk they present to the resident and the risk the resident presents to them.

The care home should ensure that the area the visit takes place in has good ventilation, and that two metres physical distance is maintained. We do not generally recommend physical contact in these cases.

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24. Can visitors wear clear masks?

Clear masks are not supplied and do not fit the specification for PPE. However, if a visitor has a single use clear masks they may wear it to support communication. The care home will not supply these.

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Screening

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25. What screening needs to take place when visitors arrive at the home?

The care home may ask screening questions but does not need to take the temperature of visitors. These questions include if the visitor has:

  • new, persistent cough
  • high temperature
  • change in sense of taste or smell
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Vaccination

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26. Do visitors need to provide proof of vaccination?

Vaccination is not compulsory and therefore care homes cannot refuse entry to a visitor who has not been vaccinated. Vaccination is one of a number of safeguards that together allow meaningful contact to resume and we would encourage uptake of vaccination.

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27. Can I visit a resident who has not been vaccinated?

Indoor visiting is now recommended to be supported due to all the layers of protection in place, not just vaccination. These protections include adherence to IPC measures including hand hygiene, and PPE. Therefore residents who have not been vaccinated should still be able to receive indoor visitors.

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Other

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28. Are there any resources for families?

Care homes are asked to support residents’ loved ones with helping them to understand the reasons for the new guidance and the safeguards for visiting.

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29. How can we maintain social distancing and also hold hands?

Social distancing should be maintained as people move through home and avoid unnecessary contact with staff and other residents. Visitors should remain in residents own room for duration of visit and wash hands before and after visit. Visitors are expected to wear a Fluid Resistant Surgical Mask (FRSM) for the duration of their visit. Hand holding is permitted and we would ask that this is for a limited time during the visit and that visitors sit apart from the resident for the majority of the visit to allow for ventilation and air circulation.   

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30. Is testing available for visitors?

Information about new testing initiatives will be released by the Department of Health.

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31. Can I bring my relative into my own home when we are on a trip out of the home?

Trips out should ideally be with one designated visitor in the car and should avoid public indoor spaces. All infection, prevention and control measures should be in place to include hand hygiene, respiratory hygiene, wearing face coverings and social distancing.

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32. Do staff and residents still need to be tested?

Yes, we must continue to maintain our surveillance of COVID-19 and continue with staff and resident testing.  Evidence is still emerging about the effectiveness of the vaccine in reducing transmission of the virus, and until such times as we are advised to stop testing, we must continue to be vigilant with testing, all IPC measures and encouraging uptake of the vaccine.

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33. As restrictions ease for the general public, will they apply to residents?

Yes – your residents on any trip out of the home must follow the guidance that is applicable to the general public including wearing face coverings and social distancing. This also applies to easing of restrictions and the places where they may go.

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