COVID-19 resources on care homes

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Winter discharges: designated settings

Department of Health and Social Care

This letter sets out: an overview of the requirement for designated care settings for people discharged from hospital who have a COVID-19 positive status; and an instruction for local authorities to commence identifying and notifying the Care Quality Commission (CQC) of sufficient local designated accommodation and to work with CQC to assure their compliance with the infection prevention control (IPC) protocol.

Last updated on hub: 22 October 2020

The predictable crisis: why Covid-19 has hit Scotland’s care homes so hard

Common Weal

This paper considers how government in Scotland has managed the Covid-19 crisis, using what has happened at Home Farm Care Home on Skye to illustrate the issues but also, potentially, to point to the way forwards. It argues that much of the Covid-19 disaster in care homes was quite predictable and, as such, represents a failure by both care home providers and the public authorities. It then looks at these failures within the broader context of the development of the care home sector in the last 27 years, with a particular focus on how this has provided for the health of older people. It concludes with some recommendations, both for immediate action and for more fundamental reform of the sector and the role of public authorities within it. Key points include: based on quality ratings at the outset of the crisis more than one quarter of Scotland's care homes (those rated adequate or below) could have been expected to be unable properly to protect older people in the event of a pandemic; the Care Inspectorate, which has few enforcement powers, was incapable of brining care homes up to the standard required by the Covid crisis; the result is that six out of ten care homes in Scotland have had a case of Covid and about 45 per cent still have a current case (as of Monday 18 May); for the first eight weeks of the crisis the Scottish Government was adamant that the providers (and not the Scottish Government) were responsible for protecting care home residents – this effectively represented the privatisation of the responsibility for older people in care during the crisis and restricted adequate access to medical treatment; the repeated updating of guidelines created a confusing impact.

Last updated on hub: 21 October 2020

COVID-19: information and guidance for care home settings (adults and older people)

Health Protection Scotland

This guidance for care homes provides advice about COVID-19 for those working in care home settings for adults and older people. It covers: measures to prevent spread of COVID-19 and protect people at increased risk of severe illness; providing care for residents during COVID-19 pandemic; measures to protect residents in the shielding category; measures for residents exposed to a case of COVID-19; admission of individuals to the care home; testing in the care home; care home placement for symptomatic residents; Personal Protective Equipment (PPE); care equipment; staffing, including staff cohorting and staff testing; visiting care homes; and caring for a resident who has died.

Last updated on hub: 20 October 2020

COVID-19: visiting nursing and residential care homes: summary for family and friend carers

Northern Ireland. Department of Health

Outlines the arrangements for visiting in nursing and residential care homes which apply in line with current regional surge level position (level 4 – high or rising level of transmission). This is subject to change depending on the prevalent rate of transmission and will be reviewed frequently. Local outbreaks of infection in care homes will require an additional specific local response and additional restrictions for visiting in line with Public Health Agency advice for management of the outbreak.

Last updated on hub: 20 October 2020

COVID-19: regional principles for visiting in care settings in Northern Ireland

Northern Ireland. Department of Health

During this COVID-19 pandemic, normal hospital, hospice and care home visiting arrangements were suspended with key exceptions. This document follows a review of the restrictions and outlines the principles for visiting which applies to the following; Health and Social Care (HSC) Trust and Independent hospital inpatient and outpatient services, maternity services, hospices, care homes, mental health and learning disability hospital inpatient services, children’s hospital services, for the duration for the COVID-19 pandemic. The principles include: anyone showing or experiencing the symptoms of COVID-19 or any other infection should not visit, even if these symptoms are mild and unconfirmed; all people visiting/attending health and social care settings will be required to wear face coverings for the foreseeable future; and children under the age of 13 and others listed in the face covering guidance are exempt from wearing a face covering.

Last updated on hub: 20 October 2020

Infection prevention and control in care homes

Care Quality Commission

A set of questions and prompts used by CQC inspectors to assess how well staff and residents of care homes are protected by infection prevention and control, including checks for COVID-19 mitigation.

Last updated on hub: 20 October 2020

Increased risk of SARS-CoV-2 infection in staff working across different care homes: enhanced CoVID-19 outbreak investigations in London care Homes

Journal of Infection

Background: Care homes have been disproportionately affected by the COVID-19 pandemic and continue to suffer large outbreaks even when community infection rates are declining, thus representing important pockets of transmission. We assessed occupational risk factors for SARS-CoV-2 infection among staff in six care homes experiencing a COVID-19 outbreak during the peak of the pandemic in London, England. Methods: Care home staff were tested for SARS-COV-2 infection by RT-PCR and asked to report any symptoms, their contact with residents and if they worked in different care homes. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. Results: In total, 53 (21%) of 254 staff were SARS-CoV-2 positive but only 12/53 (23%) were symptomatic. Among staff working in a single care home, SARS-CoV-2 positivity was 15% (2/13), 16% (7/45) and 18% (30/169) in those reporting no, occasional and regular contact with residents. In contrast, staff working across different care homes (14/27, 52%) had a 3.0-fold (95% CI, 1.9–4.8; P<0.001) higher risk of SARS-CoV-2 positivity than staff working in single care homes (39/227, 17%). WGS identified SARS-CoV-2 clusters involving staff only, including some that included staff working across different care homes. Conclusions: SARS-CoV-2 positivity was significantly higher among staff working across different care homes than those who were working in the same care home. We found local clusters of SARS-CoV-2 infection between staff only, including those with minimal resident contact. Infection control should be extended for all contact, including those between staff, whilst on care home premises.

Last updated on hub: 19 October 2020

Coronavirus: adult social care key issues and sources

House of Commons Library

An overview of key issues facing the adult social care sector during the coronavirus (Covid-19) outbreak, including links to some of the key official guidance for the sector. Section one of this briefing provides a high-level overview of policy in relation to adult social care since the start of the coronavirus outbreak in early 2020, including the development of key UK Government guidance. The second section provides more detailed information on some key issues that have been raised during the course of the outbreak, including: statistics on deaths in care homes; funding for adult social care, including the financial pressures on social care providers; testing for care home staff and residents; the discharging of patients from hospital into care homes; rules relating to visiting care homes for friends and family of residents; and the supply of PPE to the adult social care sector.

Last updated on hub: 12 October 2020

Limiting staff movement and cohorting of residents to reduce the transmission of Covid-19 in care homes: a rapid review

Public Health England

Findings from a review of the evidence to examine the effectiveness of strategies to restrict staff movement and isolate groups of residents showing symptoms of Covid-19 (‘cohorting’) in reducing the transmission of the virus. The review found low-level evidence from three Covid-19 outbreaks in North America suggesting that restricting staff movement and cohorting of residents could help to reduce the transmission of Covid-19 within care homes. To fully understand the effectiveness of these two types of intervention in relation to Covid-19, more high-quality research is needed. Indirect evidence from the management of influenza and other outbreaks in care home settings may help to supplement understanding of effectiveness.

Last updated on hub: 12 October 2020

LESS COVID-19: Learning by Experience and Supporting the Care Home Sector during the COVID-19 pandemic: key lessons learnt, so far, by frontline care home and NHS staff

National Care Forum

This report sets out findings of a research study to capture the experiences of frontline care home and NHS staff caring for older people with COVID-19 and to share the lessons learnt about the presentation, trajectories, and management of the infection with care homes that have and have not yet experienced the virus. The research comprised two phases: interviews with frontline care home and NHS staff in June and July (n=35); and consultation with senior operational and quality managers in care homes in September (n=11). The findings are presented under the following themes: clinical presentation – COVID-19 does not always present as a cough and fever in older people; unpredictable illness trajectory; managing symptoms and providing supportive care; recovery and rehabilitation – promoting physical, cognitive and emotional well-being post-virus; end of life care; infection prevention and control; and promoting partnership through cross sector working and support. The research highlights the value of ongoing reflective learning and the importance of sharing collective expertise in care and in practice. However, it also reveals systemic issues associated with underfunding, limited integration across health and social care and a lack of wider recognition and value of the contribution of the care home sector and (importantly) its staff. The report concludes with a call to action, stressing the importance of sharing collective expertise, expanding the use of digital technology, and formally recognising and supporting care home staff. It also calls on the Government to ensure policy making, guidance, effective resourcing (including PPE), and plans for action are created in equal partnership with the care sector; to invest in the care sector to enable better reward and recognition of the care workforce; and to improve the testing capacity for social care to cover all care settings, including day services.

Last updated on hub: 08 October 2020

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