Reopening care homes safely

Martin Farran is the Director of Adult Services and Health at Liverpool City Council, which has been committed to supporting the safe reopening of care homes. He explains why visits to care homes are so vital and what must happen as national lockdown restrictions ease.

There have been a wide range of different views on how care homes should be managed during the pandemic.

Understandably, there has been a focus on the science of how we keep residents safe and stop the virus from spreading. But this is only part of the picture. Physical safety from coronavirus needs to be balanced with mental wellbeing. There is a human need for meaningful interaction.

Clearly coronavirus has had a massive impact for the whole of society. But for those with dementia it has been even more difficult. Some people have found it difficult to comprehend what is happening and why. Many people living in care homes have effectively been cut off from their key supporters – family, friends and loved ones.

This lack of contact has had a major psychological impact, reinforcing their isolation and creating its own significant risks.

People with dementia need stimulation and regular contact, particularly from those who know them best. Care home staff do a brilliant job, but they don’t have the shared memories and history which can be so important.

My mum and dementia
This is something I have direct personal experience of, as my mum is 85 and living with early onset dementia.

Mum lives in an extra care scheme and receives four visits a day. These visits are largely to oversee her medication and make sure she is eating and drinking regularly.

But as well as these visits, we as a family provide daily contact. This might be visits to her home or phone calls which are essential to her mental wellbeing.

Liverpool’s approach to care home visits
Understandably care homes have been extremely anxious about the potential transmission of COVID-19. Some homes experienced many more deaths than others, and there didn’t appear to be a straight-forward explanation.

I believe this has had a direct impact on the approach some care homes have adopted to care home visits. Many care home managers have decided that the safest option is simply to cease all visits, irrespective of whether there were cases in the home or surrounding area.

We have provided support to help care homes prevent the spread of the virus, as well as provision and training on effective use of PPE. But we also encourage residential care homes to maintain contact and visiting with family, friends and loved ones. This may be by whatever means are necessary and appropriate – be it iPads, window visits, outdoor pods, indoor pods and floor to ceiling screens.

While there are practical challenges, our belief is that ethically it is in the best interest of care home residents to maintain contact with their loved ones, so long as it is done safely.

Reopening care homes safely
On this basis, and conscious that winter would make outdoor visits no longer viable, we held a focus group discussion to debate the use of lateral flow tests (LFT) to detect coronavirus infection in family visitors. The group included scientists from SAGE and a cross section of care provider and family representatives.

This concluded in Liverpool agreeing to a model adopting the proactive use of two LFTs to support indoor visiting in care homes. This would mean visitors to care homes would still need PPE, but could visit their loved ones without screens.

Twelve care homes agreed to pilot the model, with a view to us rolling it out wider. Unfortunately this had to be put on hold due to the winter national lockdown.
After nearly three very long months, care homes can once again open for meaningful visits from friends and family.

The new guidance means that all care home residents will be able to have a single named visitor and for some, an essential care giver supporting them as well. It is very welcome that this new guidance recognises family carers as integral to care and to be treated similarly to staff.

Going forward, it is essential that enabling care home visits is seen as the default position. So it is really helpful that the Government has clarified blanket bans on visiting are not acceptable.

Road to recovery
As we had prepared for in December, we will be using LFD tests alongside PPE and other infection control measures to make sure that visits can happen safely and minimise the risk. These measures alongside the rollout of vaccines are a game changer.

We will be encouraging and supporting all care homes to follow the guidance and reunite family and friends with their loved ones in care homes.

Restarting meaningful visits to care homes is just the first step for making sure that people affected by dementia in Liverpool recover from the impacts of coronavirus. In the months ahead there will be much more to do to make sure everyone has the support they need.

Social care will have a critical role to play alongside the health system in recovering from this pandemic, just as it has had in getting us through the worst of it.