On 4 June 2021 the Government updated its guidance for the admission and care of residents in a care home during the coronavirus outbreak. The Government says that this guidance should remain in place during ‘step 3’ on the roadmap out of lockdown, which England is currently in. We have summarised this guidance on our going out and shielding in England page.

We have listed below what should happen when someone is admitted to a care home and once they are living in the home.

1. What needs to happen when someone goes into a care home

• Every person must be tested for coronavirus before they are discharged from hospital or other care setting to a care home. If a person tests positive for coronavirus, they will be discharged to a care setting that has been checked by the Care Quality Commission (CQC) to ensure it provides safe care to coronavirus positive residents.
• From 21 June, if a resident is admitted to a care home from the community, they do not need to isolate on arrival. They will need to take part in an enhanced testing regime including a polymerase chain reaction (PCR) test before admission, a PCR test on the day of admission and a further PCR test 7 days later.
• To minimise risk to other residents, if a resident is admitted to a care home from another care home or from hospital, they will need to isolate for 14 days on arrival. This doesn’t need to happen if they have already isolated for 14 days in another setting. If a resident is admitted part-way through an isolation period, they should complete the remaining isolation period within their own room in the care home.
• Care homes don’t have to admit someone, whether a potential or existing resident, if they have coronavirus and they can’t support them properly during the 14-day isolation period required for positive cases. 
• The guidance recognises that people with a learning disability, autistic people and people experiencing serious mental ill health may experience particular difficulties during the pandemic, such as difficulty in understanding and following advice on social distancing. The Government has worked with the Social Care Institute for Excellence (SCIE) to provide additional guidance for care staff supporting adults with learning disabilities and autistic adults. 
• A small number of people may be discharged from hospital within the 14-day period from the onset of coronavirus symptoms because they need ongoing social care. They will need to have a positive coronavirus test result and will need to be isolated until they complete their isolation period of 14 days. 
• Councils are responsible for ensuring support is available so residents can undertake the 14-day self-isolation period. Nobody should be discharged from hospital to a care home without the involvement of the local council.
• No care home will be forced to admit an existing or new resident if they are unable to cope with the impact of that person’s illness for the duration of the isolation period. If this is the case, a person can isolate for 14-days in another setting. If new residents are admitted part way through an isolation period, they should as a minimum complete the remaining time in the care home.

2. Testing staff and residents in care homes

• If there is no suspected or current coronavirus outbreak, care homes should apply for regular testing for all staff and residents, known as “whole home” testing. This includes weekly testing of all staff on the same day at the same time with a test called a ‘PCR’ test and additional mid-weekly tests called ‘LFD tests.’ Residents should be tested every 28 days with a PCR test.
• All social care workers, including care home staff, can have a coronavirus test at least weekly whether or not they have symptoms. Staff who don’t work in care homes but work for a CQC-registered provider, including home workers, will receive weekly PCR tests to administer at home.
• Any care home resident who shows coronavirus symptoms should be isolated and tested. 
• Symptomatic care home workers and anyone who lives with them can arrange a PCR test at either a regional testing or mobile testing site, or choose to receive a kit in the post by visiting the online self-referral portal.
• Care home residents will be tested prior to a discharge from hospital. 
• Care homes should contact their local Health Protection Team (HPT) as soon as they suspect they have a new coronavirus case, or if it has been 14 days or longer since their last case and they have new cases.
• If a care home has a current coronavirus outbreak, the HPT will organise testing for all residents and staff. If staff develop symptoms, they must not be tested in the care home and should self-isolate and order a test online. It is not recommended to continue asymptomatic testing of residents. All staff should be retested again 28 days after the last resident or member of staff had a positive test result or showed symptoms.
• All family and friends visiting a care home should be tested each time they visit with an LFD test. If they receive a negative result, visits can go ahead as long as they wear appropriate PPE and follow all infection prevention and control measures. You can read more about this on our visits to care homes page.
• Care homes need to ensure that they are following the guidance on how to get social care workers and people in care homes tested.

3. Supporting people in care homes

Government guidance sets out how to keep residents who don’t have coronavirus symptoms safe, and how to monitor people so they can spot potential symptoms. Here’s what care homes should be doing:

• Wherever possible, follow social distancing rules and support people to follow the shielding guidance.
• The guidance recognises that autistic residents or residents with a learning disability may not be able to spot or verbally communicate that they’ve got symptoms. This is why care homes should assess residents twice daily to see if they have developed a high temperature, as well as looking for other signs including not being as alert.
• If a resident in a care home shows symptoms of coronavirus, the care home should:
  • isolate and test the person in a single room with a separate bathroom, where possible. If they’ve got space, they should isolate residents on separate floors or areas of the home
  • monitor the resident’s symptoms every day to make sure they’re not getting worse.
• Care homes also need to follow relevant guidance on the use of PPE, which includes recommendations on providing support to autistic people. To access PPE, care homes which have registered with the Government’s PPE Portal will be able to use this to record what they need. The Government says it is continuing to look at PPE usage so that it can match supply to demand.
• The care home may also need to support staff and residents to receive a coronavirus vaccine. You can read more about this on our vaccines page.
• Additionally, the Government says it is introducing rules by the end of the year that means care staff won’t be able to move between care settings unless it is essential. This is to reduce the risk of transmission across different care settings.

Supporting residents who may need hospital care

• If a resident’s coronavirus symptoms are getting worse, the care home should:
  • speak to a GP and consider the resident’s advance care plan or treatment escalation plan before deciding whether they should go to hospital.
  • speak to the local Primary Care Network of GPs if a resident needs medical treatment unrelated to coronavirus. This is to see whether they need to be treated as soon as possible, or whether treatment can be given virtually or delayed.

It’s important to remember that the Mental Capacity Act 2005 is still in force during the coronavirus outbreak. This means care homes need to complete an assessment of someone’s capacity before decisions about their care are made, for example to bring someone home from hospital or into a care home.

Visits to and out of the care home

We know that lots of autistic people and their families weren’t able to see each other for many months during the first national lockdown, which we raised with the Government as an urgent issue. It’s great that visits have been able to resume, as these are so important for many autistic people and their loved ones. Care home providers have also been given additional funding through the Government’s Infection Control Fund to help make visits happen safely.

Care homes can make the decision about whether to allow family and friends to visit, and under what conditions. They need to work with families and local professionals to balance the benefits of residents seeing their family or friends, against the risk of visitors spreading coronavirus in care homes. This is called a “risk assessment”. It is important that each risk assessment is specific to each individual and their circumstances. Risk assessments shouldn’t be general or apply blanket rules. 

Under the current rules in step 3 on the roadmap out of lockdown, care home residents can name up to five indoor visitors, including an ‘essential care giver’ who can provide close contact support such as washing, eating and dressing. With named indoor visitors who are not an essential care giver, close contact like holding hands is allowed. From 21 June, an essential care giver is also able to visit during any periods of isolation or during a coronavirus outbreak in the care home. Only a maximum of two of these five named visitors will be able to visit at any one time. 

If a resident wants to see more than these five named indoor visitors, they can enjoy outdoor or ‘screened’ visits with other people, with arrangements such as substantial screens, visiting pods or behind windows.

Since 17 May, care home residents have been able to enjoy ‘low-risk’ visits out of the care home, such as to go to GP appointments, day care centre or enjoy a walk in the park or someone’s garden. From 21 June, more outdoor visits, including overnight stays to a resident’s family or friend’s home, will be allowed without the resident needing to isolate for 14 days upon return to the care home. This is something we lobbied government to change. 

You can also go to our page on Helping safe visits happen in care homes in England for further information.

What we’re doing

We’re telling the Government about your experiences of the coronavirus outbreak, so they know what life is like for autistic people and their families. If you want to share your experiences and any worries or concerns you have, do get in touch with us at stories@nas.org.uk.