The Government updated its guidance for supported living services in England on 30 March. This sets out how services should plan and prepare in the context of the coronavirus pandemic to provide the best possible support to people who use their service. These procedures may need to be updated to reflect changes in general government guidance over the coming weeks and months. 

The Government says its guidance is primarily for supported living services, but many of the principles may be applicable to extra care housing for older people, as well as the wider supported housing sector such as retirement or sheltered housing. The Government recognises that in many instances, management in these services will have responsibility for developing local procedures and working with the people being supported, as well as their families, GPs, support groups and care/support providers, to ensure that individual plans are in place to protect wellbeing.

Using the Government’s guidance for supported living services, we have set out some key information for providers: 

1. Steps that supported living providers and local authorities can take to maintain service delivery

Supported living providers and local authorities are advised to follow these steps to keep services running smoothly:

• Making a list of who is providing support to people in supported living, including paid staff and carers and whether they are shielding if they choose to/self-isolating, considering whether they can still give support in emergency situations. 
• Ensuring that lists of people in supported living are up to date and establishing the levels of formal and informal care and support available.
• Creating business continuity plans to help manage in emergency situations. These should be kept up-to-date and key details might include who provides care, how and where care and support plans are located, requirements for any specialist care and/or long-term conditions and key contacts coordinating care from other community-based services such as mental health or learning disabilities and family member.
• Supporting individuals to draw up a contingency plan with their care provider/s and any unpaid carers that can be put in place if they contract coronavirus or if there is an impact on care delivery due to the pandemic. Contingency details should also include information about the person’s modes of communication and their likely reaction to changes in routine or unfamiliar carers. The Government recognises that it’s especially important to ensure risk management plans are updated for people who may find a change in routine challenging, including autistic people. 
• Looking at people’s support plans, including making a note of key contacts who are coordinating residents needs for specialist care or any long-term conditions they have, as well as identifying people who are clinically extremely vulnerable. For example, if somebody is choosing to continue to shield, they may want to remain in their current home if they can be supported.
• Maintaining oversight of people who are self-isolating and noting the arrangements that local authorities, CCGs and NHS 111 are putting in place to refer people self-isolating at home to volunteers who can offer practical and emotional support.
• Working with local authorities to facilitate mutual aid, care and support plans across their areas to inform planning ahead of a possible coronavirus outbreak. Resources can be found on the Local Government Association website.
• Identifying people who use direct payments or who fund their own support and helping them establish the levels of support available from other providers or individuals by working with local authorities.
• Identifying people who are clinically extremely vulnerable and working with their or their advocates to explain issues related to guidance and making a joint decision on how they will be supported.
• Avoiding or reducing the sharing of staff between settings to reduce the potential spread of coronavirus.
• Looking at guidance around risk assessment, risk reduction and local implementation.

2. General infection prevention and control

Providers should also make sure to protect residents and staff from coronavirus. These are the things they should do:

• Support staff who are shielding to follow the Government’s guidance on shielding and protecting clinically extremely vulnerable people from coronavirus.
• Avoid staff going between services to stop the spread of the virus. 
• Make sure residents are social distancing by staying two metres apart as much as they can, and self-isolate people who are showing signs of coronavirus. Staff also need to stay at least two metres away from the person they’re supporting if they can, and help residents to make sure they’re washing their hands and stopping the virus from spreading.
• If social distancing isn’t possible due to having to provide personal care, or if the person has behaviours and needs which make this difficult, then PPE might be needed.
• Staff providing care for autistic people and people with learning disabilities are asked to make sure that the people they support are aware of the key behaviours needed to follow infection prevention, as much as they can. Staff should consider how the person they are supporting is most likely to understand the information and use the most appropriate communication techniques.
• Any individual moving into a supported living home should be supported as if they could have the coronavirus, i.e. they need to be isolated for 14 days, even if they have tested negative for the virus. 
• All supported living staff and household members showing coronavirus symptoms can get a test. If a staff member or a member of their household tests positive they should stay home and isolate for 10 days. If staff, or a member of their household shows signs of coronavirus both should stay at home, self-isolate and order a test. If they then test positive, they should continue to stay at home and isolate for 10 days after the date of their test.
• If a staff member starts showing symptoms at work, they should immediately put on a surgical mask and go home.
• The guidance says staff need to bear in mind it might be harder to spot whether an autistic person might have coronavirus, especially if they’re not able to verbally communicate what they’re feeling. 
• Staff need to support autistic people who find it hard to self-isolate because of the change to routine. 

3. Visits in and out of supported living settings

Supported living providers should seek to support and facilitate the opportunity to enjoy visits in and out of supported living based on risk assessments which consider the individual needs of the people who live there. Visits should be supported and enabled wherever it is safe to do so. There is no expectation on people to self-isolate for 14 days after a visit out of the setting, unless they develop symptoms, test positive for coronavirus, or have been identified as being in contact with someone who has tested positive.

Following national restrictions

Some of the rules on what you can and cannot do during the national ‘lockdown’ changed on 29 March. People in supported living and extra care settings, and those wishing to take part in visits with them, must follow any national restrictions in effect at the time of the visit. You can read more about what the rules are on our going out in England page.

From 29 March people can meet outdoors, including in private gardens, with up to six people who are not in their household or support bubble, or more if including two households. This would allow someone to meet with others in a communal garden or outdoor space in the supported living setting, or an outdoor public space outside of the setting.

Many people living in a supported living setting will be able to form a support bubble. For example, a single person household could form a bubble with another household, such as parents or family, and receive visitors indoors at the setting or make a visit to the family home, including overnight. You should follow the national guidance on support bubbles and meeting others.

Setting visiting policies

In all cases, arrangements for visiting into and out of the care setting should by supported by a risk assessment for the overall setting, as well as an individualised assessment of the benefits of visiting and the risks to particular people because of their care and support needs.

Providers need to work with the people they support and their families to identify what works best for an individual. They should refer to the guidance on staying alert and safe social distancing. If the person is assessed as not having capacity in relation to this decision, the provider should work within the appropriate Mental Capacity Act framework to establish that a visit is in someone’s best interests. If a resident wants a visit (and has capacity to make decisions by themselves), the provider should:

• inform them about the safest ways to have visitors
• look at the risks of spreading the virus in the individual setting
• support the person to make decisions about visitors. 

It will also be important to consider the risks to visitors themselves during a visit to a supported living setting and anyone they may later be in contact with, and to follow these guidelines:

• If someone has symptoms of coronavirus, no one should visit, or have visitors. Equally, if a person is self-isolating, they should not have visitors, or visit anyone.
• Numbers of visitors should be limited to the current guidance on group meetings, and consideration given to staggering visits or other options for limiting simultaneous visits. 
• If possible, visits should happen in communal garden areas, and people should still stay two metres apart from one another. If this isn’t possible, providers can support people to find other outside spaces to meet one another in line with social distancing rules. 
• If there isn’t a communal garden area, then visitors should see the person in their own room and should be asked to wash their hands for at least 20 seconds on entering and leaving the accommodation. 
• PPE is not a requirement but can be used to mitigate risk. For some this will be difficult as it can cause anxiety or distress to the people they’re supporting. Visitors should try and avoid things like hugs or close interaction with the person they are visiting and stay socially distanced for as much of the visit as possible.

People shouldn’t meet in groups larger than six outdoors, and more than two households indoors. Providers might suggest staggering visits to make sure everyone can stay socially distanced.

• Visitors should try and avoid contact with other people who live in the home, including with staff. Where needed, conversations with staff can be arranged over the phone following an in-person visit.

For visits taking place away from the setting, such as at the family home, the supported living setting should consider:

• Offering support so people can find or go to outside spaces to see their relative in a safer environment in line with current social distancing rules.
• The nature and context of the visit – for example, whether the visit would include overnight stays in the family home or visits to public places.
• Those returning from off-site visits must self-isolate if they develop symptoms, test positive for coronavirus, or have been identified as being in contact with someone who has tested positive for coronavirus. 
• There is no expectation for someone to self-isolate for 14 days after a visit has happened if none of the above has happened.
• Visitor testing can be used, but is not a requirement.

4. Testing

• Testing is one tool that can help mitigate the risks of visiting. However, testing is not a requirement for visiting and managers should not refuse visits to visitors who have not taken a test unless they are symptomatic or should be self-isolating for another reason (for example if they have been in contact with someone who has tested positive).
• The Government recommends that visitors participate in on the door testing if they can, to reduce the risk of infection.
• All supported living providers who are currently eligible for staff testing have been able to access rapid lateral flow tests (LFTs) since 25 March for the purpose of supporting safer visits. Managers can place an order for tests from the test kit ordering portal, and each setting will receive four test kits per person per week which can be used to support both visits in and visits out. You can read more about this in the guidance for how adult social care services can carry out LFD tests on site.
• Visitor testing if it happens must be conducted by a trained member of staff and visitors cannot take tests home to self-test. If a setting can’t conduct all testing on sit, visitors can be asked to attend an asymptomatic rapid LFT testing site on the day of their visit.
• If they want to, providers can set up their own testing areas with clinical guidance. 
• If a visitor tests positive they must immediately leave the premises to go home and self-isolate, avoiding public transport wherever possible. They should then complete a confirmatory polymerase chain reaction (PCR) test which should be provided by the supported living setting. 
• Visitors who have recently tested positive should not be retested within 90 days unless they develop new symptoms. 
• Some providers may decide to use their additional rapid lateral flow testing allocation to test the person being supported. There is guidance for the testing service for extra care and supported living settings. However, this is down to the manager and must only be done with the consent of the person being supported or their advocates if needed.
• Rapid lateral flow testing should not, however, be seen as a condition of people in supported living being allowed to take part in visits in and out of the setting.
• Providers might also decide to test people living in high risk settings with rapid lateral flow tests if they often leave the setting to meet or visit people. This is similar to testing for people who are unable to work from home who can access twice weekly lateral flow testing from their local asymptomatic testing site. In supported living this can be done on site, assisted by a staff member.
• For people who lack the capacity to consent to testing for themselves, including people being supported who may have developed symptoms, the principles underpinning the Mental Capacity Act (2005) should be followed. 
• Autistic people may need support in keeping isolated from the people with whom they share facilities if they develop symptoms or are confirmed as positive. If isolation is not possible within the service, then appropriate alternative community provision may be explored as an option. This needs to be discussed with the individual and family members where appropriate. 
• All supported living staff displaying coronavirus symptoms can access a test. If you are a member of staff and need a test because you are symptomatic, you should self-isolate for at least 10 days from when symptoms started and get tested.
• Anyone experiencing coronavirus symptoms can be tested, including people receiving care and support. This can be accessed through the digital portal or via NHS 111 service to book testing. 

Testing for patients and discharge from hospital into the community

• Any individual moving into a supported living setting should be supported as if they were possibly coronavirus-positive until a 10-day period has passed, even if they test negative. This should increase to 14 days based on a risk assessment if the setting is considered high risk.
• All people receiving hospital care will be tested for coronavirus. Supported living settings should put support plans in place to maintain a supportive and planned transfer and discuss this with the person being discharged and family and care providers where appropriate.
• For autistic people and/or people with learning disabilities, it will be really important to make sure they and their families understand why these arrangements are needed, what they will look like and how long they will go on for. It’s important to ask how they feel about this and what, if anything, could make it easier for them. 
• If the person being discharged, or anyone they share their home with, lacks capacity to understand information about these arrangements then the Mental Capacity Act should be followed. All steps should also be taken to support the person to understand information, which may include using accessible formats such as easy read or having the support of someone who knows them well to communicate information.

What we’re doing

We are telling the Government about your experiences of the coronavirus outbreak so it knows what life is like for autistic people and their families. If you want to share your experiences with us, or any worries or concerns you have, please send an email to stories@nas.org.uk.

Find out more about what help and support is available.