Helping safe visits happen in and out of care homes in England
The Government has produced new guidance to help people who live in care homes in England have visits from their family and friends and enjoy outward visits to another household. We know just how important it is for so many autistic people to be able to enjoy visits with their loved ones and worked hard to get the Government to allow them again.
From 19 July, every resident in a care home is allowed any number of named regular indoor visitors, as long as they follow safety measures. There is also no limit on the number of visitors who can take part in an indoor visit on a given day. During these visits, people are allowed to hold hands or hug as long as visitors are tested for coronavirus and wear Personal Protection Equipment (PPE). You can read more about these visits below.
If there is a coronavirus outbreak in a care home, no visits will be allowed except in exceptional circumstances such as end of life or for visits made by an essential care giver, who is someone who provides necessary close contact care to the resident. Every care home resident is allowed to have one named person as their essential care giver.
We have summarised the Government’s guidance for visiting care homes. There is separate guidance for people in supported living and you can read more about this on our supported living page.
The Government says that care homes (also called “residential care”) should make their own decisions and a visiting policy and balance the risk of infection against the importance of visiting and the benefits it brings to care home residents and their families. This is called a “risk assessment.” Care homes should support and enable visits to take place wherever it can be done safely, in a care home which takes steps to manage risks.
This means care homes can have different rules about visiting for different residents, based on people’s different needs and health. For example, if someone is really vulnerable to getting very ill from coronavirus, they might not be able to have a visitor. Residents and their families or friends should be involved in discussions about visiting and social workers can assist with individual risk assessments too.
Anyone who wants to visit will need to arrange this with the care home in advance. They should understand that the care home may have its own policies in place to control the risk of infection. You can read the Government guidance for more information.
What are the rules for visiting people in care homes?
Every care home will have its own visiting policy. The Government currently recommends however that visitors should stick to the following rules:
Indoor visits
- Care home residents are allowed to have any number of regular indoor visitors, (including their essential care giver if they have one) and residents will have the opportunity to name these individuals and agree it with the care home. While there are no limits on numbers of visitors, it is still important that these visitors be named in advance so they can be tested for coronavirus when they arrive.
- A resident can have any number of named visitors on any given day.
- If there is a coronavirus outbreak in the care home, only the resident’s essential care giver can visit. A different named visitor can only visit in exceptional circumstances such as end of life. Every resident can nominate one essential care giver to provide additional support during visits, such as helping with things that require close contact like washing, dressing or eating. The essential care giver is intended to be someone who has a unique personal relationship with the resident. They will have access to the same PPE and testing supply as care home workers and should be allowed to continue to visit during periods of isolation or if there is a coronavirus outbreak. We advise you to talk to staff in the care home if this applies to you.
- If a resident lacks the capacity to make a decision about who their visitors or essential care giver will be, the care home should discuss the situation with the resident’s family, friends and others who may have ordinarily visited. A person can only be nominated to be one of their visitors if it is in the resident’s best interests in accordance with the Mental Capacity Act.
- This scheme allows the individual visitors to hold hands indoors with their relative or loved one in a care home, and make repeat visits under conditions that keep residents, staff and visitors safe.
- Each visitor must have a lateral flow coronavirus (LFD) test, before visiting someone in a care home. They do not have to take the test at the care home, although this is preferred. They can instead provide evidence of a recent negative test taken the same day at home or at another lateral flow site such as an asymptomatic testing site. Care homes are unable to give packs of tests to visitors, but these can be ordered on the Gov.uk website. If a visitor tests positive at the care home, they must immediately go home, self-isolate and take a confirmatory polymerase chain reaction (PCR) test which should be provided by the care home.
- Visitors will also need to wear PPE during each visit and avoid contact that is closer than holding hands or hugging briefly. If wearing PPE such as a face covering would cause distress or communication issues for the visitor or resident, they should speak to the individual care home about its approach. Removing a face covering or wearing a clear mask or visor may be allowed.
- Neither the visitor or the resident has to have had the coronavirus vaccine for visits to happen.
- It is recommended that the care home has a simple booking or appointments system, or that visitors call ahead to arrange your visit. Ad hoc or unannounced visits are not allowed.
- Outdoor, pod and screened visits can continue if residents or visitors would prefer.
- Outdoor and screened visits
- Outdoor, pod and screen visits continue and can take in place in most cases.
- Every visitor must have a negative coronavirus test result before each visit and provide evidence of this to the care home if not taking their test at the care home. All visitors should be screened for symptoms of acute respiratory infection before entering and nobody who is currently experiencing, or first experienced, symptoms in the last 10 days should be allowed to visit.
- There is no limit on the number of visitors who can visit the care home on any given day. All visits must be booked in advance and cannot happen on an ad-hoc basis. Read more about the current ‘lockdown’ restrictions on our Going out in England page.
- General guidance for all visits
- Visitors should be given support on how to prepare for a visit and given tips on how to communicate while wearing a face covering, if they need to wear one.
- Visits in exceptional circumstances including end of life should always be enabled, but should be made as safe as possible including with the appropriate infection prevention control measures. Care homes should not ban visits in these circumstances. Families and residents should be supported to plan end of life visiting more deliberately, with the assumption that visiting will be able to happen not just towards the very end of life. Visits of this nature should be tested using supplied lateral flow devices (LFD). You can read more information about this in the Care home LFD testing of visitors guidance.
- No visits can take place if the care home experiences a coronavirus outbreak, unless the visitor is an essential care giver or there are exceptional circumstances such as end of life. Families and residents should be able to plan for this, as above. Visitors should also be supervised by care staff at all times to ensure that social distancing and infection prevention and control measures are followed.
- If there is an outbreak, coronavirus testing of all staff and residents will take place 14 days after the last positive result in the outbreak. This was previously set at 28 days. If the testing shows negative results after 14 days, the restrictions on visits can be removed. This means that visits will only pause for a minimum of 14 days rather than 28 days following an outbreak.
- Some care homes might have temporary outdoor ‘visiting pods’ or use a dedicated room such as a conservatory for ‘screened’ visits so visitors do not go through a shared living space. The visiting space should be used by only one resident and visiting party at a time. There should also be a substantial floor to ceiling screen between the resident and visitor.
- Care home providers must consider the rights of residents who may lack the relevant mental capacity needed to make particular decisions. For example, some people with learning disabilities may not be able to decide whether or not to consent to a provider’s visiting policy. These residents will fall under the empowering framework of the Mental Capacity Act (2005) and where appropriate, their advocates can consent on their behalf to the visiting policy.
Do I have to wear a face covering to visit someone who lives in a care home?
You should wear a face-covering, which doesn’t have to be a medical or surgical mask, when visiting a care home. The Government will continue to provide care homes with PPE to meet this requirement. If the person you are visiting has difficulty with people wearing face-coverings, the home should recognise this and decide whether you can remove a face-covering, or wear a visor or clear face covering. The care home will need to carry out a risk assessment to decide this.
Can I bring gifts or other items into the home?
You can bring gifts or other items for residents as long as these are easy to clean by care home staff. For example, a box of chocolates that can be sanitised with wipes would be allowed. It would be a good idea to check with the care home first, to make sure.
Read more about visits to care homes in the Government guidance.
Visits out of care homes
The Government says that opportunities for care home residents to make visits out of the care home, including overnight, are an important part of care home life, and residents are now able to take visits out of the care home for brief outdoor visits or for longer indoor or overnight stays However, there are still risks involved in visits out. You can read more detail on all of the below in the Government guidance on Visits out of care homes.
Since 17 May, care home residents of any age have been able to leave the care home for low-risk visits outdoors without needing to self-isolate on their return, because of falling cases of coronavirus. This includes visiting a friend or family member’s garden, going on walks in places like parks, public gardens and beaches, attending medical appointments and educational settings, going to work and visiting day centres. Supplementary guidance for these kinds of low-risk visits has been released by the Government, and the conditions for these visits are:
Residents must be accompanied by at least one of the following:
- a member of care home staff
- one or both of their nominated visitors
- an essential care giver where applicable
- Care homes should discuss arrangements for these visits with nominated visitors or essential care provider in advance
- Visits should solely be outdoors, except for toilet facilities
- Visits to indoor spaces can’t take place, whether public or private
- Visits should not involve the use of public transport
- These visits won’t be able to take place if the resident tests positive for coronavirus or if there is an outbreak of coronavirus in the care home
- From 21 June, care home residents have been able to leave care homes for more social reasons, and enjoy overnight stays with family or friends without needing to isolate when the return, as long as an individual risk assessment is carried out by the care home before the visit. The guidance previously required residents to self-isolate for 14 days when they got back to the care home, which was difficult for many autistic people and was something we lobbied government to change. However, people who return to a care home after an overnight stay in hospital or a visit defined as high-risk by the risk assessment will still need to self-isolate for 14 days.
- From 21 June, people admitted to a care home from the community have also no longer had to self-isolate for 14 days on arrival, so residents have a less disruptive introduction to being in a care home. They need to take a PCR test before admission, a PCR test on the day of admission and a further PCR test seven days later. However, people who are admitted to a care home from another care home or from hospital still need to self-isolate for 14 days on arrival, even in step 4 of the roadmap out of lockdown.
- Care homes will need to carry out individual risk assessments to ensure visits out of care homes, including overnight stays, are not high risk, and can define their overall policy for how outward visits are supported safely. The care home should balance the benefits of visits out of care home against a consideration of the risks to others in the home, where necessary. They should consider:
- the vaccination status of residents, visitors and staff
- levels of infection in the community
- variants of concern in the community
- where the resident is going on a visit and what activities they will take part in whilst on the visit
- the number of nights the resident plans to stay out of the home
- the mode of transport the resident intends to use.
- Care homes should also always support visits out in exceptional circumstances, such as to visit a friend or relative at the end of their life.
- If a visit to another household does take place, including for overnight stays, all members of the household hosting the visit should have had a negative coronavirus test result immediately preceding the visit. For example, the test could be taken when the family go to the care home to collect the resident for the visit with a lateral flow device (LFD).
- The resident should also be tested immediately before their visit out of the care home with an LFD, and the visit should not go ahead if the result is positive. The resident should be immediately isolated in the care setting if they receive a positive result.
- Ahead of each visit, care homes should develop a plan with the arrangements and risk mitigation agreed with the resident, or a best interests’ decision if the person lacks capacity.
- Things to be considered within this plan should include:
- the nature of the planned visit, the intended activities and where the resident will be spending time. Indoor public spaces where other people will be present should be avoided and the number of different locations visited should be minimised
- the support needs that the resident may have during the visit, and whether the resident will need to be accompanied by a staff member, carer, family member or friend
- how the resident will be supported to follow good infection control practice including social distancing and hand hygiene
- transport for the visit, which should avoid exposing the resident to those outside the household they are visiting, such as a family car or private taxi. Other people the resident is visiting should take steps leading up to the visit to minimise the risk to the resident and others in the care home. For example, they should minimise their potential exposure to coronavirus by limiting the number of people they meet for two weeks before the visit out.
We are also 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.
If you want advice or are worried about these changes, find out more about what help and support is available.