Living with COVID: A provider’s view

Our Q&A with Richard Hawes, CEO of a care provider, shows good practice on visiting and supporting wellbeing and relationships for residents

How have you been managing visiting recently?

We have been fully open to visitors without any restrictions on time or the number of visits. Visitors need to undertake tests and where appropriate use PPE. The majority of visits are taking place in the residents own room unless they request otherwise. We use sensible precautions which place the least restrictions on visits, mainly because we have taken a pragmatic approach to our interpretation of the guidance. On the rare occasion where we have had two positive tests, we have had to close to admissions and restrict visiting depending on local advice which may mean a change in visiting to either our visiting pods, or having bedroom only (essential) visits. This is decided in conjunction with the local Public Health England advice, and can result in all visits being stopped if our arguments for maintaining visiting are unsuccessful.

The reality is that for some of our residents it may be their last Christmas, for families it is important to be able to spend quality time with their loved ones during the festive period.

How are you keeping residents safe?

Our infection control management procedures (including testing for new admissions, isolation for as short a time as possible for anyone testing positive) have proved to be successful. During 2020 we had fewer deaths across our homes than pre-pandemic in 2019 and this year we haven’t had large numbers of positive cases in our homes. We have throughout been having small groups of residents socialising within the homes, to ensure that if we do experience positive tests they are limited to small friendship groups, and the staff who support them, and are therefore easier to manage and control the spread of the virus. We continue to monitor the position and take minimal action as required to ensure the safety of staff and residents and return homes to a normal operating state as soon as possible.

Why is Christmas such an important time in care homes?

Christmas is a special time for most people, it’s often a time of intergenerational activity, sharing special times across both families and generations. A time to share love across community, families and society. The reality is that for some of our residents it may be their last Christmas, for families it is important to be able to spend quality time with their loved ones during the festive period.

What visiting rules will you have in place over Christmas?

We would have maintained our visiting policy over Christmas, but will now have to implement the recently issued guidance. Over the past couple of days anxious family members have been asking what this will mean for them. We will be working with residents and families to identify the three visitors. We will also be asking the resident/families who will be the essential caregiver. The visits will take place where the resident chooses. We still have visiting pods but the reality is they are rarely used now, and only if the resident or family wishes to have their visit in them. Families and residents want proper contact and we aim to facilitate this for them, albeit now in restricted numbers.

Residents can only see a limited part of their families while the general public can go and enjoy life, attend mass events and parties without the same restrictions.

What do you think about the changes to the visiting guidance limiting visits to 3 nominated visitors, plus an essential caregiver per resident?

I think that care homes - with testing, vaccinations and boosters, and PPE - are some of the safest places right now, and will continue to be so. We find those visiting are really understanding of the risks and recognise that to keep their loved ones safe they themselves have to be safe; in my opinion they can be relied on to follow sensible behaviours. I think the recent changes to visiting treat residents and their families in a different way than the general public. Residents can only see a limited part of their families while the general public can go and enjoy life, attend mass events and parties without the same restrictions. Where is the value for older people and the recognition that for many they have an opinion, and are able to make their own choices?

What will this change mean for your residents?

For our residents this means changing their plans for Christmas at short notice - families have often made arrangements by now. In light of these changes how are residents expected to decide who can visit and who can’t?

Residents in their twilight of life care deeply about spending time with their loved ones, this is an essential part of their care and wellbeing

If you had been consulted on this change, what would you have told the Department of Health and Social Care?

There are providers who have managed Covid, and visiting, exceptionally well. It is a shame that the government has not used some of the exemplars as a marker for good practice, but have gone for a risk averse policy. I am not aware that they have looked to seek the views of those affected by this policy, i.e. the families and residents in care homes, let alone those providers who have been working tirelessly to ensure visiting in care homes can take place in a safe and productive manner. These decisions will impact most on those who have not even been consulted.

What would you like to see changed in the guidance?

Not only must we consider that residents in care homes are in their twilight of life and therefore care deeply about spending time with their loved ones, being able to see family forms an essential part of their care and wellbeing. Indeed, the same applies for those family members who have suffered intensely over the last 21 months as they try – in good faith – to understand and navigate the rules that the Government has set out around visiting. With the Covid-19 vaccines demonstrating their clear effectiveness in combating severe disease and hospitalisation among all age groups – and with emerging data suggesting that the same will be true against the Omicron variant – we sincerely hope that the Government will engage with calls to reassess the current guidance. If the individual is isolated and the outbreak controlled (as we have managed) it is simply not a proportionate response to cut other residents off from their loved ones. Indeed, as people adjust to living with Covid-19, it is imperative that care home residents are not denied the same opportunity. In a nutshell we should be isolating those who test positive and not adopting wholesale closure of care homes from society and loved ones.

Richard Hawes is the Chief Executive Elizabeth Finn Homes Ltd, which runs nine personal care and nursing homes across the country, supporting the care of over 400 people.