The importance of continued social interaction of residents and their families cannot be overstated and every effort should be made, in line with public health advice, to ensure that these interactions continue, including through window visits.
Nursing home providers are ultimately responsible for the safe care of their residents. Under Regulation 11 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 it is the legal responsibility of each registered provider to make arrangements for a resident to receive visitors, having regard to any risks that may present for the resident or other residents. Public health guidance has been developed in order to assist and support providers in this regard.
The current guidance aligns with the 5 level framework of restrictive measures as outlined in the Government’s Living with COVID-19 Plan, to support long-term residential care providers in the discharge of their responsibilities and to support in the safe visiting, to the greatest extent possible, having regard for the challenging times in which we are living.
I encourage all nursing homes to remain familiar with the latest public health advice and support, and to make every effort to continue to facilitate visitors in line with public health advice and to communicate with family and friends on an ongoing basis in order to support positive mental health and well-being.
Current guidance and the recommendations of the Expert Panel report seek to enhance standardisation and consistency in service delivery, including in areas such as visiting and communication.
The current guidance notes that “Critical and compassionate circumstances are difficult to define and of necessity require judgement. The term should not be interpreted as limited to circumstances when the death of a resident is imminent.
Subject to a risk assessment in each case, other examples of critical and compassionate circumstances may include:
- Circumstances in which a resident is significantly distressed or disturbed and although unable to express the desire for a visit there is reason to believe that a visit from a significant person may relieve distress.
- When there is an exceptionally important life event for the resident (for example death of a spouse or birthday). - When the visitor may not have another opportunity to visit for many months or years or never (for example because they are leaving the country or are themselves approaching end of life)
- Increased visiting is recommended by their doctor as a non-pharmacological therapeutic alternative to an increased dose of an existing agent or introduction of a new anxiolytic or sedative agent.
- A resident expresses a strong sense of need to see someone whether for personal reasons, to make financial or other arrangements or to advocate on their behalf.
- A person nominated by the resident expresses concern that a prolonged absence is causing upset or harm to a resident.
- Other circumstances in which the judgement of the medical or nursing staff or social care worker caring for the resident is that a visit is important for the persons health or sense of well being.”
Separately, I understand that the Health Protection Surveillance Centre is currently reviewing the public health guidance on visiting, in consultation with relevant national stakeholders, to consider, in line with the range of public health factors, further potential for safe visiting within nursing homes. Visiting guidance is being considered in the context of the wider COVID-19 situation, as we plan and prepare for exiting level 5 restrictions.
Notwithstanding this, it is also important to be cognisant of the wider epidemiological situation and the risks associated with same. On the 19th November, the European Centre for Disease Control published its latest risk assessment with regard to long-term care facilities. It highlights that the probability of COVID-19 introduction into a long-term care facility depends on the level of COVID-19 circulation in the community, with a higher risk associated with higher incidence rates in the community.
This highlights the importance of suppressing the level of the virus in the community as one of the primary measures for protecting nursing homes. As citizens, we all have a responsibility in this regard and our actions across all of society can directly impact the outcomes for nursing home residents.