In brief this guidance sets out the following:
- every care home resident can nominate up to 3 visitors who will be able to enter the care home for regular visits (this number does not include essential care givers or preschool age children)
- visitors should continue to make arrangements with homes in advance of the visit, so that we can manage the number of people attending at any one time to ensure safe visiting practices can be maintained.
- visits will take place in a room most practical and comfortable for the resident (for example, residents with dementia may be more comfortable in their own room with familiar belongings)
- visitors should receive a negative lateral flow test result and report it on the day of their visit, either by conducting the test at home or when they arrive at the home – essential care givers need to follow the additional testing arrangements outlined below
- every care home resident should be supported to have an identified essential care giver (in addition to their named visitors) who may visit the home to offer companionship or help with care needs – essential care givers should be able to visit inside the care home even during periods of outbreak affecting the care home
- during an outbreak, visits will continue in well-ventilated spaces with substantial screens, visiting pods or from behind windows – rooms should be left to ventilate with external doors and windows open between uses wherever possible,
- residents should be supported to undertake visits out of the care home as appropriate:
- residents who have received at least 2 doses of the vaccine, or are exempt from vaccination, should not have to isolate following most visits out of the care home if they follow the correct testing regime
- residents who have not received at least 2 doses of the vaccine, and are not exempt from vaccination, should isolate for 14 days following a visit out
- all residents should isolate following an emergency stay in hospital, if they test positive for COVID-19 or following a visit that has been deemed high-risk following an individual risk assessment by the home
- vaccination is one of our best defenses to combat infection. The COVID-19 vaccine significantly reduces the transmission of infection, particularly after 2 or more doses. It is strongly recommended that residents and visitors receive 2 doses of the COVID-19 vaccine, plus their booster especially in light of the emergence of the Omicron variant. The data shows that booster doses are required to provide higher levels of protection against symptomatic infection. If eligible, visitors should also get their flu jab when it is offered to them
- visitors should not enter the care home if they are feeling unwell, even if they have tested negative for COVID-19 and are fully vaccinated and have received their booster. Transmissible viruses such as flu, respiratory syncytial virus (RSV) and norovirus can be just as dangerous to care home residents as COVID-19. If visitors have any symptoms that suggest other transmissible viruses and infections, such as cough, high temperature, diarrhoea or vomiting, they should avoid the care home until at least 5 days after they feel better
- visitors who are not legally required to self-isolate are advised against visiting the care home (for 10 days) if they have been identified as a close contact of someone with COVID-19, unless absolutely necessary, even if they have been fully vaccinated. Where visits do occur, visitors should have received a negative PCR test result prior to their visit, and a negative lateral flow test result earlier in the day of their visit
- anyone who is fully vaccinated, and has been identified as a close contact of a confirmed case of the Omicron variant of COVID-19, does not need to self-isolate if they receive a negative PCR test result and take daily rapid lateral flow tests until 10 days after their last exposure to the positive case
Restricted Number of Visitors
Every resident should be supported to choose an essential care giver to benefit from companionship and additional care and support provided by someone with whom they have a personal relationship. Essential care givers do not count towards the limit of 3 visitors per resident.
It is important that the named visitors remain the same people as far as possible, so each home can manage the testing of every person coming into the home. However, we recognise that there will be situations in which a named visitor cannot continue to visit (for example because of illness). In this instance we will take a pragmatic approach, with the aim of minimising change wherever possible.
In the face of new variants of the virus, we still need to be cautious to ensure we protect those most at risk in care homes while ensuring indoor visits can go ahead. Being vaccinated with a full course (2 doses) and a booster dose significantly reduces the risk of transmission, and we would recommend that all residents and their visitors consider getting both vaccinations and a booster to ensure safer visiting, in addition to all the infection control measures that are in place now.
There are exceptional circumstances where someone may need the additional support of more than one essential care giver and this should be considered (for example, if a nominated essential care giver is unwell).
Essential care givers will need to follow the following testing arrangements. Essential care givers must:
- take a weekly PCR test and share the result with the home. Care homes should use their existing PCR stocks to test essential care givers and these should be registered as ‘staff’ tests using the care home unique organisation number (UON) and be returned via courier with other staff tests
- take a minimum of 3 lateral flow tests a week: one lateral flow test on the same day as a PCR test, one lateral flow test 2 to 3 days later, and then again after another 2 to 3 days. These rapid lateral flow tests can be done onsite, at an asymptomatic testing site (ATS) or at home. These tests should be reported as ‘visitor’ using the care home UON
- in line with care home staff, be subject to additional testing should the care home be engaged in rapid response daily testing or outbreak testing. If this includes lateral flow tests, these can be done at home. This testing must be conducted in accordance with the guidance for care home staff on PCR testing, rapid lateral flow testing (including rapid response testing) and outbreak testing.
Essential care givers should read and follow the appropriate guidance for using PPE in the different care scenarios laid out in the guidance on how to work safely in care homes. PPE recommendations are different depending on whether direct personal care or companionship is being provided. More information on how to safely put on and remove PPE can be found in the guidance and visitors should also be encouraged to view the video demonstration. If you are new to this role an experienced member of staff will support you to put on and take off the PPE on the first few visits to ensure it is done so correctly.
Essential care givers are able to visit the home in all circumstances, including an outbreak, unless they or the person they are visiting is COVID positive.
Essential care givers should be briefed on the relevant IPC measures in the areas of the care home they will have access to, and reminded of the importance of remaining at least one metre from staff and any other residents they might encounter, though this may differ subject to a local risk assessment.
The care home and essential care giver should also agree any other relevant arrangements – for example, managing immediate visits (if the resident is distressed and the essential care giver is needed urgently to settle them) and communal areas such as staff rest areas that the essential care visitor should not enter.
Clinical care and medical tasks such as the administering of medication and physiotherapy remain the overarching responsibility of the care home.
Where the resident lacks the capacity to choose their essential care giver, the care home should discuss the situation with any attorney or deputy, the resident’s family, friends and others who may usually have visited the resident or are identified in the care plan. In this situation, a person can only be nominated as an essential care giver if this has been determined to be in the resident’s best interests in accordance with the empowering framework of the Mental Capacity Act (MCA) 2005. Consideration should be given to whether there is an attorney or deputy with appropriate authority to make this decision.
Due to the vulnerability of care home residents it is recommended that if a fully vaccinated essential care giver is identified as a close contact of someone who has tested positive for COVID-19, they do not visit the care home until they have received a negative PCR test, and test negative on a lateral flow test on the day of their visit.
Essential care givers who are not fully vaccinated should not visit the care home for 10 days following contact with a COVID-19 positive case.
Each identified visitor will be tested using rapid lateral flow tests before every visit, must wear the appropriate personal protective equipment (PPE) and follow all other infection control measures (which the care home will guide them on) during visits. Visitors can come in to visit subject to availability of the home, but we will endeavour to support visiting for each resident.
Visitors and residents are advised to keep physical contact to a minimum.
End of life Visits
We recognise how important visiting is as residents approach the end of their lives and this should not just mean at the very end of one’s life. Families and residents will be supported to plan end-of-life visits, with the assumption that visiting will be enabled to happen not just towards the very end of life, and that discussion with the family should happen in good time. As has been the case throughout the pandemic response, visits in exceptional circumstances such as end of life will continue in all circumstances (including in the event of an outbreak).
Professional Visitors
Health, social care and other professionals need to visit care home residents to provide services. Care homes should facilitate these visits while ensuring necessary testing, IPC and PPE measures are adhered to. The arrangements for visiting professionals differ from those for family and friends visiting the care home.
Any professionals visiting a care home – such as healthcare workers, tradespeople and hairdressers – are required to show they are vaccinated or exempt before entering the home. This includes staff who may work or volunteer in the care home on a part time or occasional basis to deliver non-care-related services such as maintenance or activities.
Exemptions include medical grounds where a person should not be vaccinated for clinical reasons (including some situations where a vaccine has been received overseas) or if the professional is providing emergency services. Emergency services in the NHS include staff deployed as part of an emergency ambulance response, including first responders. The NHS provides more information on vaccinations for NHS staff entering a care home.
The vaccination requirement only applies to people who go inside a care home. Individuals who are not entering the building will not need to show vaccination status.
Further information, including on exemptions, can be found in the vaccination of people working or deployed in care homes: operational guidance.
Visiting professionals will also need to have a negative test within 72 hours of visiting. Refer to the guidance on testing for health professional visits for further information on testing requirements (which differ from those outlined for family and friends in this guidance).
Infection Control Practices
The following precautions should be followed when visitors are inside the any of our care homes. All visitors should:
- Visitors should wear a face mask at all times when visiting the care home. COVID-19 spreads through the air by droplets and aerosols that are exhaled from the nose and mouth of an infected person. Face masks reduce the risk of spreading COVID-19, especially when there is close contact between people in enclosed, poorly ventilated and crowded spaces. It is important that face masks fit securely around the face to safely cover the mouth and the nose.
- It is important to seek advice and support from the care home management team at an early stage if the measures show signs of causing distress for individual residents. If face masks are to be removed, a comprehensive risk assessment should be undertaken for each resident identifying the specific risks to them, care home staff and visitors to develop appropriate strategies to safely manage those risks. It is important PPE items are not altered in any way as this could reduce their effectiveness in protecting staff or residents.
- It is not usually recommended to wear a face mask while undertaking visits outdoors. However, a risk assessment should be undertaken, and mitigations considered if visitors may be in very close contact with someone or if there is likely to be contact with bodily fluids, for example due to someone spitting or coughing.
- Visitors should either wash their hands for 20 seconds or use hand sanitiser on entering and leaving the home, and catch coughs and sneezes in tissues and clean their hands after disposal of tissues.
- Visitors should limit contact with other residents and staff, and maintain as much distance as possible. Regular conversations with staff can be arranged over the phone following in-person visits.
- Communal areas can be used for visits if there is only one visiting group using the area at a time. Individual groups may wish to remove face masks to share a meal together in communal areas, providing no other people are in the area.
- All homes should keep a temporary record (including address and phone number) of current and previous residents, staff and visitors (including the person or people they interact with – for example, staff members or visiting professionals), as well as keeping track of visitor numbers and staff. This information however does not need to be held indefinitely.
Risk assessments
Individual risk assessments must be written to assess the rights and needs of individual residents, as well as any specific vulnerabilities that are outlined in the resident’s care plan, and to consider the role that visiting can play in this.
Providers must develop a risk assessment that assesses how the care home can best manage visits safely, considering:
- the needs of residents and visitors
- residents’ rights to visits and the important role visitors play in residents’ wellbeing
- what is possible within the layout and facilities within the home to ensure that mixing between visitors is limited as much as possible
- where and how visitors might be received on arrival at the home to avoid mixing with other visitors, staff or residents
- the precautions that will be taken to prevent infection during visits (including PPE use, ventilation, limiting close contact and hand washing)
- legal duties relevant to visiting, including the Care Act 2014, Mental Capacity Act 2005 and Human Rights Act 1998
Residents and their loved ones should always be involved in developing individual risk assessments.
Testing arrangements
Consent must be obtained from visitors prior to participating in lateral flow testing. A consent form will be sent out to all visitors and must be returned before any visiting can occur.
While rapid testing can reduce the risks around visiting it does not completely remove the risk of infection. It is therefore imperative that visitors appreciate that as well as having a lateral flow test, PPE is used correctly, social distancing is respected, hand hygiene is carried out, physical contact is kept to a minimum, and anyone who tests positive will follow government guidance. It is crucial that visitors follow all such advice and instructions carefully – to minimise the risks for themselves and loved ones as much as possible.
Testing onsite at the care home is preferable for assurance purposes. However, we recognise that individuals now have access to testing through other routes and visitors may be travelling long distances to visit, care home managers can allow visitors to provide evidence of a recent negative test undertaken through other means, if the test has been taken that same day. Alternative routes may include:
- assisted testing at another lateral flow site such as an asymptomatic testing site (ATS)
- self-testing at home using test kits provided by the government such as at a school, workplace, the universal testing offer, or collected from a pharmacy
Visitors are not able to test themselves at home with a test from a pack of 25 in line with MHRA rules.
When considering the most appropriate testing route, managers should consider any additional risks that may arise from testing off site, as well as the confidence and ability of visitors to carry out tests away from the care home. This may include factors such as:
- visitors inaccurately conducting or reporting lateral flow testing themselves
- the increased risk of visitors needing to take public transport to a testing site, particularly where it is far from the setting, or coming into contact with other people
- visitors may not have a mobile phone or email address to receive the result of their test
Where visitors will be self-testing, managers may wish to supervise the first few tests on site and provide support to ensure visitors are confident conducting the tests at home and they are being completed and reported satisfactorily.
Wherever the test is conducted, it must be done on the day of the visit. Once the visitor has reported the test, they will receive confirmation of their result by text message (SMS) and email to show proof of result. Visitors should show proof of a negative test result before every visit, such as:
- an email or text from NHS Test and Trace
- a date-stamped photo of the test cartridge itself
We will not retain records of proof of a test. All tests done at home should be reported to the UON of the care home and managers should ensure visitors are aware of their UON and the legal duty to report the result. Where individuals are testing for multiple purposes (for example, if they’re part of a school bubble), the test only needs to be linked to one organisation. Being able to link visitors to a care home enables public health teams to better support care homes to reduce the transmission of coronavirus and prevent outbreaks.
If visitors are unable to produce the results of a negative test they may be asked to reschedule or take a test on site. Visitors who do not provide the home with results of a negative test will not be able to enter the home on that day.
Visitors who have recently tested positive for COVID-19 from a PCR test should not routinely be retested within 90 days unless they develop new symptoms or unless specific infection detection and response plans are in place for individuals or in the local area already. This means that some visitors will not need to be tested regularly because they will still fall into this 90-day window. These visitors should use the result of their positive PCR result to show that they are currently exempt from testing until the 90-day period is over following their period of self-isolation. Once the 90-day period is over, visitors should then continue to be tested. They should still continue to follow all other relevant IPC measures throughout these 90 days, including social distancing, maintaining good hand hygiene and wearing PPE.
If a visitor tests positive they must immediately leave the premises to go home and self-isolate. They must follow government guidance and immediately self-isolate and complete a confirmatory polymerase chain reaction (PCR) test which will be provided by the home. This can be returned either through a courier or through a Royal Mail priority post box.
Visits out of the care home
We will facilitate out of home visits to those who wish to leave.
Residents who have had 2 doses of the vaccine, or are exempt from vaccination, should not have to isolate for 14 days after most visits out of the care home, but should take a lateral flow test every other day for 10 days following the visit out.
Residents who have not received at least 2 doses of the vaccine, and are not exempt from vaccination, should not go on visits out of the care home unless they isolate for 14 days after the visit out. This is a necessary precaution following clinical advice in light of a more transmissive variant of COVID-19.
There are certain types of activity where the risks are inherently higher and the advice is that, in these cases, the resident should self-isolate for 14 days on their return to the care home regardless of their vaccine status. This is to ensure that, in the event they have unknowingly become infected while out of the home, they minimise the chances of passing that infection on to other residents and staff. These activities are:
- emergency stays in hospital – as they are higher risk than an elective admission
- visits assessed to be high-risk following an individual risk assessment by the care home
For planned hospital overnight stays (such as elective admissions), residents do not need to isolate upon return provided they meet the following criteria. Residents should:
- be fully vaccinated and have had their booster jab when eligible
- receive a negative PCR test following their return to the care home (and isolate until the result is received)
- complete testing requirements as detailed in the guidance on admission and care of residents in a care home during COVID-19
- avoid contact with other highly vulnerable residents in the care home
If there is an outbreak of an infection that originated in hospital in the part of the hospital where the resident stayed, refer to guidance on admission and care of residents in a care home during COVID-19. Separate guidance is available on planning visits that residents may need to make to a hospital or other healthcare setting.
When going out of the care home residents should manage the risk by:
- avoiding visiting people they do not usually spend time with regularly
- avoiding visits out that involve mixing with a large number of people indoors
- receiving a COVID-19 booster if possible before taking part in a visit out of the care home, unless exempt, and where they have had the opportunity to receive a booster
- asking those they are visiting to undertake regular lateral flow testing, and receive a negative lateral flow on the day of the visit
- asking those they are visiting to have had their COVID-19 vaccinations, including their booster if eligible
Decisions about steps to mitigate the risk of an individual resident’s visits out of a care home should be taken with the resident’s assessed needs and circumstances considered. Individual risk assessments should consider the vaccination status of residents, visitors and staff, and any testing for those involved in the visit out.
Where possible, anyone else who the resident meets as part of an indoor visit should undertake a lateral flow test and receive a negative result on the day of the visit. All tests should be reported to the UON of the care home.
We will consider the rights of residents who may lack the relevant mental capacity needed to make a decision about visits out of our homes. These people are protected by the empowering framework of the MCA and its safeguards. Where practicable and appropriate, their advocates and those with power of attorney should be consulted, as well as any deputy, and if there is a deputy or attorney with relevant authority, they must make the best interests decision regarding the visiting policy on the person’s behalf.
Wider guidance on ventilation, limiting close contact, good hand hygiene, respiratory hygiene and requirements on use of face masks should be followed while people are away from the home.
Transport arrangements will need careful consideration. If the care home is using its own vehicle then cleaning protocols will need to be in place. If comfortable, the vehicle windows should be opened to aid ventilation.
If the resident is being accompanied by a member of care home staff, a risk assessment should be carried out. This should assess the COVID transmission risk to the care worker arising from any activities during the visit to ensure that the necessary precautions are in place. This may, for example, include if the care worker is likely to undertake direct personal care, as per the how to work safely in domiciliary care and how to work safely in care homes guidance, and therefore whether the care worker requires PPE (above that recommended for individuals in a public place). If necessary, the staff member should take the required additional PPE, as well as the means to safely store or dispose of it, along with a spare replacement face mask, with them when they leave the care home.
Residents may wish to be accompanied on visits out, including to medical appointments. Wherever possible, those accompanying the resident should have received a negative lateral flow test on the day of the visit. Once at the clinical setting, whether the resident can be accompanied will be at the discretion of the medical facility they are visiting.
If a provider is concerned that protocols were not followed or there may have been exposure while at the clinical setting, they should seek advice, from the senior clinic team with SCNH and then if required, from IPC leads within the clinical commissioning group, IPC nurses in the hospital, health protection teams (HPTs) or directors of public health. If there has been a known outbreak of an infection originating in the hospital or clinical care setting then a different risk assessment may be appropriate.
Event of an outbreak
In the event of an outbreak the home may be required to stop all visiting, except in exceptional circumstances like end of life. Essential care givers may continue to visit unless there is a specific reason not to, or they or the person they are visiting is covid positive. The HPT will inform the care home of how long outbreak restrictions (including regarding visiting) need to be in place for. This will be informed by the HPT’s risk assessment and results from the whole home recovery testing.
Since September 2021, if no further positives are identified in the 2 rounds of whole home outbreak testing, subject to the HPT risk assessment, then the outbreak restrictions can be lifted. This could mean that outbreak restrictions are only in place for 7 to 8 days in some outbreaks. However, outbreak controls may be in place for up to 28 days following the last positive case especially as we learn more about real-world vaccine effectiveness and disease severity of the Omicron variant.
In the event of an outbreak, other methods of maintaining contact between residents and their loved ones should be supported. This could include:
- visits in well-ventilated spaces with substantial screens, visiting pods or from behind windows
- telephone calls
- video calls
- newsletters
- emails, letters, cards or photographs
A risk assessment should consider the impact of the outbreak and capability to facilitate window or other visits without breaching zoning or cohorting of residents and staff.
Communicating with friends and families
It is important that all visitors follow any advice and instructions provided – in order to reduce risks to themselves and their loved ones as much as possible.
This visiting policy will be made available and/or communicated to all residents and families, together with any necessary variations to arrangements due to external events. We also consider what additional communications (including posters, leaflets, letters etc) would help visitors to understand guidance surrounding visiting.
