New care home guidance for tier 4 areas

December 21, 2020

New guidance issued by The Department of Health and Social care has banned close-contact care home visits in Tier 4 areas.

According to the latest guidance, visits to care homes can take place with arrangements such as substantial screens, visiting pods, or behind windows. However, close-contact indoor visits supported by testing, which are allowed in Tiers 1-3, will not be allowed in Tier 4.

A Department of Health and Social Care spokesperson, said, ‘We know visiting restrictions in care homes have been very difficult for residents, their families and staff, and we have done everything we can to safely enable visits and reunite loved ones. In the face of a new variant of the virus, we have acted to protect those most at risk in care homes.

‘Visits to care homes can still take place in Tier 4 with arrangements such as substantial screens or visiting pods but, for the safety of loved ones, close-contact indoor visits supported by testing cannot take place in tier 4 areas.’

The National Care Forum (NCF) has said that the last-minute change to Christmas rules will cause a ‘significant challenge to all care providers’ and that care providers are receiving different instructions from local authorities and Government in relation to the use of lateral flow devices in care homes.

Vic Rayner, Executive Director, National Care Forum, said, ‘Visits can and should continue in tier 4. However, the change in government policy to refuse the use of on-site testing in tier 4 will cause enormous distress to residents and loved ones. It will also be a huge blow to providers who have spent the last week preparing and training staff to use lateral flow devices (LFDs), and communicating and planning with relatives to enable meaningful visits by Christmas.

‘Visiting is absolutely key to the delivery of great care. Therefore, it is deeply unhelpful for local authorities and central government to be providing vastly different instructions in relation to the use of lateral flow devices in Tiers 1 to 3. Visits can be supported by LFDs, but they are only part of the picture alongside the continued use of PPE and Infection Prevention and Control procedures.

‘The last-minute changes to Christmas plans will also cause a significant challenge to all care providers - residential and homecare. Staff rotas have been planned to ensure everyone got a chance to spend time with families over the five-day Christmas period. This will of course all have to change as everyone assimilates the impact of this snap change of direction.’

According to NCF, care workers have always been the occupational group with the highest number of people working on Christmas Day and say it’s this lowest paid group of staff who are being asked to make some of the biggest sacrifices.

Vic Rayner, Executive Director, National Care Forum, said, ‘If ever this government was going to follow the lead of Scotland and Wales and reward all those staff for the multiple personal sacrifices they have made throughout this pandemic and will continue to do so to keep everyone safe over Christmas - then this is the time to do it. Care workers need all our respect, and we need government to step up and show just how much it values their contribution.’

Professor Martin Green OBE, Chief Executive, Care England, said, ‘This is a terrible situation for everyone, and the short amount of notice given complicates matters further.  We hope that the next, more transportable, vaccine will be rolled out to care home residents and staff as quickly as possible in order to see any light at the end of the tunnel.’

UK charity, Age UK has raised concerns about vulnerable people who may have cancelled their home care help over the Christmas period, because they thought family would help. The cancelling of the 5-day relaxation period over Christmas could mean that vulnerable people will not be receiving the care they need, or seeing any family at all.

Caroline Abrahams, Charity Director at Age UK, said, ‘The sudden changes to tiers over Christmas are a particular problem for older people who had cancelled their home care in anticipation of family stepping in, if the latter are now unable to do so. Organising rosters over Christmas is a challenge for home care agencies every year as they try to juggle the wishes of clients and staff, but this time it’s incredibly late for them to try to sort things out. I’m sure agencies will try their best to be flexible, but with staff sickness due to COVID-19 and the usual winter bugs likely to be an issue they are unlikely to be able to put back all the care that they’d taken out.

‘It’s going to be a double whammy for some older people I’m afraid: unexpectedly on their own over the festive season and without all the care they need as well. It’s not only the personal care they are likely to miss; but the conversation that goes along with it. However brief that may be, it might often be their main opportunity to chat to someone most days. We hope this situation will not happen to very many older people and that families will stay in frequent touch with them to keep their spirits up, as well as to make sure they are ok.’

Fiona Carragher, Director of Research and Influencing at Alzheimer’s Society, said, 'The sudden U-turn in care home rules for Tier 4 is the final kick in the teeth for thousands of care home residents and their families, crushing any glimmer of hope for hugs, chats and essential human contact this Christmas. After nine months of hell, we thought understanding had finally sunk in, that mental health played as vital factor in people’s survival as physical.

'The large majority of people in care homes with dementia haven’t got any more time, they don’t know what the virus is, or why they are left forgotten in care homes for their final weeks and months. We beg the Government to act with compassion and swiftly turn this around to allow meaningful visits to continue safely, with regular testing. Tiers are irrelevant here - with testing and PPE in place there is no excuse for preventing people having the one thing that matters most to them in their final days.'

Visit the UK Government website for the latest guidance on care home visiting in the UK.

The National Care Forum (NCF) has shared the results of its second Pulse Survey of the adult social care sector, to provide in-depth analysis of how adult social care providers are operating during the second wave of COVID-19.


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