5 August 2021:
We welcome the Government’s recognition of the central role Essential Caregivers play in the wellbeing of care home residents. Guidance permitting access to Essential Caregivers (from 8 March) followed our joint call for this, as a ‘first step’ to re-opening care homes.
We now call for urgent and united action to ensure every resident who wants to can get access to their Essential Caregiver.
Full roll-out of the role is vital to ensuring residents’ wellbeing can be protected at this critical time. For residents who have spent 18 months without the support and love of their Essential Caregiver, we must act urgently to fill this hole in their lives. We are calling on care providers, relatives and friends, local and national government and the regulator to work together to make the Essential Caregiver role a reality for all who want it.
Below are some frequently asked questions about the Essential Caregiver role, based on what the Relatives & Residents Association hears via the R&RA Helpline. The questions are framed from a resident’s perspective and the answers are aimed to support care providers to facilitate the role, as well as to help residents and their relatives/friends.
What is an Essential Caregiver?
The Essential Caregiver role was introduced in the Government guidance on visiting in care homes, effective from 8 March (available here). It runs alongside other types of visiting and recognises that residents can have more regular support and companionship from a relative/friend, a greater degree of contact, or help with personal care. This means a relative or friend can visit for longer and more regularly than other types of visitors, in the resident’s room and have closer contact. They may provide companionship or emotional support, carry out personal care tasks with the resident – such as support to eat – or it may be that their presence during care tasks carried out by staff is beneficial to the resident’s wellbeing (for example by helping to relieve distress). Closer engagement/interaction and touch can be vital to ensure wellbeing. Essential Caregivers will be subject to the same testing regime, PPE arrangements and infection prevention and control (IPC) measures as staff.
Is an Essential Caregiver only allowed where my health is in immediate danger?
No. The guidance states that every resident can choose to nominate an Essential Caregiver. The role is intended to ensure residents have the support of someone they have a personal relationship with. This can include for companionship, where the person’s presence or the care they provide is central to the health and wellbeing of a resident. This makes it clear that it is not only about carrying out care tasks vital to the immediate health of the resident – such as help with eating – but also about simply being there, providing company, emotional support or relieving distress.
How do I get access to my Essential Caregiver?
The Government guidance makes clear that all residents can choose to nominate an Essential Caregiver. An individual assessment should be carried out to put in place arrangements for access for the Essential Caregiver. Blanket bans on Essential Caregivers are not acceptable. The onus is on care homes to undertake the individual risk assessments and facilitate access to Essential Caregivers. Care homes should not wait for a resident or their relative/friend to ask about the Essential Caregiver role. They should be proactive in letting residents, and the relatives/friends who used to visit them, know that the role is available. This will ensure relatives/friends feel welcomed to take up this role and that residents feel supported with their wellbeing.
Should I/my family be involved in discussions about having an Essential Caregiver?
Yes. The care home should talk to residents/their families about the process for facilitating visits from an Essential Caregiver and how they will be involved. The home should carry out an individual assessment, with the involvement of the resident and their family/representatives to ensure the resident’s wellbeing needs are fully considered. The guidance makes clear that the assessment should be discussed and agreed with the resident and their family and that the home should share the completed assessment with them. Care homes will need to consider how residents who are assessed as lacking capacity to be involved in the assessment are supported, including to participate as fully as possible. Care homes will also need to consider who they need to involve, bearing in mind any support that might be required from a Relevant Person’s Representative (where the resident is subject to a Deprivation of Liberty authorisation) and/or a Power of Attorney.
Will I only be able to have an Essential Caregiver if someone played that role before the pandemic?
No. Whilst the guidance states that it is ‘likely’ that the need for this support will already be part of – and documented in – the care plan, that is not a condition for this type of visit. The guidance is clear that every resident can choose to nominate an Essential Caregiver.
Will my Essential Caregiver have to take on all of my care needs?
No. The guidance says that the Essential Caregiver should agree with the care home what tasks they are, and are not, willing to undertake. It makes it clear that clinical care and medical tasks remain the responsibility of the care home. It would be inappropriate for the care home to insist that Essential Caregivers take on specific tasks, or require them to fulfil all a resident’s care needs. The duty to meet the resident’s care needs remains with the care home. But the guidance recognises that residents can benefit from the support or companionship of an Essential Caregiver to aid their wellbeing. The Essential Caregiver, as a relative or friend, will have a connection and relationship with the resident that care staff cannot replicate.
What if my home has decided no-one can have an Essential Caregiver?
Blanket approaches are not acceptable, as the regulator has made clear. The guidance states, several times, that every resident can now choose to nominate an Essential Caregiver. Blanket bans are also not permissible in law (under the Equality Act and Human Rights Act which require individual approaches).
What if my care home has assessed me as not needing an Essential Caregiver?
The guidance makes it clear, several times, that every resident can now choose to nominate an Essential Caregiver. Whilst previous versions of the guidance advised care homes to assess which residents needed access to an Essential Caregiver, now all residents can choose for themselves whether to have one. If a resident does not have capacity to decide about having an Essential Caregiver, a best interests decision (under the Mental Capacity Act) should be made, involving the resident’s relatives/friends/representatives. Social workers can help to support conversations and help resolve any issues.
Do Essential Caregivers present a risk to my health?
Essential Caregivers will be subject to the same testing regime, PPE arrangements and IPC measures as staff, so they present no greater risk to resident’s health than a staff member.
Will I need to have both doses of the COVID-19 vaccine before I can have an Essential Caregiver?
No. The guidance strongly recommends that Essential Caregivers receive two doses of the vaccine.
Will my Essential Caregiver have to stop visiting in the event of an outbreak?
No. The guidance states that Essential Caregivers should be enabled to visit “in all circumstances” including if the care home has an outbreak (but not if the resident or Essential Caregiver are COVID-positive, or if the Essential Caregiver is not fully vaccinated and has been notified they are a close contact of someone who is COVID-positive). They should also be allowed to visit during any periods of isolation the resident has to undertake. Remember, Essential Caregivers are subject to the same testing regime, PPE arrangements and IPC measures as staff.
Will my Essential Caregiver be restricted to timed visits?
Visits from Essential Caregivers should not be time limited. The guidance recognises that Essential Caregivers are a central part of delivering care and support to residents, alongside care staff, so may spend longer in the home. They may also use areas other visitors don’t enter. Remember, Essential Caregivers are subject to the same testing regime, PPE arrangements and IPC measures as staff.
Can I only have one Essential Caregiver?
No. The guidance states that whilst the assumption is that there will only be one Essential Caregiver per resident, exceptions may be agreed after an assessment of the individual circumstances. This is an important recognition that some residents will require support from more than one person for their wellbeing. For example, a resident with two sons who receives different support from each of them. It also allows for the necessary support from the Essential Caregiver to be shared between two relatives/friends. For example, if a resident is assessed as requiring support more regularly than their Essential Caregiver can commit to.
What if my Essential Caregiver needs someone to support them during visits?
If an Essential Caregiver requires someone to support them during their visits, for example because they are themselves an older person or disabled, the home should facilitate this request as a reasonable adjustment (required by the Equality Act). For example, if an older relative needs the support of a friend or family member during their visit.
If my wellbeing improves, will I lose access to my Essential Caregiver?
No. The guidance now makes clear that it is for each resident to choose to nominate an Essential Caregiver who can continue visiting even throughout outbreaks. Therefore, it is for each resident to choose how long they want this support. If access to an Essential Caregiver does not immediately result in improvements to a resident’s wellbeing, this should not be taken as a sign that the support is unnecessary or superfluous. Given the long period of absence, relationships will need time to rebuild and improvements in wellbeing may be gradual. For some residents it is possible that wellbeing may never improve, given the strains of the past 18 months. Residents and their relatives/friends may need support to understand and come to terms with this.
I have another question or need some support
Please get in touch with the R&RA Helpline: https://www.relres.org/helpline/contact-the-helpline/
For more information about care homes’ legal duties around Essential Caregivers see ‘Visiting and the Law’: http://www.relres.org/visiting-guide-providers/
For more information about the role of Essential Caregiver see http://www.relres.org/essential-caregivers/
A PDF version of the FAQs is available here.