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) follows 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 needs to can get access to their Essential Caregiver. Whilst this is happening for some residents, roll-out remains limited.
Full roll-out of the role is vital to ensuring residents’ wellbeing can be protected at this critical time. For residents who have spent over a year 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 need 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 some residents need more regular support from relatives/friends, 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 carry out personal care tasks with the resident – such as support to eat – provide emotional support, or it may be that their presence during personal 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 the Essential Caregiver role is intended for circumstances 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 “emotional and mental support” and relieving distress.
How do I get access to my Essential Caregiver?
The Government guidance makes clear that individual assessments are required to determine whether a resident needs access to an Essential Caregiver. Blanket approaches 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 will need to carry out an individual risk assessment, which will include the risk and benefits of the visits, taking into account the residents rights and needs. To ensure the resident’s wellbeing needs are fully considered, the resident and their family/representatives should input to this assessment. The guidance makes clear that the assessment should be discussed and agreed with the resident/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 recognises that a resident’s needs are likely to have changed over time. Whilst a resident may not have needed this kind of support previously, they should be assessed on their current needs and wishes. Others will have only entered the care home during the pandemic and such a role may not have been perceived as an option previously.
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 with the highest needs would benefit from the support or presence 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. The guidance makes it clear, several times, that individual assessments are required to determine whether a resident needs access to an Essential Caregiver. Individual assessments are also required by law (under the Equality Act and Human Rights Act). As the guidance and the regulator have made clear, because each resident is different, decisions need to be taken on an individual basis.
What if my care home has assessed me as not needing an Essential Caregiver?
If the resident/their family/representatives were not included in the individual assessment, it should be re-done, taking into account their views on the resident’s wellbeing needs. The guidance also makes it clear that a resident’s needs are likely to change over time and that the decision around an Essential Caregiver may need to be revisited or reconsidered at different times. This means that another individual assessment should be undertaken as circumstances change. Social workers can help homes to facilitate contact with Essential Caregivers 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 makes clear, several times, that the Essential Caregiver role, like other visiting, is not dependent on residents or the visitor having the vaccine.
Will my Essential Caregiver have to stop visiting in the event of an outbreak?
The guidance states (several times) that Essential Caregivers can continue to visit even in the event of an outbreak, unless there are specific reasons not to do so. No further information is provided on what these reasons might be, but given the fundamental role Essential Caregivers play in wellbeing, and the detrimental impact withdrawing this support would have on the resident, excluding them should be an exceptional step backed up by strong evidence. Remember, Essential Caregivers are subject to the same testing regime, PPE arrangements and IPC measures as staff, and the guidance makes clear that they can continue in their role even if the resident they are visiting has COVID-19.
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, taking further steps to reduce infection risks to themselves and others, and staying 2 meters away from staff/other residents. 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.
Does my Essential Caregiver have to be the same person as my nominated visitor?
No. The guidance states that this role is “in addition to” the single named visitor.
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. There is no mention of this in the guidance. On the contrary, the tone and thrust of the guidance is that the Essential Caregiver role should be available for as long as the resident wants it and the person is willing to perform it. It is hoped that residents’ wellbeing will markedly improve after being given access to Essential Caregivers. This should in no way be interpreted as a marker to withdraw the support as no longer necessary. Rather it should be taken as a sign that the support is essential and should continue. Conversely, if access to an Essential Caregiver does not immediately result in improvements to residents’ 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 year. Residents and their relatives/friends may need support to understand and come to terms with this.
Is this how my access to relatives/friends will be facilitated in the long-term?
It is important to remember that the visiting guidance is a temporary solution to the immediate COVID-19 crisis. We all want to see the restrictions on access end as soon as possible. Care homes should return to an open door policy as soon as it is safe to do so, as part of the Government’s roadmap out of lockdown.
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/
A PDF version of the FAQs is available here.