5 March 2021:
R&RA is disappointed by new guidance on visiting published yesterday by the Government. It doesn’t go nearly far enough to provide older people with the support needed to protect their wellbeing, or to make sure meaningful visits become a reality. We have been campaigning to end isolation in care and for clear visiting guidance as a first step towards this. Sadly, the new guidance is unclear, at times confusing, full of caveats, and fails to provide the clear direction needed to ensure change happens. It seems to have no basis in the reality of what it is like to live or work in a care home. We will be producing a summary of the guidance and how it relates to other legal duties of care providers, to help families to understand and use it.
The guidance fundamentally misunderstands the kind of support people living in care need, particularly those with dementia and other conditions, and the role relatives/friends play in their lives. Allowing one person to visit and hold hands will be very welcome for some residents. But most people will need much more physical contact to protect their wellbeing. This should not be a tick-box exercise with a fixation on hand-holding at the expense of all the other types of contact and interactions necessary for protecting wellbeing.
People living in care have now faced a year of isolation, having a devastating impact on wellbeing. We know from our helpline callers how desperate people are to reconnect with their family and friends, rekindle lost relationships and memories, and get back to a life that’s worth living. The guidance is only a first step to making this happen.
The devil is in the detail
So, how does the detail of the guidance stack up against the six point plan we published about the change needed?
It is welcome that the Government has answered our call to allow essential caregivers access to help protect resident’s wellbeing. However, the definition of where this applies is much more restrictive than that already in use in Scotland. We are concerned this will lead to difficult conversations with care providers about who is able to gain access to provide this kind of support.
The guidance allows a single named visitor for face-to-face visits who are able to hold hands but not have close physical contact like hugging. Many of our helpline callers will welcome this as a first step to end isolation in care. But asking residents to choose a single person will lead to heart-breaking, difficult conversations at a time when residents have already faced so much and staff are already stretched. It is welcome that other visits (behind screens/windows/pods) can still take place with additional people but we know from our helpline that these kinds of visits simply don’t work for many residents with dementia, hearing problems and other conditions. On privacy, the guidance should have been much clearer that this is essential to protect people’s rights. On timed visits, again there is a lack of clear direction and understanding that flexibility on this is fundamental to protecting people’s wellbeing.
Very little has changed to this part of the guidance, other than adding links to NHS and BGS guidance on end of life. We remain concerned that end of life visits will continue to be granted by homes only at the very end of life.
There are welcome additions to the guidance about managing outbreaks, including a clear direction that blanket approaches are not appropriate and there should be discretion for care homes recognising individual circumstances/variations. It is also welcome that essential caregivers will continue to provide support during outbreaks. However, the definition of an outbreak, and when it is over, remain unchanged. We are concerned that this will continue to mean perpetual, rolling lockdowns for some homes, which risk keeping residents in permanent isolation.
R&RA had called for the new visiting rules to be mandatory, or for the Care Quality Commission to monitor compliance. Unfortunately neither route has been taken. We are concerned that the new guidance lacks the teeth necessary to ensure change happens on the ground. Instead the guidance continues to put the onus on care homes to decide how to implement but without providing the clarity and direction needed to make sure this happens.
No strategy has been produced on wider reopening of care homes, including ending restrictions on visits out or reinstating face-to-face contact with health practitioners and other professionals.
Contact our helpline for support on how to use the guidance to reunite your family here.
Read more detail about the change we called for in our six point plan here.
Support our work here.