SAGE ADVOCACY RECOMMENDS THAT RESIDENTS AND FAMILIES ARE "WELL INFORMED" ABOUT CURRENT GUIDANCE ON VISITING NURSING HOMES March 26, 2021

Sage Advocacy recommends that nursing home residents and their families are well informed about the current guidance issued by the Health Protection Surveillance Centre (HPSC) on visiting nursing homes. 

See: Guidance on visits to RCF.pdf (hpsc.ie)

and also

visiting nursing homes and residential care facilities during COVID-19..pdf (hpsc.ie)

(Implementation date: 22.03.2021)

The guidance provides for increased visiting on general compassionate grounds at

levels 3, 4, 5 in the context of a high level of vaccination of residents and staff.

Here are 12 key points from the latest guidelines which may be helpful:

1: The latest guidance recognises the autonomy of residents in nursing homes. This includes their right to have visits to support meaningful contact with family members and also their right to decline visits. As part of this person-centred approach, timely communication in a manner appropriate to the individual resident will include an overview of the proposed visiting arrangements and any updates or changes.

2: Residents may receive two visits per week on general compassionate grounds once the nursing home has completed the vaccination schedule and there is a high level of vaccination in the facility – this means approximately about 8 out of every 10 residents and healthcare workers in the nursing home have been vaccinated.

3: Meaningful contact with family and friends is important at all times therefore there is a requirement for visiting on compassionate grounds in the absence of any specific circumstances. Where it is necessary for operational reasons to limit the duration of the visit the limit should not be less than 1 hour. If the resident and visitor are both vaccinated greater flexibility in relation to duration of visits is appropriate.

4: Where specific critical and compassionate grounds (see examples set out below) apply the duration and frequency of visiting should be as flexible as possible subject to the ability of the nursing home provider to manage the visiting safely.

Examples of specific critical and compassionate circumstances can include: circumstances in which end of life is imminent.  Circumstances in which a resident is significantly distressed or disturbed and although unable to express the desire for a visit there is reason to believe that a visit from a significant person may relieve distress. When there is an exceptionally important life event for the resident (for example death of a spouse or birthday).

5: Managing safe visiting requires that prospective visitors undertake to co-operate fully with measures required to ensure that visiting represents the lowest possible risk to all residents and staff. Visitors are required to perform hand hygiene and should generally wear a surgical mask during the visit. Testing of prospective visitors in advance of visiting is not required at present, however, this will be kept under review in line with emerging evidence.

6: It is essential that nursing home providers engage with residents, involve them in decision making and communicate clearly with each resident and relevant others regarding visiting policy including any restrictions that apply and the expected duration of restrictions. The communication should make it clear that only a very limited number of visitors can be in a nursing home facility at one time.

7: The development of an individualised visiting plan for reach resident, as part of a residents’ overall care plan, is recommended. This plan provides a basis for communication with each resident and relevant others. The needs of a spouse or other person who plays a key role in providing practical and emotional support for the resident needs particular consideration.

8: Window visiting and outdoor can be facilitated with very low risk at all Framework Levels and is always intended as a supplement to and not a substitute for indoor visiting.

9: Visits should take place either in the resident’s room if the room is a single room, or in the case of a multi-occupancy facility, in a room away from other people where distance can be maintained Visits should generally take place away from mealtimes however if a resident is taking a meal in their room and would like a visitor to assist them that can be facilitated.

10: Each resident should have nominated visitors for whom the nursing home has contact details. There is no requirement to limit the number of nominated visitors. The number of visits facilitated is independent of the number of nominated visitors for example a person may choose to have all their visits from one person or the same total number of visits rotated among the nominated visitor. The duration of the visit should be appropriate to the needs of the resident as identified in their visiting plan.

11: There is no infection prevention and control requirement to limit or restrict residents from receiving items such as books, magazines, confectionery, keepsakes or objects of religious or personal significance. The items should be clean on delivery but need not be new. There is no justification for restricting receipt of items offered to a resident to items acquired at a specific retailer or retailers. There is generally no requirement to store items for an extended period after delivery before they are given to the resident particularly when a resident has completed vaccination.

12: If there is an outbreak of Covid-19 in a nursing home indoor visiting and access will generally be suspended in the first instance with the exception of critical and compassionate circumstances.

When the situation has been evaluated by the outbreak control team and measures to control spread of infection are in place, family and friends should be advised that, subject to the capacity of available staff to manage, visiting will be facilitated to the greatest extent practical. At this stage of the outbreak, to promote wellbeing, up to one visit by one person per every two weeks should be facilitated on compassionate grounds for those residents who wish to receive visitors. During an ongoing outbreak where indoor visiting is limited based on a documented risk assessment and Public Health advice the limitations should be reviewed at least every 2 weeks.

Restrictions on visiting should be applied on the basis of Government policy, HPSC guidance and a documented risk assessment that is reviewed regularly in view of the evolving public health situation and new guidance.

If you require support or advocacy services in relation to the new HPSC guidance please get in contact with Sage Advocacy’s Nursing Home Residents – Family Forum either by calling: 1850 719400 or by emailing: familyforum@sageadvocacy.ie.