Policy briefing

COVID-19: how to make personal protective equipment less daunting for people with learning disabilities

Public Health England has issued guidance on personal protective equipment for staff in care homes supporting people with learning disabilities and/or autism

Picture: iStock

Essential information

Evidence shows people with learning disabilities and/or autism are often at a higher risk of respiratory illnesses.

An analysis published by the Care Quality Commission in June showed a rise in the number of death notifications of people with a learning disability and/or autism in a care home setting.

The data showed 386 people died in England in April and May 2020, compared with 165 in the same period last year. Some 206 of these deaths were as a result of suspected or confirmed COVID-19.

Personal protective equipment (PPE) is an important way for staff to protect themselves and those in their care from COVID-19. Yet new guidance from Public Health England (PHE) says that because some people with limited language capacity or impaired hearing depend on looking at the facial expressions of carers for communication, face masks can provoke anxiety or distress. This can sometimes lead to behaviour by service users that may cause harm to themselves or others, PHE says.

People with autism may also become upset by changes in routine. In practical terms, service users may have difficulty recognising familiar faces, while non-verbal communication is harder, especially for those who rely on seeing their carers’ facial expressions.

What the new guidance says

In June, PHE updated its guidance on PPE for those working in care homes, with a section specifically aimed at those providing support to people with learning disabilities and/or autism.

This says that anyone with new symptoms suggestive of COVID-19 must be treated as potentially having the virus and should ideally be isolated from other residents.

Picture: iStock

Care home staff should explain that isolation is not a punishment, but is to try to prevent others from becoming ill. They should also develop contingency plans, especially for those for whom this may cause serious difficulties.

The guidance also includes suggestions on making PPE less frightening, specifically:

  • Before meeting a service user, first greet them through a window while not wearing a mask.
  • Explain that the mask is to help everyone stay safe and is now part of regular clothing.
  • Wear disposable badges featuring pictures that show staff without masks.
  • Make masks as part of an art session, with a choice of colours and fabric designs.
  • Normalise mask wearing, such as by putting masks on any soft toys in the home.
  • Play a game in which service users have to guess people’s expressions behind their masks.
  • Use the Makaton language programme, British Sign Language or shared non-verbal signals for expressions usually read from faces.
  • Develop a 'matching pairs' game with pictures of people with and without their masks.
  • Praise people when they ask questions about the masks.
  • Consider changing staff photos on noticeboards to show them wearing masks.

Implications for nurses

A small number of individuals may still have difficulty in accepting staff wearing PPE, says the guidance. Comprehensive risk assessments should be undertaken, identifying whether risks involved in wearing masks – including forceful outbursts with potential injury and the effects on physical and mental well-being – are greater than those involved in not wearing them. Decisions not to use PPE should be kept under review as alternative solutions that might allow its introduction are sought.

Managers should also consider the risks to staff, including any characteristics or conditions that could make them more vulnerable to the virus, reassigning staff where necessary.

Expert comment

Jonathan Beebee

Jonathan Beebee, chief enablement officer and nurse consultant with PBS4, and RCN learning disability nursing forum chair

'As the Care Quality Commission research shows, we know that people with learning disabilities are more vulnerable to the coronavirus. They could be hit very hard if we don’t follow guidance and use personal protective equipment (PPE) where needed. But often carers are in a difficult position, thinking how to support people to use PPE.

‘This Public Health England guidance acknowledges the challenges we face and gives some practical suggestions.

'Learning disability nurses have to be creative in a person-centred way, thinking: "What do I need to do to make this happen for that individual?"

‘Using art sessions or games is something that learning disability nurses would endorse, with the guidance giving permission to use our creativity.'



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