Care homes and COVID-19: nurses need to work closely with families and ensure visits are as safe as possible

New guidance and effective infection control measures can reduce the risks to residents and staff

Most care homes closed their doors to visits from family members in March. This has had a significant and detrimental effect on the mental health of families and the residents themselves, particularly those with dementia.

Until recently, government guidance in England stated that care homes should conduct visits outside of the main building and in the open air where possible, or by using a glass or plastic barrier such as a window between the resident and their visitor. It also ruled out physical contact such as hugging and said visitors should maintain social distancing of two metres.

‘Care homes – where many older people choose to live to avoid isolation – risk becoming the epicentre of loneliness’

This guidance has just been updated and visits inside homes in all of England’s tiers can take place if the visitor can return a negative COVID-19 result on being tested.

Care home leaders now face complex challenges to reintroduce safe and meaningful visiting. Equally, nurses now have an opportunity to show their leadership by navigating these challenges safely through their expert knowledge of infection control practices and by working together with families who want to be with their loved ones.

At the onset of the pandemic, families accepted visiting restrictions as a sensible necessity to keep their loved ones safe, but as time has moved on the reality of being separated from people whose quality of life depends on family visits is all too apparent.

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Isolation, depression and confusion are all commonplace due to denied visits. As a consequence, care homes – where many older people choose to live to avoid isolation – risk becoming the epicentre of loneliness.

With Christmas looming, families, care home managers and nursing staff will now be seeking ways to enable family members to visit safely at a time when it has never mattered more for families to be together.

But just as nurses have a responsibility to protect those in their care from acquiring infection, managers also have a responsibility to protect their staff. Over 650 healthcare workers have died of COVID-19 in the UK, and many have contracted the virus in the workplace.

Ensuring healthcare staff are not exposed to unnecessary risk at work is essential as they battle through a second wave and various national lockdowns and restrictions.

‘We must not forget the critical role of infection prevention and control as an enabler to solutions’

Thankfully, solutions are coming. This week the government announced rapid testing of visitors is set to begin in care homes in England while staff will also be preparing to work with healthcare colleagues to distribute the first COVID-19 vaccines.

But, together with these welcome developments, we must not forget the critical role of infection prevention and control as an enabler to solutions rather than a barrier to them.

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In March, the management of COVID-19 presented new challenges for nurses. As clinical guidance changed and evolved rapidly, nurses needed to respond and learn quickly to interpret the guidance and adopt new practices such as wearing personal protective equipment (PPE).

Nine months on, nurses caring for older people have acquired a wealth of specialist knowledge about infection prevention and control, have shared advice and learning among their specialty and are in a very different position.

Despite the need for close physical contact when providing care, staff working in care homes have shown through their own practice that it is possible to protect their residents from COVID-19 infection.

COVID-19 infections in care homes have reduced significantly through homes following guidance on infection prevention and control, carrying out regular testing of staff and residents and staff wearing PPE. If staff can maintain these practices successfully it is possible for family members to do the same.

‘By working in partnership with families, there is an opportunity for families to form small support bubbles with loved ones’

Many family members live in small social bubbles, and with teaching and support would be able to observe infection prevention and control practices to the same standards as care home staff.

By working in partnership with families who are concerned about infection risks, there is an opportunity for families to form small support bubbles with loved ones – isolating in their own homes but having more freedom to spend time in the care home.

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If a family member isolates or has limited contacts outside of the care home, is tested for COVID-19 as set out in the new government guidance, and follows care home guidance for all infection prevention and control processes, it is possible to keep risks of infection low. This may not suit all families or be possible for those who live in larger households who are unable to isolate themselves.

But for many others, who live alone or in small households with little external interaction, this may be a way forward until the new vaccines can be rolled out fully.

Family members who are desperate to visit their loved ones would not knowingly put them at risk. Nurse leaders now have an opportunity to work closely with families by providing clear ground rules and guidance and building trusting and honest relationships to support these vital visits to take place.

Emily McWhirter, @McWhirterEmily, was the director of nursing at the Royal Hospital for Neuro-disability, London, until September 2020 and is now an independent nurse consultant

Find out more

• Department of Health and Social Care (2020) Visiting Care Homes During COVID-19