Find out how we are working together to support visits to care homes and other settings during coronavirus.
Making sure that residents in care settings across the county and their families can keep in touch during coronavirus is vital for physical and mental wellbeing. But we know that we must act now to save lives and limit the spread of the virus as much as possible.
With cases rising, and some residents of our care settings being among the most vulnerable, we wrote to all care providers asking them to stop visits from 1 October, which would be reviewed before the end of the month.
Thank you to all colleagues for your response to protect care home residents and staff as the Covid-19 infection rates rise across North Yorkshire and around the UK.
Last Friday, I wrote to you to update about a number of issues, including the steps that the County Council and NHS partners are taking; potential funding; new Government policy announcements; and updates on PPE and testing. I also requested that all provider colleagues take further steps around Covid security and a recommendation that, in three districts (Harrogate, Scarborough and Selby), providers should put restrictions should in place for care home visiting, with the exception of visits to people who are nearing the end of their lives. I said that these arrangements would be in place until 30th September 2020.
I am grateful for your feedback and ideas in response to that letter. I have had a number of conversations with provider colleagues as well as with some care home residents and their relatives. I have also held the first of our weekly NY Care Connected webinar sessions and we have had some discussions about this issue there, too.
I am writing to you today to update you further.
Care home and supported living visiting
Infection rates have increased again in the last week and whilst we have a good overview of outbreaks and are working hard to contain and manage them, including within the care sector, the overall rates within the community are worrying and we are
seeing household and community transmission. Infection levels are evenly spread across 5 of the 7 districts within the County, with Craven being higher and Ryedale lower. At this stage, the virus is mainly presenting amongst people aged under 60: however, this creates a real challenge in terms of staffing for care services and continuing with normal visiting within care homes.
The Director of Public Health’s advice is that care homes and supported living schemes should now cease routine visiting (except for people who are near the end of their lives) across the County and that we should do so for a fixed period of time, so that we can:
- Protect people early on as cases and hospital admissions increase
- Review Covid security for care home visits, as part of the task group I announced last week and see what, if anything, we can do to provide Covid-secure visiting options that meet the imperative of protecting people from the virus and ensuring that residents and families can keep in touch
Our strong preference would be to have a locally responsive, Covid-secure approach that allows visiting to continue. Given the current capacity issues with the national testing programme, a more flexible approach, which could test regular named visitors, is difficult to guarantee at the present time and, therefore, reluctantly, we are introducing more stringent measures for the time-being.
I am writing to advise and recommend that all residential and nursing homes and supporting living schemes in all parts of the County:
- Cease routine visiting (except for people who are near the end of their lives and for essential visits by NHS and social care practitioners) with effect from 00:00 on Thursday 1st October – this timescale gives you time to prepare residents and to enable weekend visits to take place
- Continue window visits for all residents so that family members and residents can still see each other face to face
- Encourage remote contact by telephone and other technology
We recommend and advise that these arrangements should be in place until 31st October 2020 and that during this time we will assess them in the context of 1) the infection and outbreak rates and the prevalence of the virus and 2) assurance about any alternative measures which could help providers to re-introduce some form of visiting throughout the Winter in a safe and secure way
Please take this letter as our advice and recommendations to prepare for restrictions to be in place from 1st October. In the meantime, please ensure that indoor visits over the next few days are planned and managed well, to ensure the maximum protection from the risk of Covid.
During October, we would advise that visits can still continue for people who are, sadly, near the end of their lives and for individuals who need support from an NHS or social care professional. In both situations, national rules around hand-washing, face masks, PPE, distancing and other requirements need to be followed.
We will issue further advice about other activities such as hairdresser visits into a home but we would recommend that you to restrict these to a minimum where possible for the time being.
We would also recommend that you do make arrangements for regular window visits to continue during this time as well as increased contact via technology.
Care home and supported living residents’ trips into the community
At the same time we are recommending that you reduce, and make more Covid-secure, any visits by residents into the local community. Ideally, any trips should be in open space and socially distanced, for exercise and fresh air. People are advised to wear face coverings where they are able to do so and to be vigilant when in the community.
We will be reviewing the situation with regard to visits to, and from, extra care schemes and we will issue further advice in the near future. For the time being, however, we are not recommending restrictions to visiting in extra care schemes or to trips out by extra care residents. The reason for the difference is that people live in their own self-contained apartments. However, we would advise all schemes to consider, and prepare for, further potential restrictions; to enhance their Covid security; and to plan the flow in and out of buildings to reduce the risks.
We are still awaiting the detailed guidance on the next round of the national Infection Prevention and Control Fund. We will contact you as soon as further information is available and we will be keen to get money out to providers at the earliest opportunity.
We have also reviewed our North Yorkshire additional Covid payments and can confirm that we will extend these for a further 4 weeks at the 2.5% premium that has been paid to eligible providers during September (having tapered from 5% earlier in the year) and we will keep this arrangement under review. PPE will also be provided nationally on a free basis to care providers.
As mentioned in my letter last week, we will continue to support you as much as we can. A mix of daily calls and daily electronic contacts are in place. We are continuing to offer webinars with practical advice and training. And there is an open invitation to a weekly briefing, NY Care Connected, every Wednesday at 5pm.
A number of our teams are also available to help and our Quality Improvement Team,
alongside NHS colleagues, will be undertaking drop-ins and are available to provide practical help.
Thank you for all that you are doing.
Dear residents, families and friends,
I am writing to you about recent advice that I gave to residential and nursing homes and supported living schemes about visiting for people who live in care. I know many people have been affected by this, and I want to be clear with you about why this advice was given and what we are doing to see how visiting can continue in some way in the future.
I know that 2020 has been a difficult time for many people living in care and for your loved ones, family and friends. The initial lockdown earlier this year meant that personal visits were, at best, limited to window visits or use of technology. I know many people were greatly relieved when personal visits were able to start again through the summer, although I am also aware that this has not happened in all places. I would like to thank you and colleagues in the care provider sector for the way that you have supported these Covid-safe measures for opening up visits in care home gardens and other spaces.
Sadly, in the past month we have seen Covid-19 infection rates rising again across North Yorkshire and around the UK. This situation has seen a return to local lockdowns in some parts of the country including in neighbouring counties. Fortunately, we have not had any local lockdowns in North Yorkshire yet, but the situation is volatile. Transmission rates in the community are worrying and we are seeing enough to need to take further action.
In mid-September, I wrote to all care providers to update them on the situation and to ask them to consider visiting restrictions within the Harrogate, Scarborough and Selby districts for the period up until 30 September. As the infection rates continued to grow, the Director of Public Health advised that we should advise all homes to stop routine visiting temporarily across the County. This was a precautionary measure to protect people early on and to try avoid a repeat of the rapid increases in care home outbreaks that we saw earlier in the year. Consequently, I made the reluctant decision to advise homes that restrictions on visiting should be extended to the end of October.
The only exception is for people who are, sadly, near the end of their lives, and for essential visits by NHS and social care practitioners. In both cases, practice around hand washing, use of face masks, PPE, distancing and other requirements must be followed.
Protecting care home residents and staff from Covid-19 is our absolute priority. However, we know that people’s mental health is also very important. I have heard directly from residents, families and friends impacted by these changes and I know from personal experience how important it is for people to have visits. I have advised that care providers continue window visits for all residents, where possible, so that people can still see each other face to face. This might mean less frequent, pre-booked visits, for example, so that everyone can have a window visit. I have also encouraged providers to support contact by telephone and other technology.
These arrangements will be in place until 31st October 2020. The decision about what happens after 31st October will depend on the infection rates and the prevalence of the virus. However, I want to assure you that we are looking very carefully at ways in which we could provide Covid-secure visiting options that protect people whilst still ensuring that they can keep in touch. I am very conscious, as the Prime Minister has said, that we could be living with Covid into the Spring of 2021 and so I would like to find a way forward, if national regulations allow, that supports safe visiting and protects residents.
My own preference is for regular Covid testing for designated visitors. However, given the current capacity issues with the national testing programme, it is difficult right now to guarantee that this approach will be practicable.
We have also asked care providers to reduce, and make more Covid-secure, any visits by residents into the local community. Ideally, any trips should be in open space and socially distanced, for exercise and fresh air. People should wear face coverings where they are able to do so and be vigilant when in the community.
For the time being, we are not advising restrictions to visiting in Extra Care or to trips out by Extra Care residents. This is because people live in their own self-contained apartments. However, we have recommended all Extra Care schemes to consider and prepare their Covid security, including planning about the flow of people in and out of buildings to reduce the risks. We will continue to review visiting for Extra Care schemes and we will issue further advice in the near future.
We are currently working with a task group of residents, relatives and care providers from across North Yorkshire. They are helping us better understand what works and what new ideas are possible to keep people connected. They are looking at visits to care homes and supported living schemes, as well as residents’ trips out into the community. I have asked that they report back to me with recommendations before the end of October.
I would like to thank you again for your understanding at this time around these difficult decisions. We will continue to work with you to support you and your loved ones and I will keep in touch with you about these developments.
Richard Webb, Corporate Director Health and Adult Services
On 30 October, new advice was released, with visits to care settings permitted as long as the updated visiting guidelines were followed. We wrote to people in care settings, their families and providers, which you can see below, about the update.
Dear care providers, residents, families and friends,
Update on visiting for people who live in care settings
Further to my recent letter about visiting arrangements for people who live in care, I am writing to update the advice that North Yorkshire County Council is now sharing with all care providers, residents and their families and friends, with effect from 1 November 2020.
We have heard from and spoken with residents, family members and care providers about this issue this month and I know how difficult the past few weeks have been for many people.
As you know, we advised all care providers to stop visits in person in September. This was done out of concern for the rising infection numbers in the community. We simply could not risk a repeat of what happened earlier in the year when so many lives of people in care settings were lost due to Covid-19. I then asked that the advice be extended to 31 October, with a commitment to review the decision by the end of this month.
Since then our Public Health and adult social care teams have been working closely with care providers and NHS colleagues to understand the risks of this second wave, and how we can make sure that people are safe now, and throughout the winter. This work has included daily contact with care homes across the county, a weekly meeting for all care providers to share experiences and ideas, and additional support to individual providers.
It is important to say that the community infection rates are deeply concerning. Although North Yorkshire is currently at, or just under, the national average, we have continued to see infection rates increase overall. This past week we have seen a rise in cases of Covid-19 in North Yorkshire care homes. We cannot ignore the very real risk of more people dying or becoming very ill. It is clear that social distancing helps stop the virus passing to others. Because of this, the advice from the Director of Public Health is to continue to minimise physical contact with others. In terms of being able to see loved ones, this means using window visits, socially distanced outdoor catch-ups, phone calls and video chats as much as possible.
However, it is also clear that these arrangements do not work for many people. Not being able to have visits is causing distress for many residents and their families and friends. There are also very real concerns about the long-term mental and physical wellbeing of loved ones. We need a plan that allows people to stay safe and which also makes sure people are keeping in touch.
Consequently, following discussion with the Director of Public Health and taking into account changes to the UK Government advice on visiting, I feel able to update our advice to care providers.
Starting 1 November, in-person indoor visits to people living in care settings can re-start, providing that each service can demonstrate that visiting arrangements meet the current guidelines on visits as set out in the government’s update on policies for visiting arrangements in care homes. This includes visitors wearing PPE, following rules about hand washing, and maintaining social distance during the visit. This would be based on each resident having one agreed designated visitor. If that person is not available, care providers can work with families to allow a substitute visitor, as long as a risk assessment of the care setting’s ability to support visiting takes place.
Where a care home has an outbreak (two or more residents or staff with Covid), then sadly in-person visits will need to be suspended. Contact will be restricted to virtual contacts, phone calls and outdoor window visits, except for people nearing the end of their lives or for visits by health and social care professionals.
A small number of care providers in North Yorkshire are now supporting people who are Covid-positive to be discharged from hospital into a bed in a care setting when they are unable to return home. These beds are in separate parts of the care setting, have a dedicated staff of carers working there and have been inspected by the Care Quality Commission (CQC) as being Covid secure. People in these beds will not be able to have visitors as they will still be in the isolation period. Other residents in those homes will be able to have visitors as long as the home does not have an outbreak in its non-Covid accommodation.
Expectations around indoor visits
In setting out this advice, I am asking all care providers to ensure that every resident (except where there is an outbreak) has the opportunity to have at least 30 minutes face-to-face, in person, time with their designated visitor each week. This means a minimum of 30 minutes of time together. Time needed to clean and sanitise meeting spaces should be planned in addition to people’s face-to-face time. I would hope that many care providers will be able to find ways of offering longer meeting times than this minimum.
Meeting up outdoors
We have also been asked about people being able to meet loved ones outdoors. This might mean meeting up for a walk in the park, the countryside or along a beach. My advice is that if people limit the contact to a maximum of two people, avoid crowded spaces, keep physically distanced and take precautions such as wearing face coverings, then outdoor meetings are a good way of keeping in touch.
I hope that this news brings some relief to those people who have not been able to see their families and friends. However, as winter approaches, I am aware that we will need to be creative and to find new and different ways for people to keep in touch.
To help with this work, I asked our team to bring together a task group of people who live in care, family member/friend representatives and care providers. The group included disabled people, younger and older people in care, parents and children of people in care, dementia advocates and service managers. Over three meetings in October, they shared how the restrictions on visiting are affecting them, and made suggestions about how people can stay in touch safely. This included stories about some very creative solutions by families and care providers to support Covid-safe visits over recent months.
The group has written up some recommendations and ideas for the county council to consider as part of work on a broader ‘Keeping in Touch’ plan. These are attached, and are available on the care visits during covid page of our website. They set out a broad range of practical actions for the county council, the care sector and the wider community so that we can all play a part in making sure people have contact with loved ones.
Having read your correspondence over recent weeks, I know that the points raised by the group will chime with many people. In particular, we are aware that people are concerned about what will happen for upcoming religious festivals, including Christmas. Although we cannot predict the rate of transmission for Covid in the months ahead, we will make sure that everyone has clear information about how to plan ahead.
I would like to thank the group for their commitment and hard work and their practical and helpful recommendations. I have shared these with the North Yorkshire County Council Management Board and our two Executive Members, who have asked us to work through all of the recommendations in the coming days and weeks. We will also keep supporting the task group to meet so we can be transparent and listen to people directly impacted by these issues. Updates will be posted to the care setting visits page on the North Yorkshire County Council website.
North Yorkshire MPs have also represented your views strongly in their conversations with the county council and are keen to see people protected and able to keep in touch with their families and friends. They have already joined me, the wider county council, the Independent Care Group and others to ask the government to support people living in care to keep in contact with their loved ones and to see if routine care home testing can be extended to designated visitors.
It is important to note that we are very dependent on the national picture, too. Since my last letter, the government has introduced the three-level structure for managing Covid restrictions in local areas. Although North Yorkshire is currently still in Level 1, if part, or all, of North Yorkshire, moves into a higher level of restrictions at any point then decisions about visiting may be taken out of our control. However, I have already alerted Public Health England that we would like to see a more flexible approach to care home keeping in touch arrangements than the current Level 2 and Level 3 restrictions allow.
Whilst North Yorkshire is currently in Level 1, I would encourage us all as a community to do all we can to keep the transmission rate down – in so doing, we make a big personal contribution to enabling care home residents and their families and friends to keep in touch in person. This includes hand washing, wearing face coverings, maintaining social distancing over two metres and reducing day-to-day contact with others. All of this will help keep us all safe and reduce the need to make any restrictions in the future.
Thank you all again for your understanding at this time around these difficult issues.
Corporate Director Health and Adult Services
In September we also set up a task group to see what could be done to support people who live in care to stay in touch with loved ones in a Covid-secure way. Members of the group include residents of care settings, family and care provider managers as well as our Health and Adult Services staff. Read about the first meeting of the task group.
In October the task group presented its recommendations to the county council. Read the task group report and recommendations or an easy read version of the report and recommendations.
You can read more about the changes, as well as the story of one of the members of the task group on our keeping in touch with people in care page.
Additional comments on the recommendations can be sent to HASCovidComms@northyorks.gov.uk.
We'll continue to work closely with care providers across the county and keep everyone up to date as the situation changes.