Preparing to visit a person with dementia in a care home during coronavirus

Visits to care homes were restricted or not possible at the start of the pandemic. Now care homes are opening up again for indoor visits. Our advice here should help you prepare for visiting.

What does the latest guidance for care home visits say?

The government issues guidance on care home visits in England. The most recent update recognises the continued risk from coronavirus to care home staff, residents and visitors. But it also recognises the impact on residents, including many with dementia, of not having visits for so long – especially indoor visits and close contact.

Towards the end of 2020, it was getting easier for most care homes to open to visitors safely again. This was due to more help than they had previously with personal protective equipment (PPE) as well as increased regular testing for residents and staff. Infection control measures are also now well established.

The availability of rapid diagnostic tests (lateral flow tests) to detect coronavirus infection in family visitors made visiting easier. Now the vaccination of care home residents and staff against coronavirus provides even more protection.

The gradual easing of national restrictions includes updated guidance on care home visiting, effective from 12 April 2021 in England. This new guidance supports indoor visits by more people, including close contact in some cases, as well as visits outdoors or behind screens if appropriate. 

In all cases, you will need to book your visit in advance.

(Guidance for care homes in Wales and Northern Ireland is broadly similar.)

For more about how care homes are making decisions about opening, see our advice on keeping in touch with a person with dementia in a care home.

The home should show you their general visiting policy. The home should also agree a visiting plan with you as part of the person’s individual care plan. The visiting plan should be person-centred – it should look at their specific risks from the virus, as well as the risks to the person’s wellbeing due to not having visitors.

For a person with dementia, especially if they have struggled with remote contact, a lack of in-person visits (rather than virtual contact) may be making their dementia worse. It may also cause apathy, agitation and changes to their behaviour that might be challenging for them and other people. Talk to the home about the benefits to wellbeing that your visit could bring.

How do indoor and close contact visits work in care homes?

With indoor visits, two named visitors will be allowed to see the person regularly. The visitors will need to wear PPE – unless they are children aged under 11 – and they must follow rules that the home has set out to control infection.

For these visits there can be a minimum of physical contact, such as holding hands, but the visitors should not hug the person.

Importantly, the visitors will need to have a rapid test before every visit and be negative (uninfected) beforehand. They will not need to have been vaccinated against coronavirus, although the government strongly recommends vaccination for anyone offered it.

Where a resident has higher care needs, they can also have an essential care giver. This means that the care giver is critical to provide the person with practical, emotional or mental support in close contact with them. For example, the care giver might help with tasks (washing, dressing, encouraging the person to eat) when their absence would pose a risk to the resident’s wellbeing. Or a family member may be able to calm down challenging behaviour more easily than care home staff can.

The care home, family and resident will decide who qualifies as an essential care giver. There will usually be one named carer, but under exceptional circumstances there could be more. They will need to wear the same PPE as care home staff.

On testing, they will need to take a rapid flow test on the day, another test three of four days later, and a weekly PCR test. Results will need to be shared with the home.

Visiting at the end of life

There have always been exceptions to the rules for visits to someone who is nearing their end of life. They need not be limited to the very end of life but could be within their final months or weeks.

If you are visiting someone who is near the end of their life, the home should communicate clearly with you and involve you in all planning decisions. You will need to have a rapid diagnostic test before each visit, which must be negative for the virus (not infected). You should then be able to visit indoors.

Testing for coronavirus

The care home will set up a special area for rapid testing on arrival for visitors – to test for coronavirus. This will have a waiting area and a one-way system. Hand hygiene and social distancing will also be in place. You will need to wear PPE during testing, provided by the care home.

Care home staff will give you the result 30 minutes after you do the test, so you will need to be patient.

After a negative test result

If you test negative (not infected) then the home should enable you to visit indoors straight away. You will still need to follow good hand hygiene and social distancing around the home. It’s natural to want to hold hands, hug or cuddle or possibly provide personal care. If so, you will be helped by staff to put on PPE to make such contact safer. (It might still feel strange wearing a mask, to both you and the person with dementia. You can ask about a visor, but these don’t offer as much protection from coronavirus as a mask.)

After a positive test result

If you test positive (infected) with the rapid test you will not be able to visit that day. Instead you will need to go home straight away, self-isolate and take a second different kind of test that the home will give you. You should take this second test and post it off. Follow the advice with the test, but if the result of that comes back positive, your household will need to self-isolate.

How do outdoor and ‘screened’ visits work in care homes?

These visits are encouraged so that the resident can see a wider range of family and friends.

With outdoor visits, these must take place outside of the care home building. You will need to stay at least two metres apart. Being outside and socially distanced reduces the risk of coronavirus being spread. 

Depending on the home, its layout and the weather, for an outdoor visit you might be supported to:

  • chat through an open ground-floor window or patio door
  • meet in a gazebo, under an awning or similar
  • meet in a garden or marquee (or similar) space
  • have a ‘drive-through’ visit – where you talk through your open car window to the person sitting two metres away.

These options may work for you, but the guidance does acknowledge that they will not be appropriate for many residents during the winter months.

What is a 'screened' visit at a care home?

A ‘screened’ visit is when you meet from behind a screen in a temporary outdoor structure (sometimes called a ‘visiting pod’) or a conservatory. In a ‘screened’ visit:

  • you speak to the person from behind a see-through plastic screen – similar to those seen in supermarkets now
  • the space will be thoroughly cleaned between visits
  • expect the space to be well ventilated.

 For both outdoor and screened visits, visitors are limited. The home will allow a maximum of two visitors each time, where possible. You will need to wear PPE during the visit. But you will not need to have a rapid virus test first.

Your reunion

When you get to visit the person with dementia, your reunion may well be emotional. If it’s been a long time since they saw you – and if the person has memory problems, you may need to gently remind them who you are.

Familiar aspects of your appearance such as clothes, a hairstyle and perfume/aftershave that the person associates with you may help them to remember. The home may also have shown the person photos of you together and talked to them about you, to help with this.

You may need to mention coronavirus to explain why you couldn’t visit before. Talking about earlier times you’ve enjoyed together may be a way of keeping the conversation more cheerful. Speak clearly and louder than usual to be heard through your face covering.

Don’t be surprised if the person’s dementia has got worse since you last saw them or if they seem low. They may improve with ongoing support, and their feelings for you remain, even if they seem hidden.

Try to be flexible and work with everyone as best you can. Before you leave, arrange the next visit. This will give you and the person something to focus on and look forward to.

Dementia Connect support line
Our dementia advisers are here for you.
Visiting care homes during COVID-19

The Department of Health and Social Care has a downloadable one-page leaflet outlining the guidance.

Download guidance
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