How are care homes changing during coronavirus?

Care homes have been responding quickly to coronavirus – and need to continue to do so as government guidance changes. You may well be anxious about a person living in a care home. Read our advice for friends and family, and speak to the home about updates and any concerns.

Staff are working hard to keep coronavirus out of care homes, and protect residents, visitors and staff from getting the virus if someone has it.

While doing this, staff will also be working to limit the impact of restrictions for people living in the home. This can be a difficult balance to achieve.

Talk to care home staff about any of the below topics or if you have other concerns. They can’t share details about other residents but should explain how they’re controlling coronavirus while maintaining the wellbeing of residents, staff and any visitors.

Personal protective equipment (PPE) and good hygiene

Because of the way coronavirus spreads, care home staff are wearing personal protective equipment (gloves, plastic apron and face mask) when carrying out personal care such as washing or dressing on all residents. Staff will also follow strict hand and respiratory hygiene practice – for example, frequent hand washing. 

Shared areas are being cleaned more often to kill any virus on surfaces, such as tables or chairs. Natural ventilation from safely open windows also helps to reduce the risk of the virus spreading. All of this is recommended even if there is no known coronavirus in the home.

When care home staff are wearing masks, this may be unsettling for people with dementia who can’t see familiar faces. Staff will be reassuring and may attach a labelled photo of themselves to their front, to make it easier for people to see who they are.

The effects of social distancing in care homes

Care homes have found creative ways to promote wellbeing while keeping residents at a safe distance from each other. These include:

  • allowing more distance between people during group activities
  • greater use of outdoor or garden areas – for example, for safe exercise or entertainment 
  • staggered mealtimes – so people can sit down with more spacing.

If changes to the person’s normal routine reduce their stimulation or social contact, they may feel low or sad. Where people are asked to eat alone in their rooms they may eat and drink less. A person’s dementia may make the changes harder to understand and cause agitation, irritability or anxiety. 

Keeping in touch with the person, even if you can’t visit, may help to reduce these problems. Talk to the care home about how you can do this.

Changes to visiting arrangements

Care homes have had to severely limit visiting to try to keep the virus out. These restrictions have probably been one of the hardest things to cope with. It’s normal to worry when you can’t see the person.

Some people with dementia and those close to them have found that alternative means of contact – such as phone or video calls – work well enough. For others, they might not. 

Read our advice on supporting a person in a care home.

Testing for coronavirus

Testing for coronavirus is now being extended to care homes. It is the only way to be sure who is or is not infected. Going on a person’s symptoms alone only allows a ‘suspected’ diagnosis of COVID-19, and not everyone with the virus has obvious or any symptoms. 

Everyone leaving hospital will now be tested before they come into a care home. The hospital will send the test results to the care home. As a precaution, the person will be isolated in their own room for 14 days. 

Care homes are moving towards regular testing of all residents and staff ('whole care home testing'), whether they have symptoms or not. The home then know which residents to isolate and which staff are OK to continue to work.

Rapid on-site testing of designated family visitors is also now being rolled out. Coupled with the above measures and new guidance, this testing should make it much easier for indoor visits to be arranged.

Coronavirus vaccination

Under the national COVID-19 vaccination programme, care home residents and staff have been among the first groups to be offered a vaccine.

The coronavirus vaccines need two doses and a few weeks to have their full effect. Together with other measures such as handwashing and wearing PPE, they are an important way of protecting the care home community from the risks of coronavirus.

Checking for symptoms of COVID-19 

Care home staff check all residents twice daily for symptoms of COVID-19. These may be a cough or fever, but are more likely to be ‘atypical’ symptoms of coronavirus (for example, delirium, loss of appetite, diarrhoea).

Where possible, staff are also checking people’s ‘vital signs’ (for example, temperature and heart rate) and their blood oxygen levels with a simple pulse oximeter. Low blood oxygen in an older person can be a better sign of severe COVID-19 than any other symptoms.

Read more about what happens if a person in a care home gets ill with coronavirus.

Isolating residents with coronavirus

To help prevent the virus spreading, care homes have had to isolate any resident who is suspected of having the coronavirus infection (from symptoms) or confirmed (by a virus test).

A home will need to isolate just a single person with coronavirus in their own room. Here, staff in PPE provide support such as with activities or eating – that would normally take place in shared areas of the home.

A person with dementia may find isolation like this particularly difficult. They may not understand or may forget that they need to stay in their room. Or they may be used to walking about. The home may be able to support them to do this safely.

Where the home layout allows it, and there are several residents with coronavirus, some homes are separating people into different ‘zones’ for those with and without coronavirus. Different staff may then support people living in each zone. This will mean moving some people from their usual room, so will not be done lightly – rather, if it is the best option.

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