How care homes are keeping residents safe and well during coronavirus

Care homes were affected significantly by coronavirus in the early stages of the pandemic. Read about how they have adapted and continue to work to keep residents safe and well.

As government guidance changed, care homes responded quickly to coronavirus over much of 2020. Staff continue to work hard to keep coronavirus out of care homes, and protect residents, visitors and staff from getting the virus.

While doing this, staff also work to limit the impact of restrictions for people living in the home and facilitate safe visiting – a difficult balance to achieve.

Personal protective equipment (PPE) and good hygiene

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

Shared areas are 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.

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. 

Visiting and keeping in touch with the person may help to reduce these problems – see below.

Visiting arrangements

At times during the pandemic, care homes had to stop or severely limit visiting to try to keep the virus out. These restrictions have probably been one of the hardest things to cope with for the person with dementia and their friends and family.

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. 

The gradual easing of national restrictions has meant that homes are now supporting safe face-to-face visits, supported by testing and other measures. You can read more about the current care home visiting guidance, including our advice on visiting a person with dementia in a care home during coronavirus.

Testing for coronavirus

Testing for coronavirus is the only way to be sure who is or is not infected, because not everyone with the virus has obvious or any symptoms. Read our advice on testing.

Everyone leaving hospital will now be tested with the PCR test before they are discharged into a care home. This includes people returning to a care home and those who are going into a care home for the first time.

If someone receives a positive test result (infected) before leaving hospital they will be sent to a designated setting for the isolation period. A designated setting has extra infection control measures in place to prevent the transfer of the virus. A negative test result (uninfected) means the person can be discharged directly to the care home but as a precaution they will be isolated in their own room for 14 days. 

Care homes should be able to access 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 visitors is also now available. Some care homes will accept proof of a negative test result taken before arrival at the care home. Coupled with the above measures and new guidance for visiting care homes, , this testing should make it much easier for indoor face-to-face visits to be arranged.

Coronavirus vaccination

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

The coronavirus vaccines need two doses for the highest level of protection 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.

NHS England reported in mid-June that over 90% of eligible residents and over 70% of staff in older adult care homes had received two doses of coronavirus vaccine.

Checking for symptoms of COVID-19 

Care home staff check all residents twice daily for symptoms of COVID-19. These may be a cough, fever or shortness of breath, but are more likely to be ‘atypical’ symptoms (for example, delirium, loss of appetite, reduced fluid intake or 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 to isolate any resident who is suspected of having the coronavirus infection from symptoms or confirmed (by a 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.

Current guidance suggests that if there are multiple cases of residents who have tested positive for coronavirus they should ideally be isolated in their own rooms. But if necessary, people can temporarily be placed in a shared room with others who also have the virus.

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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