Yesterday (2 April 2020) the Department of Health and Social Care, Public Health England, Care Quality Commission and NHS published their guidance for care home admissions and re-admissions during the COVID-19 outbreak. The document, Admission and Care of Residents during COVID-19 Incident in a Care Home, states that the care sector will be expected to play a vital role in accepting patients from hospitals during this pandemic – both allowing patients to recuperate in non-acute settings and ensuring hospitals have enough beds to treat acutely sick patients.
Focus on full capacity
Care homes are being asked to assist with the national effort by operating to their full capacity and accepting patients once they have been discharged from hospital. This new emphasis may be the result of homes previously refusing to accept elderly patients discharged from hospitals without testing, for fear of potentially exposing existing residents and staff to the virus.
All care homes are required to input data into the Capacity Tracker and keep it updated "as close to real time as practicable". This will track care home vacancies and bed capacity and will support system-wide bed and discharge planning. The government have also confirmed that they will work with commissioners to ensure fair and prompt payment for the existing care commitments and additional care provided during the response to the pandemic, recognising that both PPE and staffing costs will be higher than usual.
Guidance on accepting patients
The guidance provides advice on receiving patients who are discharged from hospital, and highlights that some patients being admitted may be COVID-19 positive, whether symptomatic or asymptomatic. The guidance goes on to state that:
- If an individual has no COVID-19 symptoms or has tested positive for COVID-19 but is no longer showing symptoms and has completed their isolation period, then care should be provided as normal.
- Care homes may receive residents who have previously tested positive for COVID-19, are no longer showing symptoms, but have not yet competed isolation. In these circumstances, care should be provided in isolation.
- The Hospital Discharge Service and staff will clarify with care homes the COVID-19 status of an individual and any symptoms during the process of transfer from a hospital to a care home. Tests will primarily be given to patients in critical care or requiring admission to hospital for pneumonia, acute respiratory distress syndrome, or flu like illnesses, or where an outbreak has occurred in a residential or care setting.
- However, the advice is clear that negative tests are not required prior to transfers/admissions into the care home.
The industry response
The Government's approach has so far been met with criticism from the care sector, with providers raising concerns that they are being put under pressure to admit residents who are either possibly or confirmed positive for COVID-19. Significant concerns remain around how care homes can maintain the safety of existing residents, and how social distancing and shielding guidance is followed when caring for high need residents.
The Government's guidance notes that whilst patients may be returned to a social care setting with suspected or confirmed COVID-19, "all of these patients can be safely cared for in a care home if this guidance is followed". The guidance (which is available in full here) goes on to provide guidance in respect of caring for residents (depending on their COVID-19 status), advice for staff, and infection control and PPE measures that should be adopted. We will be publishing articles about this guidance in due course.
Care providers will no doubt be concerned about accepting new residents during this time, and providing ongoing safe, effective and caring service to all residents irrespective of their COVID-19 status. Provider concerns will undoubtedly also extend to the health, safety and welfare of their staff and how they can best protect them. If you would like further information with regards to these issues, or require input from our specialist regulatory healthcare team, please do not hesitate to get in touch with Vikki Woodfine and Kate Kay.