Minister for Health, Stephen Donnelly TD and Minister for Mental Health and Older People, Mary Butler TD, have welcomed the publication of the new Health Protection Surveillance Centre (HPSC) COVID-19: Normalising Visiting in Long Term Residential Care Facilities (LTRCFs). This guidance will come into effect on 19 July.
COVID-19 cases and outbreaks in nursing homes are now at a very low level, largely due to the positive impact of the vaccination programme. The public health advice is to restore visiting to near normal in terms of frequency of visits in those settings with a high level of vaccination of residents as quickly as possible, while also recognising the need to remain cautious as we continue to deal with the evolving risks associated with COVID-19. The guidance will be kept under continuing review as new evidence and data emerges.
The new guidance provides that:
Providers should put in place the necessary measures to progress to more normalised visiting and visiting frequency as quickly as possible in line with public health guidance with no more than two visitors at any one time.
Routine visiting will no longer need to be scheduled in advance.
There is no requirement to have a list of nominated visitors.
The duration of the visit should not be limited.
Fewer restrictions will apply to residents going on outings or visits outside of the nursing home.
Visiting arrangements should continue to take account of general public health advice and the necessary infection prevention and control measures, to reduce the risk of introduction and spread of COVID-19 and protect those living in our communities. This is particularly important in the context of the increasing prevalence of the more transmissible Delta variant. This new variant poses a significant risk, in particular to those who are not yet fully protected though vaccination. Visitors are reminded of their responsibilities with regard to self-checks for COVID-19 in advance of visits, infection and prevention control and social interaction with all individuals, while in the nursing home.
Following the publication of the new guidance, Minister Donnelly said: “We have seen incremental changes over the last number of months to increase the opportunities to visit loved ones in nursing homes. Today, we are seeing yet another positive change with the opportunity for nursing home residents to further embrace the benefits of the vaccine programme.
“We have been living with this pandemic for 16 months now, and there is no doubt that it has been and continues to be a difficult experience, and one that has acutely impacted those living in nursing homes. I’m sure it will be considered a very welcome development for people living in nursing homes, and their friends and families.”
Welcoming the new guidance, Minister Butler said: “I am very pleased to be able to announce this new guidance today.
“Nursing home staff and residents, and their friends and families have made huge sacrifices over the last 16 months. People living in nursing homes and other residential care facilities have a right to maintain meaningful relationships with people who are important to them. Visiting is an essential part of that right.
“I expect that all nursing home providers will facilitate visiting, to the greatest extent possible, in line with the new guidance, and communicate early with residents and families on a clear plan towards more normalised visiting.”
Notes for Editors:
The Government’s revised plan for managing the virus ‘COVID-19 Resilience and Recovery 2021 – The Path Ahead ‘ is a cross-government approach to managing the pandemic for the coming months and was published on 23 February 2021. It sets out the approach to the next Phase.
COVID-19 is highly contagious and when it is circulating at high levels within the community, there is an increased risk that it will enter into nursing homes and other long-term residential care facilities. People in these settings are often very vulnerable to this virus and its effects, as well as the settings themselves posing risks in terms of infection control and prevention.
In order to reduce the risk of COVID-19 or other viral infections being transmitted to vulnerable populations, it may be necessary to reduce the number of visitors to long-term residential care facilities at certain critical times based on public health advice.
Visiting restrictions have been widely practiced internationally as a protective measure with some variations in how they are applied. However, as per regulatory requirements, visiting is part of the normal daily functioning of nursing homes. Therefore, the nursing home provider has a legal obligation for doing all that is practical to support safe visiting to the greatest extent possible. The nursing home should have the capacity and relevant skill sets within its staffing complement to manage this appropriately – this is a well-established legal obligation.
The surge in COVID-19 in January 2021 and the resulting harm to residents and staff is a reminder of the ongoing need for vigilance. While significant progress is being made in relation to the rollout of our vaccination programme, the prevalence of the more transmissible Delta variant is rapidly increasing in Ireland and this poses a significant risk, in particular to those who are not yet fully protected though vaccination.
The HSE’s Health Protection Surveillance Centre (HPSC) has developed this new guidance, which takes account of the benefits of vaccination, to support long-term residential care providers in the discharge of their responsibilities and to support safe visiting, to the greatest extent possible, having regard to the principle of a cautious approach to reopening.
The guidance recognises the positive and continuing impact of the vaccine rollout, especially in nursing homes, with a minimum of four visits per week now possible, where 8 out of every 10 residents in the nursing home have been vaccinated. The guidance recommends that providers develop an individualised visiting plan for each resident as part of the resident’s overall care plan.
There are additional specific critical and compassionate circumstances where there is no upper limit on the frequency or duration of visiting that is acceptable, subject to the ability of the nursing home to manage the visiting safely. These include, for example, circumstances in which end of life is imminent and when there is an exceptionally important life event for the resident.
The guidance notes that the target level of visiting, which should be achieved as quickly as is practically possible in the context of the assessed level of risk at the time, should be determined by the resident, in terms of the number and duration of visits. The guidance notes the particular risks and challenges that arise in the context of an open outbreak in a nursing home. Where there is an open outbreak, further public health measures are required, including limitations on visiting. The guidance outlines these measures.
The guidance also highlights the ongoing public health measures that are required in order to ensure visiting occur is in the safest way. Visitors are reminded of their responsibilities with regard to self-checks for COVID-19 and other viral infections in advance of visits, and infection and prevention control and social interaction with others other than the resident they are visiting whilst in the nursing home.
The revised guidance has been developed in consultation with key national stakeholders. The publication of this guidance also supports the implementation of recommendation 12.1 of the COVID-19 Nursing Homes Expert Panel Report.
Recognising the difficult landscape that COVID-19 has presented for long-term residential care settings, a series of enhanced measures have been agreed by the NPHET to provide support to these settings and these are currently being implemented by the HSE, HIQA and service providers. The substantial package of support measures for nursing homes includes measures to support those which have outbreaks of COVID-19 and measures aimed at breaking the chain of transmission of the virus. These supports encompass:
Enhanced HSE engagement;
Multidisciplinary clinical supports at CHO level through 23 COVID-19 Response Teams;
Supply of precautionary and enhanced PPE, free of charge;
Serial testing programme for all staff of nursing homes (implementation of serial testing is now evolving with changing epidemiological situations, risk profile, vaccination coverage and in line with public health advice);
Where possible, access to staff from community and acute hospitals;
Suite of focused public health guidance and training resources;
Temporary financial support scheme for private and voluntary nursing homes with over €109m in additional funding support (in excess of the approximate €1.4 billion provided to all providers through the Nursing Homes Support Scheme) thus far (including an additional one-off grant for visiting infrastructure) – the main Scheme closed on 30 June 2021, but the Ministers have secured sanction to maintain the outbreak assistance component of the Scheme to year end;
Temporary accommodation to nursing home staff to support measures to block the chain of transmission;
HIQA COVID-19 quality assurance regulatory framework.