Minister Butler welcomes updated Visiting Guidance for Nursing Homes

Minister for Mental Health and Older People, Mary Butler, has welcomed the publication of new guidance by the Health Protection Surveillance Centre (HPSC) COVID-19: Normalising Access in Long Term Residential Care Facilities (LTRCFs). This guidance comes into effect on 8 February.

Through the prioritisation of vaccination and booster programmes among nursing home residents and staff there have been very positive impacts in terms of reducing the level of infection and severity of disease.

In this context, the public health advice is to fully restore normal access to visiting, 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 review as new evidence and data emerges.

The guidance published this week specifically provides for:

• the minimum level of visiting should normally be daily visits by up to 2 people at one time
• the introduction of a “nominated support person”, for each resident who should normally have regular and unrestricted visiting access
• there will no longer be a need for visitors to show immunity through vaccination or previous infection

Welcoming the new guidance, Minister Butler said:

The guidance is available on the HPSC website.

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.

There has been significant progress in the roll out and uptake of vaccination and booster programmes in nursing homes; however, the prevalence of the more transmissible Omicron variant has posed a risk to nursing home residents.

The HSE’s Health Protection Surveillance Centre (HPSC) has developed this new guidance, which takes account of the removal of public health measures in the general public, whilst also recognising the need for continued vigilance and adherence to good infection prevention and control measures in healthcare settings such as nursing homes, due to the increased vulnerability of nursing home residents to the disease. The guidance supports long-term residential care providers in the discharge of their responsibilities and to support safe visiting, to the greatest extent possible, including through the provision of a minimum level of visiting, even in the event of an outbreak.

The guidance sets out minimum levels of visiting in nursing homes where there is no outbreak, with daily visits to be facilitated in these instances, and no limit on the maximum number of visits. The guidance also sets out a minimum level of visits where a nursing home is experiencing an outbreak, which is two visits per week with the same visitor. The guidance recommends that providers develop an individualised visiting plan for each resident as part of the resident’s overall care plan.

The guidance introduces a “nominated support person”. The nominated support person should normally have unrestricted access to the resident for most of the day. If is considered necessary to limit access in the morning or evening when staff and residents are occupied with getting up or preparing for bed, when then at a minimum the nominated support person should have access from at least mid-morning to late afternoon. This is in addition to and not instead of visitor access as outlined below. The nominated support person should comply with the infection prevention and control measures that apply to a visitor when they attend the LTRCF. This will further support the mental health and wellbeing and social connection for residents.

The guidance published this week also outlines that:

• unless specifically advised by public health, at an early stage of outbreak, the nominated support person should continue to have access to some part of each day. If a resident does not have a nominated support person, visiting should generally not be less than 2 visits per week by one person during an outbreak
• limitations on visiting should be justified by an up-to-date risk assessment and should be reassessed twice each week
• there should be no restrictions on movement of residents within the nursing home after going on outings or visits outside of the nursing home, unless a significant exposure risk occurred during the outing
• there will no longer be a need for visitors to show immunity through vaccination or previous infection
• in line with established guidance, there remains no infection prevention and control requirement to restrict window visits

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. While it is not a requirement for visiting, visitors are recommended to take an antigen test prior to visiting. Visitors should refrain from visiting if they have a positive test or experience symptoms.

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 have encompassed:

• enhanced HSE engagement
• multidisciplinary clinical supports at CHO level through 23 COVID-19 Response Teams
• supply of precautionary and enhanced PPE, free of charge, including provision of FFP2 masks for patient care activities
• 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 €122m in additional funding payments made to January 2022; the outbreak assistance is in place to March 2022
• temporary accommodation to nursing home staff to support measures to block the chain of transmission