The Minister for Health, Stephen Donnelly TD and the Minister for Mental Health and Older People, Mary Butler TD, have welcomed the approval by the National Public Health Emergency Team (NPHET) of revised Health Protection Surveillance Centre (HPSC) COVID-19 Guidance on visitations to Long Term Residential Care Facilities. The new guidance will come into effect on 4th May.

The COVID-19 pandemic has had a profound impact across society, especially for older people. It is recognised that the necessary public health protective measures, such as restrictions to visitations in long term residential care facilities has effects on the social, psychological and emotional well-being of residents and their families. The extensive provision of vaccines to nursing home residents brings great hope and is providing an opportunity for additional visits.

The revised visitation guidance continues to build on learning from the positive impact of the vaccine rollout nationally and internationally and will provide a further easing of visiting restrictions as we continue to see huge benefits from the vaccine roll out across the community.

Residents may now be facilitated to receive four routine visits per week. This will be possible following two weeks after the full vaccination of approximately 8 out of 10 of all residents in the nursing home. Otherwise, two visits per week should be facilitated.  The duration of visits should be appropriate to the needs of the resident and should not be less than one hour. Where there is high vaccine coverage, 2 people may visit at a time but there is no requirement to limit the number of nominated visitors.

The increased level of visiting provided for under the new guidance follows the move to two visits per week announced last month.

Most nursing home residents are now fully vaccinated against COVID-19 and, in recognition of this, and the increasing evidence of the protection conferred by full vaccination, new guidance has been developed that further expands the scope of visiting. Although the situation in nursing homes has greatly improved, the risk associated with COVID-19 remains very real. There is still a risk of introduction of infection, including the possibility of a new variant of COVID-19. There is a particular concern about the possibility of introducing a new variant, against which the vaccine may be less effective.  Therefore, caution remains appropriate.

At all times vigilance on the general infection prevention and control measures must be maintained and we must continue to follow public health advice, including when visiting, to reduce the spread of COVID-19 and protect those living in our communities. The guidance will be kept under continuing review as new evidence and data emerges.

Following the approval of the new guidance, Minister Donnelly said:

The most recent guidance, published in March, paved the way for a return to visiting our loved ones in nursing homes and has given great joy and hope to nursing home residents and their families and friends. And now, with the further benefit of full vaccination for so many nursing home residents, it is a very welcome step, through this new guidance, that there is a return to more normalised visiting for nursing home residents.

The experience associated with this pandemic has been and continues to be difficult and has been acutely felt by those living in nursing homes. Through the necessary measures to protect one another from the virus, we have also all experienced the loss of important social connections with loved ones, a loss which has been particularly felt by our family and friends in nursing homes.

Meaningful contact with family and friends, which is so important to our wellbeing, is something that we have striven to provide as safely as possible. With high levels of vaccination having now been achieved in many nursing homes, it is really encouraging news that this also brings the chance for nursing home residents to have more opportunities for that meaningful contact.

Welcoming the new guidance, Minister Butler said:

There is no doubt that the last 14 months have been incredibly difficult and challenging for nursing home staff, residents and their families and the sacrifices made have been enormous. I would like to acknowledge and thank nursing home staff for their tireless efforts and hard work in keeping people as safe as possible.

I understand that, for some, there may be apprehension about an increase in visiting, given the considerable challenges posed since the arrival of the pandemic. However, a balance must be struck between protecting residents and staff from the risk of COVID-19, and individual’s rights to visits from family and friends. Visiting, social connections and meaningful contacts are an inherent part of the wellbeing of residents and of the quality of care provided. With the benefit of the vaccine, regular visiting is now moving away from general and compassionate circumstances only, towards a more normalised situation.

The implementation of the new guidance from 4th May will allow time for nursing home service providers to communicate with families, book visits and prepare for additional visiting. I expect that all nursing home providers will facilitate visiting, to the greatest extent possible, in line with the new guidance announced today.

Notes

• 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 23rd February 2021. It sets out 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 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.
• Visiting restrictions are 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. The nursing home should have the capacity and relevant skill sets within its staffing complement to manage this appropriately.
• 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 to prevent introduction of COVID-19 into nursing homes. Although the situation has improved considerably there is a continuing risk even with vaccination of introduction of infection. There is a particular concern about the possibility of introducing a new variant that the vaccine does not protect against.
• 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 balancing the principle of a cautious approach to reopening with recognising the early data on the positive impacts of the vaccine.
• The guidance recognises the positive and continuing impact of the vaccine rollout, especially in nursing homes, with four visits per week now possible at all levels of the framework of restrictive measures, where 8 out of every 10 residents in the nursing home have been vaccinated. Aside from operational requirements, flexibility on the duration of visits is permitted and where such operational requirements exist, a minimum of one-hour visits should be facilitated. The guidance recommends that providers develop an individualised visiting plan for each resident as part of the resident’s overall care plan and the duration of visits should be appropriate to the needs of the resident.
• 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 (for example death of a spouse or birthday).
• The guidance also re-states the existing position that there are very limited, if any, circumstances, including outbreaks, in which outdoor or window visiting should be suspended on infection prevention and control grounds.
• 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. 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 include measures to support those which have outbreaks of COVID-19 and measures aimed at breaking the chain of transmission of the virus. These supports include 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; 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 €86.4m in additional funding support provided thus far (including an additional one-off grant for visiting infrastructure) – The Scheme is open until 30th June 2021; Temporary accommodation to nursing home staff to support measures to block the chain of transmission; HIQA COVID-19 quality assurance regulatory framework.

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