The Minister for Mental Health and Older People, Mary Butler, T.D., welcomes the publication by the Health Protection Surveillance Centre (HPSC) of new COVID-19 Guidance on visitations to Long Term Residential Care Facilities. The new guidance aims to further support long-term residential care services (including nursing homes) and residents in planning visiting across all levels of the framework for restrictive measures in response to COVID-19 contained in the Government’s Resilience and Recovery 2020-2021: Plan for Living with COVID-19.
Welcoming the publication, Minister Butler said:
This is an important guidance document that provides pathways for safe visiting. We are all aware of the importance of continued social interaction and of the difficulties that have been experienced in maintaining these interactions in a safe manner, especially with older people and those who are medically vulnerable. It is critical that the right to have visitors is balanced with the need to ensure that visitations to nursing homes do not compromise overall resident care or adherence to requisite infection control procedures.
The new guidance provides enhanced detail and further clarity aimed at balancing protective public health measures and the mental health and wellbeing of residents and their contacts. Minister Butler continued:
To protect nursing home residents, especially those who are most vulnerable, the way in which nursing homes receive visitors will continue to reflect the changed environment in which we are living. However, the new guidance provides a clear and open framework for visiting. It provides guidance on the measures required to be adopted by nursing homes and by visitors to mitigate risks associated with visiting. It also re-emphasises that in circumstances where visiting may need to be restricted or suspended in nursing homes for the protection of residents and staff, alternative arrangements such as “window visiting” is acceptable across all 5 levels of the framework of restrictive measures, providing a nursing home can safely facilitate them, and that arrangements should be in place to support virtual visiting (telephone or video-link) to the greatest extent possible. Crucially, the guidance also provides further clarity on visiting in critical and compassionate circumstances, which is a key issue for residents and families.
I encourage all nursing homes to remain familiar with the latest public health advice and support, and to make every effort to continue to facilitate visitors in line with public health advice. While many nursing homes have shown great, innovative practice throughout the pandemic, I now urge all nursing homes to have plans in place for innovative, safe alternative visiting and communication arrangements for residents and their families and friends, during periods of enhanced protective measures.
The new COVID-19 Guidance on visitations to Long Term Residential Care Facilities is available on the HPSC website: www.hpsc.ie.
The ‘Resilience and Recovery Plan for Living with COVID-19’ is a cross-government approach to managing the pandemic for the coming months and was published on 15th September 2020.
The ‘Resilience and Recovery Plan for Living with COVID-19’ is a framework to provide clarity on what restrictive measures are appropriate around the country based on the pattern and progress of COVID-19 in a particular area at a particular time.
The system is communicated through a numbered system of alert Levels (from 1 to 5) with:
- Level 1 being the lowest and having the least amount of restrictive measures in place
- Level 5 being the highest and having the most restrictions in place
These Levels are applied to each county based on the current COVID-19 situation in each county. The Level in an area is determined by multiple factors, including the 14-day incidence rate of COVID-19 cases and other key indicators including hospitalisation, admissions to Intensive Care Units (ICU), community transmission rates and the profiles of those with the virus.
COVID-19 has a distinct presentation and impact on those over 70 or with certain underlying medical conditions. Older adults are more likely to already have underlying conditions such as cardiovascular disease, diabetes, or respiratory illness — comorbidities that are known to raise the risk of severe COVID-19 and COVID-19-related death. In addition, a likely weaker immune system makes it harder for older adults to fight off infection.
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. Those 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 is responsible 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 HSE’s Health Protection Surveillance Centre (HPSC) has developed this new guidance, which fully aligns with the 5 level framework of restrictive measures as outlined in the Government’s Living with COVID-19 Plan, to support long-term residential care providers in the discharge of their responsibilities and to support in the safe visiting, to the greatest extent possible, having regard for the challenging times in which we are living. The guidance provides public health support and advice for the 5 levels of restrictive measures, when outbreaks/clusters are being experienced and visiting in compassionate and critical circumstances. 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. They include measures to support facilities which have outbreaks of COVID-19, measures aimed at breaking the chain of transmission of the virus and support the provision of PPE and other protective measures.
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