The importance of face-to-face contact with our loved ones
Older people living in care homes, like all of us, benefit greatly from face-to-face contact with loved ones and friends, and care home visits play a crucial role in residents’ health and well-being, and their quality of life, particularly for those who are most vulnerable. Evidence shows, for example, that the progress of dementia is slowed down by this kind of contact, while a lack of connection can accelerate it.
It is also important to remember that ‘visiting’ often involves far more than just social interactions: many relatives and friends provide additional support to older people, such as spending time with them to help them to eat and drink sufficiently, or helping a loved one to communicate their wishes, supplementing the care available from staff.
When care home visits were suspended earlier this year as Wales went into lockdown, older people, their relatives and care home staff expressed significant concerns about the impact that a lack of visits was having on their loved ones, as captured in my recently published Care Home Voices report.
“If anything happens to me and I won’t be able to see my children again and that depresses me.” Care Home Resident
“Since lockdown my mum has gone downhill quite a bit. What is so upsetting is mum must be so confused and must feel that her family have abandoned her.” Relative
“Another impact it [isolation] has had is on the emotional well-being of our residents. Many feel that they have been abandoned by their family and cannot understand why we need to keep them away at the moment.” Care Home Manager
With a period of further uncertainty ahead of us, it is important to understand just how difficult lockdown and prolonged separation has been for many older people and their families, and the impact this has already had on the health and well-being of many care home residents. Alongside this, recognising the additional risks to people’s health and well-being that will be created should visits be stopped again will be crucial as difficult decisions are taken in the weeks and months ahead.
Guidance on care home visits
On August 28, the Welsh Government published updated guidance on enabling safe care home visiting. The guidance, drawn up in collaboration with stakeholders including the Older People’s Commissioner for Wales, provides advice on indoor visits, outdoor visits and enabling care home residents to go out into the community. It provides a framework to help to guide the decisions being made by care home providers, and includes a set of ethical principles to underpin decision-making.
Since the guidance was published more homes have been opening their doors to visitors and enabling older people and their loved ones to be reunited, sometimes after many months of separation.
The guidance indicated that if local rates of coronavirus transmission in the community and/or at a national level rose then visits may cease. This has now sadly happened. However, the principles that underpin the guidance – which include protecting people’s rights, involving individuals in decisions that affect them and ensuring that decisions are fair and proportionate – should still be used by care home providers to guide their actions and decisions.
Assessing risk on an individual basis
It is easy to understand why local outbreak teams and care home providers want to take every precaution they think necessary to protect older people living in care homes, and why a blanket ban on visiting, might seem appropriate under the current circumstances.
However, taking decisions in this way fails to account for the differences between individuals, and the differences between care homes, which could affect potential risks relating to visits significantly.
By taking a more individualised approach, and assessing the risk for people and places on a case-by-case basis, there could be opportunities to enable visits where it has been assessed that potential risks to residents and staff could be managed through measures such as the use of PPE, social distancing and hygiene measures, and holding visits in outdoor spaces.
It is crucial that the risks to residents and staff of potential Covid transmission due to visits are considered against the risk to older people living in care homes if their physical and mental health declines as a result of prolonged separation from those who mean most to them.
It is also important to recognise the wider impact that seeing this decline, which in some cases may be irreversible or result in a resident sadly passing away, will have on the mental health and well-being of relatives and friends, many of who will be older people themselves.
Moving forward: What needs to happen to enable safe care home visits in Wales?
This is an important question for us all, given the importance of face-to-face contact with those that matter most to us. These relationships matter to everyone, regardless of our age or where we live, and having opportunities to spend time with family and friends – to talk, laugh or to share our troubles and concerns – is crucial to sustain us.
Through the hard work and collaboration of care homes, public bodies, the Welsh Government and others, we had begun to see these opportunities being available again; we saw older people living in care homes being reunited with their family and friends.
The response to the rise in coronavirus cases in many parts of Wales has put a sudden stop to this in many areas, which I can understand given the tragic loss of life we saw in care homes throughout Wales earlier this year.
However, given the significant and long-term impact that the suspension of visiting will have on the health and well-being of older people living in care homes, we must question whether this approach is proportionate and justified.
We must also consider what steps could be taken, and the ways we can work together, to manage potential risks and enable visits to continue safely throughout Wales.
In order to determine the way forward, and the way we can ensure a more enabling approach, we need to find answers to a number of key questions:
- How can we ensure that the voices and experiences of older people living in care homes, and their families and friends, are captured and used to inform decisions being made by care home providers, and that they are involved in discussions about decisions that affect them?
- How can care homes be supported to manage the additional staff time and costs associated with arranging and coordinating visits?
- Could further training or support for care home staff ensure further improvements to infection control?
- Could increased testing capacity and faster turnaround times for test results prevent Covid outbreaks within care homes that may prevent visits from taking place?
- Could a family member be made a designated visitor with ‘key worker’ status so they could access regular testing, PPE and training needed to be able to visit their loved one safely? This has been suggested by carers of people living with dementia as a way to enable more frequent visits and allow them to continue to play an important part in their loved one’s care, to the benefit of the resident, the carer and the home.
- How can care homes be supported to make changes within their buildings or outdoors to enable safe visiting? Some homes have led the way and there is good practice to be drawn upon, but support and financial assistance may be needed in order to do this – a good investment given it seems likely that Covid will be with us for many more months to come.
- Could the Welsh Government offer public liability indemnity for care home providers and the care sector, similar to the indemnity it has provided to the NHS? Issues relating to insurance create pressures that impact on organisations that run care homes, which may lead to risk aversion around visiting.
- What data is publicly available that could support the management of risks relating to visiting?
By answering these questions and working together to explore the ways we can support a more enabling approach to care home visits, Wales has an opportunity to lead the way and demonstrate its compassion, solidarity and commitment to ensuring that people can remain connected to their loved ones. Whilst this will no doubt be challenging, it should be a priority for us as a society.