Background
It is expected that 4% of those people who will be discharged from hospital under the NHS’s new Covid-19 Discharge Service will require on-going care and will be discharged therefore to appropriate care homes with vacant beds. It is possible that people will be placed ‘out of area’ due to demand and availability of beds.
People who require discharge to a care setting will either not have Covd-19 or will be recovering from Covid-19 but not considered to need acute care.
Full background information can be found in The NHS Covid-19 Hospital Discharge Service Requirements here.
What is the risk?
All people being admitted to a care home would obviously undergo the normal assessments, although in the case of someone with Covid-19, there is a risk that they could possibly infect any person in the care home that they come into close contact with.
What is the procedure?
There are a number of actions that can be undertaken to prepare the care home for Covid-19 admissions, as well as procedures that can be followed when an infected person is resident. These are not significantly different from procedures usually undertaken when there is an outbreak of flu in a care home or another transmissible sickness.
Preparation
One of the first things to prepare is your staff’s knowledge of Covid-19 or Coronavirus.
Training
All staff need to receive up to date training on Covid-19, its symptoms, methods of transmission, effects, impact and duration. A set of accurate guidance notes that portray only facts about the disease is essential.
The following are all on-line Covid-19 training sessions for Health & Social Care staff:
There is also a mass of online guidance, particularly from:
The client or service user's room
Try to identify a specific room for the person to be admitted - Single en-suite rooms work best. If no en-suite rooms are available, consider having a dedicated commode and creating arrangements for appropriately disposing of the bedpan and cleaning it thoroughly. Ensure the whole room is meticulously cleaned ahead of admission and throughout the person’s stay. Ensure it is clearly identified from the outside to anyone passing it, by labelling the door. Ensure that no-one enters the room unless authorised to do so and that all staff are clear what the room’s purpose is. A separate risk assessment may be required for anyone who wanders around the home, as they may inadvertently wander into the quarantine room.
Staffing rotas
should be adjusted so that as few different staff members as possible provide care for the person, thus limiting the number of people exposed to possible infection.
Ordering of PPE
Try to order more than normal amounts of full PPE (see below for examples). This may not be easy to get hold of, however. As a registered service, you can try the hotline also:
The National Supply Disruption line
Tel: 0800 915 9964
During the admission
Cleaning
Adopt more stringent than normal infection control procedures, not only for the entire room, but also for anything that goes into or out of the room – furniture, cutlery, crockery, clothing or laundry etc. Anything touched by the person or anything worn by staff must be bagged and disposed of or scrupulously washed after every intervention with the person.
Personal Protective Equipment (PPE)
Any person entering the room must have appropriate PPE – mask, gloves, apron and shoe covers and eye protection if necessary (i.e. Type IIR masks). Personal care should only be undertaken with full PPE. All PPE must be bagged and safely disposed of after every intervention as if it were clinical waste.
Visitors
To the home should only be allowed by exception and in the most urgent of circumstances.
Meals
For the person infected should be taken into the room by PPE protected staff. All PPE should be bagged and disposed of afterwards and the implements used during the meal washed separately from any others in a machine at the highest possible temperatures. Ensure only the person infected uses those implements.
Isolation
The person admitted will need to be isolated until they have fully recovered from the virus. That does mean they are unlikely to be able to move around the home and go outside, unless their room or part of the building has a separate entrance to a garden for example.
Deaths
In the sad, but hopefully unlikely event that the person admitted may die, ensure you follow the guidance from the government here: https://www.gov.uk/government/publications/covid-19-guidance-for-care-of-the-deceased/guidance-for-care-of-the-deceased-with-suspected-or-confirmed-coronavirus-covid-19