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Shielding the most vulnerable living in care homes during the coronavirus outbreak

Many providers will have heard the Prime Minister’s comments last week regarding the need to shield those most vulnerable to becoming seriously ill from the Coronavirus. In the main discussions have focussed on the measures to assist those living alone. Below we highlight the aspects of the guidance published by Public Health England, relevant to individuals with conditions which make them extremely clinically vulnerable or have received a letter from the NHS who are living in care homes.

Care providers should carefully discuss the guidance with the families, carers and specialist doctors caring for such vulnerable persons to ensure it is strictly adhered to.

What is shielding?

Shielding is a measure to protect those who are clinically extremely vulnerable by minimising all interaction between those who are extremely vulnerable and others. This means that those who are extremely vulnerable are advised that they should not leave their homes and avoid face to face contact for at least 12 weeks. Within their homes they should minimise all non-essential contact with others. Those who have an underlying health condition listed below, are advised that they are at very high risk of severe illness as a result of coronavirus requiring admission to hospital.

Who is considered to be extremely vulnerable?

The following are considered to be in this group (‘the vulnerable’).

  1. Solid organ transplant recipients.
  2. People with specific cancers:
  3. those with cancer undergoing active chemotherapy or radical radiotherapy for lung cancer
  4. people with cancers of the blood or bone marrow who are at any stage of treatment
  5. people having immunotherapy or other continuing antibody treatments for cancer
  6. people having other targeted cancer treatments which can affect the immune system
  7. people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
  8. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
  9. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
  10. People on immunosuppression therapies sufficient to significantly increase risk of infection.
  11. Women who are pregnant with significant heart disease, congenital or acquired.

The NHS is directly contacting people with these conditions to provide further advice. If providers do not receive letters for residents who they anticipate will fall into any of the above categories by Sunday 29 March 2020, they should consider contacting the resident’s GP or hospital clinician to discuss, in line with the guidance.

What providers need to know

Those who are vulnerable are advised to stay at home at all times and avoid any face-to-face contact for a period of at least 12 weeks from the day they receive their letter. This period of time could change.

People providing essential support such as healthcare, personal support with daily needs or social care should continue, but carers must stay away if they have any of the symptoms of coronavirus.

What measures are advised for the vulnerable?

  1. Strictly avoid contact with anyone displaying symptoms of coronavirus. These symptoms include high temperature and/or new and continuous cough.
  2. Do not leave the home.
  3. Do not attend any gatherings. This includes gatherings of friends and families.
  4. Do not go out for shopping, leisure or travel and, when arranging food or medication deliveries, these should be left at the door to minimise contact.
  5. Keep in touch using remote technology such as phone, internet, and social media. Providers should consider how they can facilitate this where possible. Telephone or online services should be utilised to contact GPs or other essential services.

What to do if others are living in the same premises?

  1. Minimise, as much as possible, the time others spend in shared spaces such as kitchens, bathrooms and sitting areas, and keep shared spaces well ventilated.
  2. Aim to keep 2 metres (3 steps) between those are who are being shielded and others.
  3. If toilets or bathrooms are shared with others, it is important that they are cleaned after use every time. Consider drawing up a rota for bathing, with the vulnerable residents using the facilities first.
  4. If kitchens are shared with others, those who are vulnerable should avoid using them while others are present. Where possible, those who are vulnerable should take their meals to eat in their own rooms. Providers should ensure appropriate risk assessments are in place for this and that any prescribed observation regimes continue. Use of a dishwasher to clean and thorough drying of crockery and utensils are both advised. If designated utensils are being used these should be dried with a separate tea towel.

What if the resident has a GP or hospital appointment during the shielding period?

Medical assistance should be accessed remotely, wherever possible. However, if a vulnerable resident has a scheduled hospital or other medical appointment during this period, their GP or specialist should be contacted to determine which of the appointments are absolutely essential.

What is the advice for visitors?

Regular visitors such as friends and family should be contacted to inform them that they should not visit during this time.

Coronavirus care plans for those who require shielding

Many providers will be developing specific policies and protocols to advise staff of the necessary operational changes in light of the evolving situation. Providers should consider the implementation of care plans for those who require shielding which detail the precise care arrangements required in the interim. The introduction of supplemental charts which capture how the risk is being managed will also assist providers’ understanding of whether the measures are proving effective.

Clearly the first step will be to identify those who are considered extremely vulnerable and thereafter to re-emphasise that those staff who are concerned that they are unwell with the virus should not attend work.

Should any provider require any further advice or support please do not hesitate to contact us.


Disclaimer

This briefing is for guidance purposes only. RadcliffesLeBrasseur LLP accepts no responsibility or liability whatsoever for any action taken or not taken in relation to this note and recommends that appropriate legal advice be taken having regard to a client's own particular circumstances.

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