Guidelines for care homes for older people in the context of COVID-19

While older people in care homes are particularly vulnerable to COVID-19, there are steps that can be taken to reduce their risk, and to ensure they are well cared for and supported. Care home staff must also be looked after and must be equipped with information to protect themselves as well as those in their care.

The document includes information on personal behaviour, action to take inside the care home, interaction with the outside environment, management responsibilities, governance, and what to do if someone has COVID-19. These guidelines have been informed by experience in China, Korea and Japan.

1. Personal behaviour

• Staff, older residents and all visitors to care homes, including independent contractors should take precautions to protect themselves and those in their care from contracting COVID-19. These precautions include:

1. Washing hands with soap and water for at least 20 seconds
2. Using alcohol-based hand rub
3. Sneezing or coughing into a tissue, and discarding it immediately, or into an elbow, and then washing hands
4. Keeping at least one metre (3 feet) from each other wherever possible.

• Care home staff looking after older residents who are unwell should wear masks. They should wash their hands after putting on their mask, if they touch their mask while wearing it and after they have taken their mask off and throw it away.
• Care home staff should remind and help older people to take these precautions.

2. Inside the care home

• Care home staff should not go to work if they have symptoms, including a fever, a cough or shortness of breath. This applies to all staff members, from care providers who have direct contact with older residents, to clerical workers, transfer staff and volunteers.
• If possible, staff should measure the older residents’ body temperature every morning and evening.
• Door handles, handrails, tables, chairs and other surfaces should be cleaned with disinfectant regularly.
• Staff should regularly empty garbage bins in which tissues are disposed.
• Care home staff should be aware of older people’s mental health and wellbeing. Affectionate personal communication can relieve anxiety.
• Older residents and staff should be well nourished.
• Warm temperatures should be maintained in the care home, and spaces should be regularly ventilated.
• Staff should try to maintain older residents’ normal schedule and daily routine.
• If possible, care home staff should organise or facilitate regular online contact between older residents and their family members and friends (i.e. via Skype, WhatsApp, WeChat). This will help to relieve stress and isolation.
• Staff with symptoms who cannot work should not face any employment-related disadvantages or penalties such as reduced wages or loss of their job.

3. Interaction with the outside environment

• Decisions on whether visitors should be allowed to attend care homes should be based on advice from government or other relevant authorities. Visits should be discouraged where possible.
• All visitors should consider any potential contact they may have had with infected people before making a decision to visit. If they think this contact may have occurred, they should not visit a care home.
• People should not visit a care home if they have symptoms, including a fever, cough or shortness of breath.
• Care home staff should ask all visitors if they have symptoms before allowing them to enter the home.
• All visitors should take basic precautions when visiting. This includes hand washing, sneezing or coughing into a tissue or elbow, maintaining one metre distance from residents and avoiding personal contact.
• In a widespread outbreak or high-risk situation, visits should be limited to emergency needs only, for example, for medical professionals if a resident is ill.
• Delivery of goods should be restricted to a single entrance. If a contractor or vendor needs to enter the care home, staff should ask if they have symptoms such as fever, a cough or shortness of breath. If any of these symptoms are present, they should not be allowed to enter the care home.

4. Management responsibilities

• Care homes should establish links with their nearest health facility providing COVID-19 testing and care.
• Care homes should discuss with the health authority and their nearest facility, what they should do if a resident has symptoms.
• Care home managers should regularly refresh basic health education for staff. This should include knowledge of the virus and training in basic precautions. Posters and leaflets should be used as reminders.
• Care home managers should prepare and manage prevention and control items such as thermometers, masks, gloves, soap, alcohol-based hand rub, tissues and paper towels.
• The psychosocial support needs and wellbeing of staff should be supported through regular communication.

5. Governance

• Care home staff should maintain close contact with related institutions and local administrations or health authorities. They should respond promptly to changes in their local situation or advice provided.
• Care home staff should keep families regularly informed of the situation, including prevention arrangements. This can be done through telephone calls, text messages and emails.

6. If someone is suspected of being infected

• If an older resident or a member of staff feels unwell and has symptoms, they should be isolated from other residents, in a separate room. Symptoms include a fever of 37.5°or above, a cough or shortness of breath.
• Care home staff should immediately contact relevant health authorities or facilities and follow their instructions.
• Anyone isolated because of suspected COVID-19 infection should wear a mask.
• Any staff looking after someone suspected to have COVID-19 should wear a mask.
• The room where someone is isolated should be in a relatively separate, wellventilated area. It should have a door that can be closed and an independent toilet if possible.
• If health authorities require an older person to go to a designated facility for testing or treatment, care home staff should follow their instructions immediately. Public transport should not be used. The older person and accompanying staff should wear a mask.
• An isolated older resident should be given quality care and should be provided with support to maintain their mental health and wellbeing.
• Any older residents who have come into contact with someone known or suspected to have COVID-19 should be isolated from other residents.
• After an older resident or staff member with symptoms has been transferred to a health institution, care home staff should thoroughly clean and disinfect any areas the person has been in.
• Staff should be divided – as much as possible – between those providing care for older residents suspected to have COVID-19 or who have been in contact with those who have COVID-19, and those providing care for other older residents.
• Older people whose symptoms have ended and who return to the facility should be observed in a separate room for 14 days.

Please remember: COVID-19 is a serious illness, but there are things we can all do to protect ourselves and others. Taking sensible precautions is important but there is no need to panic.

Download the document here.

Find out more: Helpage.org/coronavirus-COVID19