Guidelines from British Geriatric Society

The COVID-19 pandemic raises particular challenges for care home residents, their families and the staff that look after them. This guidance has been developed to help care home staff and NHS staff who work with them to support residents through the pandemic.

COVID-19: Managing the COVID-19 pandemic in care homes

 Key recommendations

1. Care homes should have in place standard operating procedures for individual residents with suspected and confirmed COVID-19 infection, including appropriate infection control precautions to protect staff and residents.

2. Care home staff should be trained to check the temperature of residents displaying possible signs of COVID-19 infection.

3. Where possible, care home staff should be trained to measure other vital signs including blood pressure, heart rate, level of consciousness, new confusion, pulse oximetry and respiratory rate. This will enable external healthcare practitioners to triage and prioritise support of residents according to need.

4. All staff working with care home residents should recognise that COVID-19 often presents atypically in this group. An isolate and test approach, erring on the side of caution, is advised.

5. If taking vital signs, care homes should use the RESTORE2 tool, or other equivalent tools supported by local healthcare providers, to recognise deterioration in residents, measure vital signs and communicate concerns to healthcare professionals.

6. For most residents, the risks of exposure to COVID-19 from visitors outweigh the benefits. Exceptions may include residents nearing the end of life and some residents with a mental health disorder such as dementia, autism or learning disability where absence of visiting from an immediate family member or carer would cause distress. Visiting policies should be based upon individualised risk-assessments and shared decision making with residents, their families and care home staff.

7. Where face to face visits with with carers or family members aren’t possible, these should be facilitated using other means such as telephone and/or technology such as tablet with video.

8. Care homes that allow visitors should have an infection control and PPE policy that applies to visitors.

9. Care homes should have standard operating procedures for managing COVID positive residents who ‘walk with purpose’ (often referred to as ‘wandering’) as a consequence of cognitive impairment. Physical restraint should not be used. Community health services should provide clinical advice and support for managing these situations. Having areas for residents to explore safely should be considered as part of zoning and cohorting policies.

10. Care homes should review available guidance on zoning and cohorting and consider whether this could work in their home. Zoning and cohorting plans should be written in advance of any outbreak and should be subject to review as situations change. Such approaches may involve temporarily moving residents away from their usual room during an outbreak.

11. During an outbreak, care homes should consider cohorting staff teams into those who work with COVID positive and negative patients to minimise cross-infection.

12. Care homes staff, General Practitioners, community healthcare staff and community geriatricians should work to review Advance Care Plans with care home residents. This should include discussions about how COVID-19 may cause residents to become critically unwell and what they and their families would wish if their health deteriorates.

13. There are some situations in which supportive treatments such as care home-based oxygen therapy, antibiotics and subcutaneous fluids should be supported as part of the local response to COVID-19. The harms and benefits of such treatments must be considered carefully.

14. Advance Care Plans must be recorded in a way that is useful for healthcare professionals called in an emergency situation. A paper copy should be filed in the care home records and, where the facility already exists, an electronic version used which can be shared with relevant services.

15. In accepting new admissions which are, or could be, COVID-19 positive from hospital or the community, care homes must establish that they have sufficient resource to safely isolate them. They must obtain written confirmation of when the diagnosis was made and when isolation is anticipated to end.  In Scotland, residents must be confirmed COVID negative prior to admission.

16. New admissions who do not have suspected or confirmed COVID-19 should be undergo swab testing to confirm status. They should be isolated for 14 days regardless of the result.

17. New or returning residents should not be accepted by a care home if there is insufficient resource to manage them in isolation.

18. Care homes should work with GPs and local pharmacists to ensure that they anticipate palliative care requirements and order anticipatory medications early in the illness trajectory.

19. Care homes should work with community pharmacists and GPs to ensure that they have a Standard Operating Procedure in place to reuse anticipatory medications in line with government legislation.

20. Care homes should work with residents and families to ensure residents’ emotional needs are being met. 

21. Multiprofessional local or regional peer-support groups should be established to provide support to care home staff who may feel isolated and worried by the pandemic.

22. Effort should be made to provide appropriate urgent medical care within a care home to prevent urgent admissions to hospital, thereby risking infection with COVID-19 to the resident and others in the home. This could take the form of urgent senior medical advice for care home and ambulance staff or making appropriate use of hospital at home services if available.