The outbreak of this coronavirus has been a challenging time for everyone, but especially for people living in care homes, their families and the care home staff. This is because people living in care homes are likely to be older, living with dementia, frail or have other underlying health conditions; all of these factors place them at increased risk of coronavirus.
Social distancing and visiting restrictions have deprived residents of vital stimulation and support from family visits, which can lead to a marked deterioration in their wellbeing. This has put significant emotional strain on family carers as they grapple with questions around when they will be able to visit next, and what condition their relative will be in when they are allowed to visit.
To offer support, Dr Sarah Russell and Suzanne Wightman from our Professional and Practice Development Team have put together some common questions and answers. We hope this information will help you, along with the care home, to support the person you love and care for.
What is the government guidance about visiting in a care home?
Care homes are understandably cautious about visits because of the risk of infection, the variability in access to testing for residents and staff for coronavirus, as well as access to personal protective equipment (PPE). The guidance about care home visiting for England, Scotland , Wales, and Northern Ireland are all informed by the local Director of Public Health and health protection team, who assess the risk of the number of coronavirus infections in the local community or individual care home. Guidance includes information about visiting policies, making decisions for particular residents or groups of residents, infection-control precautions as well as communicating with family and others about their policy and visiting decisions.
The aim is to prevent future outbreaks as well as ensure the health and safety of care home residents and staff, in addition to families who visit. This means that the guidance could change if there is an outbreak in the home or local community, and visiting could be further restricted again. Talk to your care home to find out about the position and latest updates in relation to local visiting requirements and restrictions.
Can I visit?
Discuss with the care home manager how the home can meet the care home visiting guidance, such as through an individualised visiting care plan. This could include visiting to support the mental or physical health and wellbeing of your loved one, end of life care, and, in some circumstances, to provide essential mental or physical care (see the Methodist Home Association More Than Just a Visitor: A Guide to Essential Family Carers).
Ask the care home manager about their visiting protocol. Some examples of questions you can ask include: how long and how often you can visit; if they have a designated visiting area (inside or outside); if you can visit in the room and what infection control precautions you might have to take.
Some family carers may still be denied contact due to the restrictions in place. This may be very frustrating and distressing but having regular and open conversations with the staff team should help. If you are feeling distressed and need support, then the Admiral Nurse Dementia Helpline can help you work through these feelings and plan a course of action.
What might happen before my visit?
As well as the practical arrangements, such as traveling to the care home, the home may discuss specific details for your visit. This includes an allocated time to visit, how many visitors are allowed, staying outside until you are called in, having your temperature taken or showing a coronavirus test result, using hand sanitiser, staff wearing PPE, being asked to wear PPE yourself and going direct to the designated visiting place, hub or pod (see an example of what one of our Admiral Nurses has done on this).
During your visit you may have to wear PPE, or be in a space with a glass or plastic dividing screen or table between you. The home may also confirm what gifts you can bring in, and if they can be given immediately or have to be quarantined first to be cleaned.
I’m feeling a bit anxious about my visit. What if my relative doesn’t recognise me, or if they get upset during the visit?
Visiting in the current circumstances is very different to before. Discuss with the home how they can prepare and support your loved one before and after your visit. It may be difficult for your relative to recognise you if you are wearing PPE, and social distancing may stop you from being able to touch them to show your affection. Whether you are wearing a PPE or are behind a protective screen, some tips for communicating include speaking loudly, clearly and in short sentences. Use your body language to communicate affection, such as ‘miming a hug’ or ‘blowing kisses’.
It is possible that your loved one may become upset during your visit. Listen to why they are upset. If it feels right, apologise for why you have not been able to visit by reminding them that a virus is going round, and reassure them of your love, care and affection. Bring in gifts and mementos to help keep in touch, and include the family; for example, grandchildren’s drawings, photographs of friends and relatives, and cards with short written notes. You could take a photo during the visit, and ask the care home staff to display this clearly in the person’s room.
Regardless of how your visit went, make sure that you have someone to speak to afterwards, such as a friend, Admiral Nurse or member of the care home staff.
How do I stay in contact with my loved one?
Staying in contact might not feel the same as before the coronavirus outbreak.
For some people, particularly families who are caring from a distance, using video calls such as Skype, Zoom or FaceTime will be successful and enjoyable. Check out if the home has Wi-Fi and how much help your loved one needs to use such technology. Perhaps suggest a regular time of the day and add in other family members to the call, if this won’t overwhelm your relative. There are also other things you can do if conversation proves challenging, such as a virtual cuppa together, reading a favourite story or newspaper, or perhaps just sharing family news.
Not everyone likes video calls, so other methods might be more helpful. You could arrange a regular phone call, using simple and short sentences. Send letters, postcards, or emails regularly to your loved one, with news, photos or messages, and discuss with the staff about helping your loved one to read them. Include small reminders of who is in photos and where it was taken, so the care home staff can discuss and share it with them.
You could send small gifts; perhaps something tactile, comforting or familiar. Something that has a lovely scent or feels soft, such as a new pair of pyjamas or scarf spritzed with a favourite perfume, can be evocative to the senses and provide stimulation. You could send an audio story book, music CD, or recording of you reading a story. Ask staff to build a photo or life story (see link to our resources on this) board in your relative’s room and send relevant items to add to it.
Staying in contact works both ways. Discuss with the home how your loved one can contact you, or share news of their day. Ask the care home staff if they can take and send you photos of what your loved one has been doing, or when they receive your letters or gifts, or maybe help write you a letter, postcard or email.
How can I continue to contribute to the care of my loved one?
Discuss with the care home how you can contribute and be informed of any changes to your loved one’s care, particularly if there is deterioration in your relative. This might include asking when the next care plan review is due, so you can be involved. Check that the home still has the correct emergency numbers for you, particularly if you hold Lasting Power of Attorney (Health and Welfare), and if there is any advance care planning in place, (please see our resources on this) so if there is a change in your loved one’s condition, you will be consulted.
I am not happy with the care that my loved one is receiving: what do I do?
There may be times when you are not happy with the care your loved one is receiving or how the care home is communicating with you. The coronavirus outbreak has challenged us all in extraordinary ways. It may be helpful to make a list of your concerns and consider if they are related to the coronavirus social distancing requirements or something else. Arrange to speak to the home manager, saying what you want to discuss with them and why. Ask for a plan of action from your meeting, so that you can work together to support your loved one.
My relative is dying in a care home. I need to be there for them but I’m not sure how I can be
Care home visiting guidance from England, Scotland, Wales and Northern Ireland all identify the importance of a relative/family carer being supported to see their loved one if they are dying.
Discuss with the home their end of life visiting procedures, as well as how and when they will update you about your loved one’s condition. Speak to the home about what you think is important at this time. Perhaps there is a particular type of music your loved one would enjoy listening to, or a favourite night dress or blanket. Maybe the smell of your perfume or aftershave on the bed spread or your picture by the bed will be a comforting reminder of you when you are unable to be there.
You may feel feelings of loss, grief and bereavement during this time. This is normal, but you might find it helpful to discuss and share with a friend or family member how you are feeling. Our Admiral Nurse Dementia Helpline is also there for you to discuss any feelings of grief you are experiencing.
For anyone who has any questions or concerns around the issues raised here, or around dementia generally, please get in touch with Dementia UK’s Admiral Nurse Dementia Helpline on 0800 888 6678 or firstname.lastname@example.org.
Find out more about our campaigning work during the coronavirus pandemic, including ‘One Dementia Voice’.