Guidance

[Withdrawn] Coronavirus (COVID-19): provision of home care

Updated 15 March 2022

This guidance was withdrawn on 1 April 2022

The information in this guidance has been superseded by Infection prevention and control in adult social care: COVID-19 supplement.

Applies to England

• Publication for Northern Ireland
• Publication for Scotland
• Publication for Wales

What has changed

There is no longer a legal requirement for people with coronavirus (COVID-19) infection to self-isolate. However, the public health advice for people with any of the main symptoms of COVID-19 or a positive test result is to stay at home and avoid contact with other people. Due to the higher risk nature of health and social care settings, the advice for staff members working in these settings has not changed.

1. Introduction

This guidance is intended for home care service providers only and not for supported living and extra care housing services, personal assistants and unpaid carers.

What we mean by 'home care'

By home care (also known as domiciliary care or care at home) we mean support provided to people living in their own home. This may include providing personal care, ‘live-in’ home care, nursing services and sometimes other support, offered by professionals, which is regulated by the Care Quality Commission (CQC).

Purpose of the guidance

The purpose of this guidance is to support the safe delivery of services throughout the COVID-19 pandemic. In addition to protecting against the risk of COVID-19, we want to support home care providers to enable the people they support to lead healthy, independent lives.

This guidance should be read in conjunction with how to work safely in domiciliary care in England.

Who this guidance is for

This guidance is intended to be used by:

• registered home care providers
• home care staff
• local authorities
• commissioners

2. Providing home care

Providing care including to those previously identified as clinically extremely vulnerable

Following expert clinical advice and the successful rollout of the COVID-19 vaccine programme, people previously considered to be clinically extremely vulnerable (CEV) will not be advised to shield again. If you were previously identified as CEV, you are advised to continue to follow the guidance contained in Coronavirus: how to stay safe and help prevent the spread. Individuals should consider advice from a health professional on whether additional precautions are right for them.

How homecare providers can ensure they are caring for people safely

Homecare providers must ensure that the level of support provided to an individual meets their assessed needs. However, home care providers may need to reallocate duties or reduce visits if a person being cared for tests positive for COVID-19. These decisions will need to:

• be made subject to agreement with partner agencies and/or commissioners that the reduction in duties or visits balances the risks of reducing care with that of potential transmission of COVID-19
• consider the care support needs, wishes and feelings of the relevant person and the unpaid carer or carers, in line with a personalised care approach
• where significant changes are made, be based on a new assessment of the person's needs – the new level of support provided to the person must meet their assessed needs
• be made in agreement with the person’s family, social workers (if applicable) and commissioners of services

What to do if someone being cared for develops COVID-19 symptoms or tests positive for COVID-19

If a person receiving care develops COVID-19 symptoms they should take a PCR test and stay at home until they get their result. Anyone being cared for who tests positive for COVID-19 with a PCR or rapid lateral flow test should stay at home.

If anyone being cared for by a home care provider reports COVID-19 symptoms they should be supported to contact NHS 111 via telephone or online.

Home care workers should report suspected cases of COVID-19 to their managers.

Providers should work with other community providers of care to review and assess the impact of risk on their care needs if they have symptoms and when they test positive. This could include district nurses, GPs, other health professionals involved in the person's care, commissioners and the relevant person. Ring 111 or speak to the relevant community provider where appropriate.

All confirmed and suspected cases of COVID-19 should be reported in the Capacity Tracker.

Suspending care

If a person receiving care or their unpaid carer wishes to suspend their care, the commissioner should be alerted to this by the provider. All parties should work together to agree whether this is the appropriate step and what can be done to ensure the person's assessed support needs are met and they have access to essential items throughout this period, for example food or medicines. It is important to understand the reasons behind the request to suspend care and to provide advice about the precautions which should be taken to help reduce the risk of transmission of COVID-19.

Providers should assess the risks to the person posed by a reduction or suspension of visits or care. If the care provider is concerned about the risks, or the capacity of the person to make this decision, they must seek advice from the relevant commissioning authority. If the person receiving care is self-funding, they can contact the local authority for advice.

There is further guidance available on how the Mental Capacity Act applies to a person's ability to make decisions around receiving care.

If at any time providers or managers think that someone may be acting against the person's best interests in making the decision to suspend care on their behalf, then they should contact their local authority's adult safeguarding team.

Where care is commissioned by the local authority then the decision to suspend the care package must be made by the local authority in partnership with the person and the ethical framework for social care.

If staffing capacity leads to care being suspended or prevents any care duties from being delivered, those identified as most at risk from not receiving care should be prioritised. The relevant people should be alerted to this, such as local authorities and CQC. If the provider is unable to meet the assessed needs of one or more supported people because of staff shortages, they should discuss this with the relevant service commissioner. Adequate provisions should be put in place should care be suspended due to staffing capacity. When assessing their staffing capacity, providers should refer to the guidance on restricting staff movement between their care home and other health and care settings.

Providers can access advice on recruiting and maintaining staffing capacity.

3. Hospital discharge

Guidance on hospital discharge states that discharge to assess pathways 1 to 3^{[footnote 1]} require NHS organisations to work closely with adult social care and housing colleagues, the care sector and the voluntary sector.

Upon discharge, individuals should receive information about who they can contact if their condition changes, ranging from direct contact points within the clinical team who supported the person in an acute or community hospital, through to signposting to relevant voluntary or housing sector partners for help in day-to-day duties.

For further details refer to the hospital discharge staff action cards. The action cards summarise the responsibilities of health and care staff in the hospital discharge process.

Testing and discharge

For information on hospital discharge, and testing before discharge, refer to the stepdown guidance on people recovering or recovered from symptomatic coronavirus and being discharged to their own home.

Escalating inadequate discharge summaries

Where people are discharged from an acute or community hospital back to their own home, the requirements of the hospital discharge service guidance apply. The guidance states that every system around an acute hospital should have a single co-ordinator who has been appointed to act on behalf of the system to secure safe, timely discharge on the appropriate pathway for the person concerned. This includes the provision of discharge summaries.

The coordinator will coordinate discharge arrangements for all people from acute and community bedded units on pathway 1 returning home or on pathway 2 entering a short term bedded facility; escalating any relevant issues to the executive lead. Where home care agencies identify inadequacies in discharge summaries, these need to be escalated to the single co-ordinator. Providers should contact their local authority for clarity around who this person is, if required.

4. Vaccination

Why it is important to get a COVID-19 vaccination

People who have received both doses of the vaccine, and the recommended booster doses, are far less likely to get COVID-19 with symptoms, become seriously unwell, be admitted to hospital or die from the disease.

Frontline social care workers are more likely to be exposed to COVID-19 at work than the population as a whole and are at higher risk of repeated exposure to the infection due to the nature of their work. Catching COVID-19 can result in serious illness and may lead to long-term complications. These are more common in older staff and those with underlying health conditions.

All home care workers have now been offered a vaccine. The first dose of the vaccine offers good levels of protection, but to get maximum protection everyone must get a second dose and further recommended booster doses.

Recent data published by the UK Health and Security Agency (UKHSA) shows people who have not been vaccinated are up to 8 times more likely to be hospitalised with COVID-19. Having a booster vaccination or third dose was shown to be 88% effective in preventing people from ending up in hospital due to Omicron. For the latest advice and information, see Coronavirus (COVID-19) and the COVID-19 vaccination guide for social care staff.

Home care providers and employers can continue to support the COVID-19 vaccination programme by directing staff to the National Booking Service and providing support to ensure they can attend vaccination appointments in line with the standard operating procedure which states:

Providers of social care or employers of frontline social care workers (which may include the local authority and NHS organisations) are responsible for:

• ensuring all relevant employees are aware of the national offer for priority booster vaccinations and how they can access this offer through the National Booking Service and using www.nhs.uk/grab-a-jab
• continuing to support all eligible frontline staff to obtain the necessary documentation needed for the COVID-19 booster vaccination to enable vaccination sites to validate their identity at the point of delivery (this could be a workplace photographic identity badge, a letter from the employer or a payslip dated within the last 3 months)
• continuing to work with employees to manage the logistics of any support required to access or travel to vaccination sites. This includes releasing staff to receive their vaccinations, while maintaining safety and continuity of care. Where the employer is a home care provider, it should work with staff to maximise the opportunities for workplace-based vaccinations administered by roving primary care network (PCN) teams. In the event of COVID-19 or other infections being present, care providers should seek advice on whether any vaccination should be delayed and, if so, for how long, from the local authority coordinator or the hub. They in turn can take advice from the UK Health Security Agency, Office for Health Improvement and Disparities or from the local Director of Public Health
• maintaining a record of vaccinated staff, with staff members' agreement, to include date and location of each vaccination (CQC registered providers should report uptake directly through the Capacity Tracker and non-CQC registered providers/employers should provide information on staff uptake to their local authority for input into the Capacity Tracker)
• being responsive to changes in data collection systems
• ensuring both the COVID-19 boosters and flu vaccines are promoted equally to all frontline social care employees
• working in partnership with the NHS and public health leads to implement the use of evidence based resources and approaches to support the uptake of the offer among social care workers with protected characteristics, who are known to have low vaccine confidence. They should also continue practical support for employees, or individuals facing difficulties with vaccine confidence or in arranging vaccination, ensuring this is extended to cover booster vaccination.

National data monitoring continues to be vital to our COVID-19 response, and so we ask that vaccination records are maintained and reported.

It is essential that home care workers continue to follow guidance on infection control, including recommendations for hand hygiene, testing and the use of PPE regardless of vaccination status.

Flu vaccination

The flu vaccination programme is now running which protects people from serious complications from getting flu. We would encourage people, if eligible, to get their flu vaccine. See further information on the flu vaccination.

Frontline social care workers who are employed by registered residential or home care providers, voluntary managed hospice providers, as well as those employed through direct payment and/or personal health budgets to deliver domiciliary care to people are eligible for a free flu vaccination this season for those who are unable to get the vaccine through their employer. For further information, see the guidance on flu vaccinations for social care workers.

The flu vaccine is given free on the NHS to people who:

• are children aged 2 to 15 (but not 16 years or older) on 31 August 2021
• are 50 and over (including those who'll be 50 by 31 March 2022)
• are pregnant
• have certain health conditions
• are in long-stay residential care homes
• live with someone who is more likely to get infections (such as someone who has HIV, has had a transplant or is having certain treatments for cancer, lupus or rheumatoid arthritis)
• are carers

You can have the NHS flu vaccine at:

• your GP surgery
• a pharmacy offering the service
• a hospital appointment

5. Infection, prevention, control (IPC) and personal protective equipment (PPE)

IPC measures should continue to be practised in home care to reduce transmission of COVID-19 and other infections including flu. This includes regular cleaning, ventilation, limiting social contact and hand hygiene.

PPE must be used correctly and is only effective when combined with:

• cleaning your hands regularly and appropriately for at least 20 seconds
• respiratory hygiene (catch it, bin it, kill it) and avoiding touching your face with your hands
• following standard infection prevention and control precautions
• correct technique for putting on and taking off PPE
• safe disposal of used PPE

Home care workers should continue to follow the recommendations on use of PPE in how to work safely in domiciliary care.

For more information, see Reducing risk in adult social care and Ventilation of indoor spaces to stop the spread of coronavirus (COVID-19).

Free PPE provision for health and social care workers

The government has committed to the provision of free COVID-19 PPE to the adult social care sector until March 2023, or until the Working safely during coronavirus guidance on PPE usage for COVID-19 is either withdrawn or substantially amended (whichever is sooner).

CQC-registered homecare providers can access free PPE for COVID-19 needs via the PPE portal.

Questions about the PPE portal can be directed to the customer service team on 0800 876 6802. The team is available Monday to Friday 8am to 6pm. Providers should not use the portal to order PPE for non-COVID-19 requirements and should obtain this through their normal channels.

6. Advice for staff

Staff in individual risk groups

Healthcare workers and those working in social care are at a higher risk of repeated exposure to infection. COVID-19 infection can be serious and may lead to long-term complications. These are more common in older staff or those with underlying clinical risk factors.

Factors including age, sex, ethnicity, certain underlying health conditions and pregnancy may be associated with an increased risk of or from COVID-19. Employers are encouraged to ensure that an appropriate person, such as a line manager, carries out individual conversations with all staff who may be at greater risk, in line with the latest guidance on reducing risk in adult social care.

Staff from black, Asian and minority ethnic (BAME) backgrounds may have increased concerns about COVID-19 and employers should handle these conversations sensitively. Employers should ensure that staff are supported and any necessary steps to reduce risk are considered on an individual and proportionate basis. The employee should consult their employer if they have any concerns and discuss issues raised with their line manager.

Many staff will be able to work normally. Guidance on how to work safely in domiciliary care is available if staff wish to follow additional measures.

COVID-19 testing for home care workers

Full information on the testing regime and how to access, conduct and report tests can be found in Coronavirus (COVID-19) testing for homecare workers: information for agencies.

Anyone who has symptoms of COVID-19 should stay at home and get a PCR test from the online government portal or by calling 119.

Additionally, a symptomatic individual who tests negative for COVID-19 may have another infectious illness like flu and actions to limit transmission may be needed.

Adult social care staff who test positive for COVID-19 or who are close contacts

Staff who test positive for COVID-19 or develop symptoms

For advice on staff who test positive for COVID-19 or develop symptoms, see COVID-19: management of staff and exposed patients or residents in health and social care settings.

Staff who are a close contact of someone with COVID-19

Staff who are a close contact of someone with COVID-19 should follow the advice in the COVID-19: management of staff and exposed patients or residents in health and social care settings guidance.

Consideration should be given to how to ensure staff can deliver safe care during the 10 days after being identified as a close contact of someone who has tested positive for COVID-19. This includes applying the measures known to reduce risk such as distancing, maximising ventilation, PPE, cohorting, and enhanced testing of COVID-contacts.

This should be built into home care providers' general risk assessments for responding to infectious diseases and ensuring safe staffing levels are maintained. Where possible, staff should be redeployed for 10 days following contact with a positive COVID-19 case to undertake service where contact with people who are at higher risk of severe illness if infected with COVID-19 can be minimised; recognising this may be challenging in adult social care settings.

Reducing contact between staff

From 24 February 2022, the requirement to self-isolate following a positive test has been removed. To limit the spread of the virus in the future, it will be important that people adapt their behaviour. You can mitigate this risk by reducing the number of people your staff come into contact with, for example:

• holding supervision and team meetings remotely, wherever possible, or in small groups in well-ventilated rooms
• not conducting information sharing (for example at the end of a shift) through face to face meetings unless necessary
• staggering times at which staff access designated locations from which PPE and other equipment are collected
• minimising the risks of transmission of the virus in locations visited by multiple people through good infection control (for example, regular cleaning of touch points and surfaces)
• minimising vehicle sharing
• making use of secure means of sharing information remotely between agencies such as NHSmail or other secure email systems

Staff returning from international travel

Staff should take a cautious approach to international travel.

For advice on international travel, see Travel to England from another country during coronavirus (COVID-19).

Mental health support for staff

Guidance to support and maintain the wellbeing of those working in adult social care has been published on GOV.UK. It provides advice and resources on maintaining mental wellbeing and how employers can take care of the wellbeing of their staff during and beyond the COVID-19 pandemic.

7. National support available for social care

In January 2022, an additional £60 million was made available to local authorities through the Adult Social Care Omicron Support Fund to help support the adult social care sector’s response to the Omicron variant. The Omicron Support Fund is on top of the £388 million Infection Control and Testing Fund, round 3 announced in October 2021 to prevent infections and support testing to the care sector. This grant is available until 31 March 2022 and can be used to support community care providers to take key infection prevention and control and testing measures, as set out in the grant conditions.

Providers can use the Infection Control and Testing Fund to pay full wages to staff who are advised to stay at home and avoid contact with others, in line with government guidance.

There is £462.5 million available through the Workforce Recruitment and Retention Fund (WRRF) to support local authorities working with providers to further boost staffing and support existing care work through the winter.

8. Advice for local authorities

Steps for local authorities to support home care provision

Local authorities, working with their local resilience forums and drawing on local resilience and business continuity plans, should:

• ensure their list of individuals in receipt of local authority-commissioned home care is up to date and record levels of informal support available to individuals
• work with providers to identify people who fund their own care and help them to establish the levels of informal support available (it may be helpful for providers to share the number of hours of care they provide to help with planning, but they will want to satisfy themselves that it is lawful for them to share that information)
• map all care and support plans commissioned by the local authority to inform planning during an outbreak, and support providers similarly to map those packages that are self-funded
• consider how voluntary groups can support home care provision and link home care providers and the voluntary sector

Safeguarding people

The government has published an ethical framework for adult social care to guide local authorities in the event that they need to prioritise between competing needs. This states that decisions need to be made in a way that ensures people are treated with respect, minimises harm and is inclusive.

Regard should also be given to the ethical framework for adult social care and the wellbeing duty in section 1 of the Care Act 2014, and all decisions should be taken in light of general legal obligations, such as those under the Equality Act 2010 and Human Rights Act 1998, as applicable.

Any concerns that the guidance is not being followed should be raised with the relevant local authority. This could be done through usual contacts or any established complaint process where relevant.

Support from commissioners

Business continuity planning and emergency preparedness

All local areas are required to have arrangements in place to respond to emergencies under Civil Contingencies legislation, which specifies the roles and responsibilities of the different organisations involved in planning for, responding to and recovering from emergencies.

In relation to adult social care, the lead role in responding to emergencies lies with the local authority.

Risk monitoring and emergency response

Local authorities need to have the strongest possible intelligence about emerging risks and national government needs to have robust information about risks to enable a national-level response where necessary.

Home care providers should continue to update the Capacity Tracker to provide information about the impact of COVID-19 on their service. This will support local resilience forums (LRFs) and local authorities to direct mutual aid to providers where needed.

The role of LRFs in supporting the stabilisation and recovery of home care and home care providers is specified in The role of local resilience forums: a reference document.

Strategic Co-ordinating Groups should continue to work with local authorities, CCGs, and Safeguarding Adults Boards (SABs).

9. Other guidance

How information and data is collected

To enable us to understand the impact of COVID-19 on the people providers care for, their workforce and their ability to deliver services, we need to collect data to ensure resources are targeted most effectively where they are needed. Read the latest guidance on information governance.

This will mean that home care providers should complete the Capacity Tracker daily.

Local authorities, CCGs and other local bodies will receive this data if this information is provided daily and through the appropriate route. This means they will not need to make the same request and should not be contacting individual services for this data.

Additional resources

Further guidance is available on the Social Care Institute for Excellence (SCIE) website, including on supporting autistic people and people with learning disabilities, and supporting those living with dementia.

1. Pathway 1 – people who are able to return home with new, additional or a restarted package of support from health and/or social care.
   
   Pathway 2 – includes recovery, rehabilitation, assessment, care planning or short-term intensive support for people in a 24-hour bed-based setting, ideally before returning home.
   
   Pathway 3 – people who require bed-based 24-hour care: includes people discharged to a care home for the first time (likely to be a maximum of 1% of people discharged) plus existing care home residents returning to their care setting. ↩