Guidance

Supporting vulnerable people before and during hot weather: social care managers

Updated 21 March 2024

Applies to England

Who this guidance is for

This guidance advises social care managers on how to reduce the risks of hot weather to the health and wellbeing of people they provide care for. Social care managers have an essential role in implementing this guidance and sharing it with staff before and during hot weather.

Social care managers should also consult the Heat-Health Alert action card for providers, summary posters, and sign up for the Heat-Heath Alerts. This guidance details actions that providers of social care should consider when preparing for and responding to each Heat-Health Alert type (yellow, amber, or red). It also identifies some of the key long-term actions which will help minimise the impact of hot weather on health. For more information about the Heat Health Alerts, see the Weather Health Alerts user guide.

It’s important that managers also share guidance on how to stay safe during hot weather and the keep cool at home checklist with staff providing care to social care clients (including in their own homes), for advice on keeping homes cool during periods of hot weather.

Other carers providing direct care to people, including in their own homes, should also review guidance on staying safe in hot weather and keeping cool at home.

Main messages

Hot weather can cause people to become unwell through dehydration, heat exhaustion and heatstroke, and can increase the risk of heart attack, stroke, lung problems and other diseases.

In all settings, you can reduce the risks associated with hot weather for those you care for by:

• ensuring all social care staff are familiar with this guidance, and your local hot weather and business continuity plans before 1 June each year

• considering changes to the building that could reduce exposure to heat in the home or the care setting

• ensuring those in your service’s care drink plenty of fluids throughout the day, that staff monitor people in their care for significant changes in hydration status compared to what is normal for them (for example, peeing less often, feeling dizzy or light-headed) and know what action to take if these changes occur

• planning activities for times of the day when it is cooler such as the morning or evening

• working with staff to keep those they care for out of the sun at the hottest time of the day, usually between 11am and 3pm  

If you work in a setting that provides care in clients’ own homes, you should also:

• ensure staff know who is at higher risk of heat related illnesses and how to reduce that risk

• have plans in place for individuals you are responsible for to keep them and their home cool

About hot weather and health

Severe hot weather is dangerous to everyone. Hot spells can happen suddenly, and rapid rises in temperature affect people at higher risk (see below) very rapidly and can be fatal. Climate change means dangerous hot weather is becoming more common in England. Deaths and morbidity from hot weather are preventable and requires careful preparation. Plans need to be in place before high temperatures are forecast and should be ready before 1 June each year. 

Who is at risk?

While anyone can be affected by hot weather, some groups are at higher risk than others. People adapt to heat via physiological responses (like sweating) and behavioural changes (changing clothes). Individuals are at increased risk to heat when one or more of these mechanisms is limited, for example by illness (including physical and mental/cognitive health problems), frailty, or medication.

Consider what:  

• the individual’s risk factors are for being ill during hot weather

• can be changed to protect them

An individual’s risk is related to a combination of factors relating to their health, behaviours and environment.

Older people and those with underlying medical conditions are particularly vulnerable to the effects of hot weather. This means that people living in all kinds of care homes, those who are unable to care for themselves or those who require support in their daily activities are at higher risk of becoming unwell. High-risk groups include:

• older people aged over 65 years

• people with underlying health conditions, particularly heart problems, breathing problems, dementia, diabetes, kidney disease, Parkinson’s disease or mobility problems

• people on certain medications

• people with serious mental health problem

• people who are already ill and dehydrated (for example from diarrhoea and vomiting)

• people with alcohol or drug dependence

• people experiencing homelessness, including rough sleepers and those who are unable to make adaptations to their living accommodation such as sofa surfers or those living in hostels

• people who live alone and may be unable to care for themselves

Air pollution combined with hot weather can also worsen symptoms for people with existing breathing problems or heart conditions. A full list of those at risk can be found in the Beat the heat guidance.

How to recognise heat exhaustion and heatstroke and what to do about them

The main causes of illness and death during a heatwave are respiratory and cardiovascular diseases. However, specific heat-related illnesses such as heat exhaustion and heatstroke can affect most at-risk groups and the general population more widely.

Heat exhaustion

Heat exhaustion occurs when a person has lost too much water. Common symptoms of heat exhaustion include:

• tiredness

• weakness

• feeling faint

• headache

• muscle cramps

• feeling or being sick

• heavy sweating and intense thirst

• a core temperature between 38ºC and 40ºC.

What to do if someone has symptoms of heat exhaustion

Carers should take immediate action to cool a person with these symptoms down. Heat exhaustion does not usually need emergency medical attention if the person cools down within 30 minutes. If action is not taken to help the person to cool down, heat exhaustion can lead to heatstroke.

How to cool someone down if they have symptoms of heat exhaustion:

• move to a cooler place such as a room with air conditioning or somewhere in the shade, or cool the room down if it’s not possible to move them

• remove all unnecessary clothing like a jacket or socks

• help them drink a rehydration drink or cool water

• apply cool water by spray or sponge to exposed skin. Cold packs wrapped in a cloth and put under the armpits or on the neck can also help

If a person is cooling down and feeling better within 30 minutes, this suggests they are improving. However, if this does not happen, if you are concerned about symptoms, or they are worsening, seek medical advice by contacting NHS 111. In an emergency, or if you think someone has heatstroke, dial 999.

Further information on heat exhaustion and heatstroke symptoms can be found on the NHS website.

Heatstroke

Heatstroke happens when the body is no longer able to cool down and core temperature exceeds 40ºC for more than 45 minutes. Common symptoms of heatstroke include:

• a very high temperature

• hot skin that is not sweating and might look red (this can be harder to see on brown and black skin)

• a fast heartbeat

• fast breathing or shortness of breath

• confusion and lack of coordination

• a seizure or fit

• loss of consciousness

Heatstroke is a medical emergency: if you suspect someone has heatstroke you should dial 999. While you wait for assistance, put them in the recovery position if they have lost consciousness, and continue efforts to cool them down (as above). 

How to reduce the risks of hot weather

During the summer, UKHSA works with the Met Office to issue Heat-Health Alerts alongside the weather forecast if people’s health is threatened by hot weather. Many of the harms caused by heat exposure can be prevented by taking a few simple actions.

In addition to the recommendations below, reviewing the Heat-Health Alert action card for providers and the summary posters will help you to take steps to protect those you care for. The effects of heat occur rapidly, and preparatory action should be considered throughout the year for your response to hot weather to be effective.

Preparing for hot weather

In preparation for hot weather, there are actions you can take depending on your role. In all settings, you should:

• ensure all social care staff are familiar with this guidance, and your local hot weather and business continuity plans before 1 June each year

• ensure staff have undertaken relevant training, for example the NHS e-learning for healthcare platform’s Hot Weather Guidance for Carers

• consult the action card for providers  to identify actions to support preparation and planning for hot weather, and distribute information on recommended actions where relevant to your teams

• check fridges are working at correct temperatures and, for those where medicines are being stored, make sure they are set up, maintained and monitored in line with NHS Specialist Pharmacy Service guidelines

• if your setting uses fans or air conditioning units, ensure that they are clean, working, serviced and portable appliance tested and ensure a protocol for cleaning and servicing is included in your local plans and risk assessment, according to national infection prevention guidance

• listen to the news and check your local weather forecast so that you know when hot weather is expected

• look out for advice on what to do if services such as power, water supplies and transport are likely to be affected

• check air pollution forecasts and advice (pollution can worsen the effects of heat on those with breathing problems)

• when hot weather is expected, ensure staff plan any activities to avoid being outside during the hottest part of the day between 11am and 3pm

• ensure relevant staff know how to check and record room temperatures, and follow internal procedures if a cause for concern is identified

• consider whether additional staffing or support will be required during periods of hot weather

• ensure that staff have a way of measuring room temperature where clients spend the most time

• if you are concerned, speak to the relevant healthcare professional to see if changes to medications are needed during extreme heat, as some medications may put individuals at greater risk of hot weather

• consider adding relevant checks to your setting’s work management system to remind staff to keep high-risk clients and areas cool.

In care homes and other residential settings, you should:

• ensure staff know the steps to take to keep the home, themselves, and those they care for cool and hydrated during hot weather

If you work in a setting that provides care in clients’ own homes, you should ensure that staff and those paying for care (clients themselves, families, local authorities) know who is most at risk in hot weather, and are aware of what local and national support available to make improvements to homes and protect these individuals. As detailed in Beat the heat: keep cool at home checklist, this could include:

• increasing outside shading, in the form of shutters, shaded areas, trees or leafy plants

• using reflective paint to help keep the building cool

• increasing outside greenery as it aids cooling by acting as a natural air conditioner

• adding well-designed insulation to the building, which can help to keep it warm in winter and cooler in the summer

Responding to hot weather

Keep the home environment cool 

Homes can overheat and become uncomfortable during warmer weather, particularly when people are trying to sleep.

High-risk groups that are vulnerable to the effects of heat can find it hard to cool themselves efficiently once temperatures rise above 26°C.

In all settings, ensure that staff:

• regularly check weather forecasts, and check and record indoor and outdoor temperatures regularly during the hottest periods

• close windows when outdoor temperatures are higher than indoor temperatures (for example during the day)

• close any external shutters or shades, blinds and curtains – this keeps cooler air in, and hotter air out

• close and shade windows very early in the morning so that the heat does not build up

• consider adding temporary internal or external shading to any windows that do not have blinds, shutters or curtains, especially if they face east, west or south

• open windows (if it is safe to) when the air is cooler outside than inside, for example at night – try to get air flowing through the building

• check that any heating is turned off, and turn off lights and electrical equipment that are not in use to reduce indoor temperatures

In care homes and other residential settings:

• ensure that there is a cool room or area (able to be maintained below 26°C) where people can go to cool down – cool areas can be developed with appropriate indoor and outdoor shading, ventilation, the use of indoor and outdoor plants and, if necessary, air conditioning

• ensure that staff know the main actions to take to cool down individuals who cannot be moved to cool areas, or for whom a move might be too disorienting (see below)

• consider encouraging family members to visit in mornings and evenings to prevent extra heat during the afternoon from increased numbers of people being present

If you work in a setting that provides care in clients’ own homes, you should ensure that staff:

• use a thermometer to measure the temperature and identify when a room is too hot (above 26°C)

• check local plans and procedures for what to do if a cause for concern is identified

Further advice on keeping buildings cool can be found in Beat the heat: keep cool at home checklist.

Keep the people you care for cool

There are things you can do to prevent people from overheating when the weather is hot. In all settings you should ensure that staff:

• monitor clients closely for any early signs of heat-related illness and initiate appropriate treatment when needed.

• are aware of which service users are taking medications that may increase a person’s risk of developing heat related illness, such as anticholinergics, vasoconstrictors, antihistamines, drugs that reduce renal function, diuretics, and antihypertensives  

• use electric fans if the air temperature is below 35°C

• do not use fans if it is hotter than 35°C, as they can raise body temperatures

• do not aim fans directly at people’s bodies as this can lead to dehydration

• if using fans, be aware there is potential for these to spread germs, debris or dust around the setting – avoid blowing air from one person to another, and follow local and NHS advice on cleaning, servicing and decontamination

• monitor closely for any signs of dehydration – this is especially important for those who are less mobile

• be aware that plastic pads and mattresses can make someone warmer during hot weather and consider alternatives if feasible

• check that those you care for wear lightweight, loose-fitting, light-coloured clothes

• if going outdoors, consider clothes such as long-sleeved shirts, trousers or long skirts in close-weave fabrics to absorb sweat and prevent skin irritation as well as protect them from the sun

• encourage people to remain in the coolest parts of the building as much as possible

• go outside if it is cooler outside in the shade or consider moving people to a cooler part of the building, especially for sleeping, if possible

In care homes and other residential settings, you should ensure that staff:

• monitor body temperature, pulse rate, blood pressure and hydration (consider regular body weight measurement to assess water loss – see information above on heat exhaustion and heat stroke)

• for those who can’t be moved, or for whom a move might be too disorienting, take actions to cool them down (for example liquids, cool wipes) and be vigilant for signs of dehydration or heat-related illnesses

• check that you have an adequate supply of fans and sponges (or similar), and that these are maintained in line with NHS advice on cleaning, servicing and decontamination

• regularly put cool water on exposed parts of the body, for example with a damp sponge or cloth on the back of the neck to help with temperature regulation

• arrange cool showers or baths, if possible

Prevent dehydration

Enable staff to prevent dehydration by checking that service users drink enough fluids throughout the day, supporting those who are unable to drink unaided, and encouraging them to drink overnight. They should drink enough so that their urine is a pale straw colour.

Ensure that water and ice are widely available, and that there is a good choice of suitable drinks available for staff to share with service users. Water and diluted squash or lower fat milks are good choices. Limit fruit juice, smoothies, and soft drinks, which can be high in sugar and dehydrate the body. Instead swap for diet and sugar-free varieties or squash.

Lollies and water-rich foods may be alternatives for individuals who do not drink much fluid.

Alcohol has a dehydrating effect on the body, so it is a good idea to choose alcohol-free options, or alternate alcoholic drinks with a glass of water.

If those you care for are going out, take a refillable bottle filled with water.

Plan to adapt menus to cold meals (preferably with a high-water content, such as fruit and salads) in consultation with those you care for.

If those you care for are fasting during hot weather, ensure your staff understand what is expected and support them to take medical and pastoral advice before fasting.

More information on the signs and symptoms of dehydration is available from the NHS.

Protect those you care for from the sun

The sun is often strong enough in the UK to cause sunburn. In addition to ensuring staff are aware of heat exhaustion and heats stroke guidance, support staff in providing the following advice and support to service users:

• stay inside or in the shade between 11am and 3pm when the sun is strongest

• if going outside, wear lightweight, loose-fitting, light-coloured clothes, such as a long-sleeved shirt, trousers, or long skirts in close-weave fabrics

• wear a wide-brimmed hat to protect the face, eyes, head, ears and neck

• wear sunglasses which are wraparound or with wide arms to provide protection from the sun

• apply sunscreen generously and reapply frequently, especially after activities that remove it, such as swimming or towelling – the NHS recommends that this should be with a sun protection factor (SPF) of at least 30, and 4- or 5-star UVA protection

More information on sunscreen and sun safety, including how to apply sunscreen, is available from the NHS.

Avoid strenuous exercise and activities

If possible, help service users avoid activities or exercise during the hottest part of the day, between 11am and 3pm. If they do want or need to carry out any physical activities, such as exercise or gardening, plan to do these during the morning or evening when it is cooler. Also consider limiting staff exertion during the hottest hours where possible.

Avoid hot closed spaces

Small, closed spaces such as stationary cars can get dangerously hot very quickly. Make sure that those you care for are not left alone in stationary cars or other closed spaces.

Storage of medications

Most medicines should be kept below 25°C, so they should be stored somewhere cool, dry, out of direct sunlight and away from windowsills. Medicines should only be stored in the in fridge if specified. The NHS Specialist Pharmacy Service has further guidance on medicines storage. Consider whether clinical input is needed for changes to treatment or medications.

Staff health and wellbeing

Staff can also be at risk during high temperatures. Encourage and enable staff to carry water and stay hydrated. Ensure staff are aware of the high-risk factors that might affect them, and to report concerns about their own health promptly.

Consult the Health and Safety Executive for advice on wearing personal protective equipment (PPE) in high temperatures, and for advice on managing high temperatures in the workplace more generally.  

Further resources and information

Additional documents

• Heat-Health Alert action card for providers (this summarises what actions you should take at each alert level and should be read alongside this guidance)

• Supporting vulnerable people before and during hot weather: guidance for healthcare professionals

• Beat the heat guidance (advice for the public)

• Adverse Weather and Health Plan

• Adverse Weather and Health Plan: supporting evidence

• Weather-Health Alerting System: user guide

• NHS advice on heat exhaustion and heat stroke

• NHS advice on sunscreen and sun safety

• Temperature in the workplace guidance – Health and Safety Executive

About the Heat-Health Alert System

In line with other weather warning systems in England (and the UK), warnings are issued when the weather conditions have the potential to impact the health and wellbeing of the population. The alerts are given a colour (yellow, amber or red) based on the impact the weather conditions could have on health, and the likelihood of those impacts occurring. Yellow alerts are sent out when weather poses health risks to vulnerable people, amber when weather is also likely to affect the health service, and red alerts indicate a significant health risk to the general population. These assessments are made with the Met Office when adverse weather conditions are forecast.

Once the decision is made to issue an alert (yellow, amber, or red), these are sent to those registered to receive the alerts and made available on the Weather-Health Alerts web platform. Alerts are issued with as much time before the weather event as is possible, to allow users to make their local assessments and to take action to reduce harm to health. Read the Weather-Health Alerting System user manual for more information and to register.

Information on air quality

If you would like more information about air pollution in the UK or health advice to those who may be particularly sensitive to air pollution visit the Department for Environment, Food and Rural Affairs (Defra).