Guidance

Forming a Christmas bubble if you live in a supported living setting

Published 23 December 2020

This guidance was withdrawn on 13 January 2021

This page has been withdrawn because it’s out of date. For the latest guidance, see Supported living services during coronavirus (COVID-19).

Applies to England

Who this guidance is for

This guidance is for anyone who lives in a supported living setting, whether by themselves or with other people. It includes people whose care and support is paid for by the local authority or where a person pays themselves, for example by a Direct Payment or by an Individual Service Fund. It is for people who live in Tier 1, 2 or 3 areas. This guidance relates to Christmas Day (25 December) only.

This guidance is also for supported living managers.

General COVID-19 guidance for supported living is also available.

People who live in Tier 4 areas

If you live in a Tier 4 area, you must follow the rules in your Tier over the Christmas period. This means that you cannot meet other people indoors, unless you ordinarily live with them, or they are part of your existing support bubble. Outdoors, you can only meet one person from another household.

These rules will not be relaxed for Christmas for Tier 4 – you cannot form a Christmas bubble in Tier 4.

Guidance for Christmas Day (25 December) for Tiers 1, 2 and 3

If you do not live in a Tier 4 area, you may see a maximum of 2 other households (your ‘Christmas bubble’) on Christmas Day (25 December). You cannot see anyone from a Tier 4 area.

Many people want to be with their friends and family over the Christmas period. Some people have not been able to see their friends or family for a long time because of coronavirus restrictions.

For this reason, the government is changing some social contact restrictions for Christmas Day (25 December) only, allowing people to spend time with their friends and family through forming a ‘Christmas bubble’. All other restrictions, including around hospitality and entertainment, will not change and you should follow the rules in your Tier.

See the rules on Christmas bubbles.

Spending time with others outside of a supported living setting will increase the risk of exposure to coronavirus for the individual, staff and other people who live in their supported living setting on their return. People who live in a supported living setting, their families, friends and supported living managers should very carefully consider whether this is the right thing to do.

If you do form a Christmas bubble, then be especially careful to observe the guidance:

• meet outdoors where possible
• wash your hands regularly
• keep a distance from those you do not live with
• if you meet indoors, ensure good ventilation by letting in fresh air

Scientific advice is clear that the longer you meet others for, the higher the risk of you catching and spreading the virus. You should minimise the time you spend with your Christmas bubble and should not stay overnight. You cannot meet your Christmas bubble except on 25 December.

Before deciding to be part of a Christmas bubble you should consider the risks very carefully.

This rule is for Christmas Day (25 December) only. From 2 December to 24 December and after 25 December, you should follow the coronavirus rules that apply in your area.

The rules if you live in a supported living setting are not the same as the rules if you live in a care home.

Things to consider before deciding if you want to be part of a Christmas bubble

If you are considering forming a Christmas bubble, there are some things that you will need to think about before making your decision. Your supported living manager should help you with your decision:

• Support staff and other people you live with need to be protected from risk of infection from coronavirus. If other people may be put at risk, it may not be appropriate for your friends and family to spend Christmas Day in your supported living setting with you. People who live in a supported living setting, their families and supported living managers should very carefully consider whether this is the right thing to do. If you want to form a Christmas bubble, your supported living manager should carry out an individual risk assessment.

• It may not be possible to give you the care and support you need if you stay somewhere else at Christmas. Your supported living manager can tell you if this is possible and help your friends and family support you if you do spend Christmas somewhere else.

• If you have a condition which makes you clinically extremely vulnerable to coronavirus (COVID-19) then you should also see section 7 of the Christmas bubble guidance

• The more people you see, the more likely it is that you will catch or spread COVID-19. Therefore, it is important you keep your bubble as small as possible and to a maximum of 3 households.

• If you decide to spend Christmas Day (25 December) at your friends or families’ house, you should take steps to reduce the risk of exposure to COVID-19 before you go, to prevent passing on infection to your friends and family if you have the virus. For example, if you regularly attend a day service you should consider not attending.

When seeing your Christmas Day bubble, you should keep taking steps to reduce the spread of the virus, and this will help ensure that the festive period is as safe as possible. This includes:

• ensuring indoor spaces get as much fresh air as possible
• making space between members of different households wherever you can
• washing your hands regularly and for 20 seconds
• following rules on self-isolation if you develop symptoms or test positive for coronavirus

On no account should you visit another household if you, or anyone in your household, is feeling unwell or self-isolating. You should get a free NHS test if you have symptoms, have been asked to by your local council or your hospital, or are taking part in a government pilot project.

You should consider these things carefully.

If you live in a supported living setting which is at high risk of a COVID-19 outbreak

There is a higher risk of an outbreak of COVID-19 in supported living settings where:

• it is a ‘closed community’ where many important facilities (such as bathrooms and kitchens) are shared by several people

• most people being supported receive the kind of personal care that is CQC regulated (rather than simply help with cooking, cleaning and shopping)

If you live in a supported living setting like this, then there are additional things you should consider.

Supported living settings which meet these criteria have been identified in local areas with advice from local directors of public health. The list of settings is reviewed and updated from time to time.

Following the roll-out of a single round of national testing to the most high-risk extra care and supported living settings, we have launched regular retesting: weekly testing for staff and monthly for residents. Eligible settings have been able to use an online portal to order test kits from 11 December.

Our first priority continues to be to reduce the risk of COVID-19 transmission, prevent future outbreaks and to ensure the health and safety of both care workers and people being supported.

If you live in a high-risk supported living setting, you and your supported living manager will have to consider the risks to other people who live with you as well as to staff. They should undertake a risk assessment to see how a visit could be done safely.

You should talk to your supported living manager to see if you can plan a Christmas visit that minimises the risks of anyone becoming infected with COVID-19. Where possible we recommend that your supported living manager considers using some of their existing testing allocation (where available) to test you when you return home. This is to protect other people who live there and staff.

Social workers can help you and supported living managers by providing advice in individual cases should that be required.

Minimising the risk of infection before and during Christmas

It is advised that:

• you maintain social distance from those you do not normally live with at all times, avoiding physical contact whenever possible. You may want to consider wearing a face covering indoors where social distancing may be difficult as well as encouraging others to do the same

• everyone should wash their hands regularly

• you should keep the space where you spend time with those you do not normally live with well ventilated where it is safe to do so (for example have windows open for fresh air)

• make sure you clean things you touch regularly, such as door handles and surfaces

If you do not feel comfortable spending time with other people indoors, there are other ways that you can safely spend time together, for example on walks outdoors or using technology to make a videocall. Going outdoors carefully for exercise is encouraged.

It is important that you do not feel pressured to celebrate Christmas in an environment that makes you anxious.

There may be a lot of expectations and pressure around celebrating Christmas together, but you should feel comfortable to do what is right for you over this period.

To do that, the other people in your Christmas bubble need to understand your needs and increased risk. They must also be extra careful in the days before you get together, reducing any unnecessary contact with people, especially as some people with the virus have no symptoms.

Returning home

When returning home on 25 December, you should follow the restrictions for your local area.

Before you return to your supported living setting you should:

• ensure that you have taken action to minimise the risk of being infected with COVID-19

• check if you have symptoms of COVID-19 and if you do then you should arrange to get tested, self-isolate and follow the guidance on what to do if you suspect you have a COVID-19 infection

• follow the rules on self-isolation, which apply if either you, someone you live with, someone in your childcare or support bubble, or someone you have been in contact with, has symptoms or has tested positive for coronavirus. If a member of your Christmas bubble tests positive for coronavirus or develops coronavirus symptoms on 25 December, or up to 48 hours after members of the bubble last met, all members of the bubble must self-isolate

• contact your supported living manager so they can assess the risk to other people who live with you and staff at your supported living setting and advise you on any actions you may need to take before you return

If you have been asked to self-isolate by NHS Test and Trace or have symptoms of COVID-19 or have had a positive test result, then you must tell your supported living manager straight away so they can help you to self-isolate safely.

If you live in a high-risk supported living setting you should:

• take a test on return if this has been agreed with your supported living manager

• consider self-isolating for 14 days on return even if you have no symptoms, where this is possible. This may not be possible where you need to share facilities

If you have been part of a Christmas bubble and you have been asked to self-isolate or have symptoms of COVID-19 you should self-isolate with your Christmas bubble. This means if you have been staying with family or friends you should stay with them while you self-isolate, if you can.

If you have to self-isolate but are unable to get the support and care you need where you are, you should contact your supported living manager to make appropriate arrangements for you to return safely to your normal supported living setting.

How your supported living manager can help you make a decision

Supported living managers can help you to follow the new guidance and decide what to do at Christmas. Ask your supported living provider to:

• advise on the safest way to be part of a Christmas bubble, if you want to do this

• where possible, assess the risk of your plans, considering the risks to other people (if in shared settings)

• encourage, agree and support decision-making regarding Christmas bubbles

Guidance for supported living managers

Supported living managers should help people being supported decide whether to form a Christmas bubble. You should:

• advise on the safest way to be part of a Christmas bubble, if someone living in the supported living setting wants to do this

• carry out an individual risk assessment, considering the risks to other people (if in shared settings) and to support staff. You should try to identify ways to mitigate these risks

• if yours is a ‘high risk’ supported living setting, as designated by your local director of public health, then you should consider allocating some of your existing PCR testing allocation (where available) to test anyone you support returning home after a Christmas visit. You will also need to undertake a risk assessment for anyone who wishes to be part of a Christmas bubble as the priority will be to protect other people who live there and staff

• encourage, agree and support decision-making regarding Christmas bubbles

If there is any disagreement about arrangements to support someone to be part of a Christmas bubble and to visit friends and family safely, social workers can be approached by the supported living manager, tenant or family to support this conversation – in particular to help resolve any issues or concerns, and to ensure professional support and or oversight where required.

You may want to discuss this guidance with a named social worker. The local social work team could also help to resolve any concerns.

If the person is assessed as not having capacity in relation to this decision, the provider should work within the appropriate MCA framework to establish that being part of a Christmas bubble is in someone’s best interests.