By Anna Selby, Regional Director of Operations and Head of the Covid-19 task force, at Gracewell Healthcare
Over the last six months, care homes and the social care sector have acted as one of the most challenging frontlines against Covid-19. And while most of our attention has rightly been paid to preventing the virus from entering these settings, the effect of these prevention measures is now becoming increasingly clear. Undeniably, the immensely effective action of limiting contact between care home residents and those from outside, including with their family members, has taken a toll on the health of all involved. Recognising the emotional and physical strain this lack of contact has had on residents, Gracewell Healthcare has begun implementing a series of ‘Safe Visits’ protocols to begin reintroducing safe visits into our care homes.
In March 2020, Gracewell took the difficult decision to suspend all visits from relatives and friends to our homes, unless under exceptional circumstances. This necessary step undoubtedly helped to reduce the spread of the virus and, in turn, save lives not just within our care homes, but outside, through reducing the possibility of community transmission. Although it was expected that this would cause a degree of concern among family members and residents, on balance, this measure was a just and appropriate decision.
Yet, for residents living with dementia or other cognitive illnesses, this was especially distressing as they were unable to comprehend the justification for the absence of contact with their loved ones. For many, a regular visit from their family and friends was a vital cornerstone in their daily lives and one which helped them stay contented, calm and reassured about their living environment. In some cases, residents who normally ate with members of their family had reduced appetites, while others began to show signs of social withdrawal. Equally, some family members of residents have also struggled with the anxieties of not being able to see their loved ones, despite their relative coping well under the strict guidance. At Gracewell, we understood these concerns and, after communicating closely with family members, began exploring ways in which visits could be safely organised.
Led by Jackie Pool, Director of Memory Care, and myself, we began to investigate whether an enhanced visitor status could be established for family members of those residents who were demonstrably distressed due to social distancing. Along with Natalie-Jane Macdonald, CEO of Gracewell, and Senior Director of Care and Quality, Annie Webber, we met with various family members to better understand their views and experiences in order to identify the nature of the intervention that would be required.
After understanding the pressing need to reintroduce visits, we developed a framework for a protocol based on our ‘Safe Choices’ model. This model, which was developed in consultation with relatives, has three core pillars:
- ‘Safe Start’ which supports new residents when they first move into one of our care homes,
- ‘Safe Visits’ which enables enhanced visiting where there is a clinical need, and
- ‘Safe Outings’ which facilitates residents to leave care homes where it is safe to do so.
Our ‘Safe Visits’ protocol identifies mechanisms that would allow relatives to visit their loved ones in a safe, controlled, and managed way. Each protocol is then personalised to the needs of both the resident and relative, with the needs, risks, training requirements and potential outcomes identified and taken into consideration.
For example, if a resident is experiencing weight loss issues, our protocol will allow for their relative to support activities which will help increase the consumption of food and drink. In addition, where possible, residents are also given the opportunity to agree to this protocol to seek the consent of all those involved. Once agreed and following the successful completion of training, the family member is accredited with an enhanced visitor status which safely waivers them from the current visitor restrictions.
These Safe Visits protocols are now being rolled out across our care homes, with numerous family members indicating an interest in joining the programme.
One of our care homes has been one of the first to engage with the Safe Visits protocol. Here, Alice Thomas*, a family member of a resident, had expressed to the home their own personal struggles with being unable to see their loved one in the same capacity and frequency as before the pandemic. Alice, who had visited the resident almost daily, also spoke of the toll this had taken on the mental state of herself as well as her relative.
In response, the home and Alice set in motion the Safe Visits protocol in order to alleviate the distress of their current separation. Using the protocol, we identified the needs, risks and possible outcomes which could be achieved from awarding Alice with an enhanced visitor status. For example, prior to the suspension of family visits, Alice would often visit the balcony in the home’s Memory Care Neighbourhood with her mother where they would plant and maintain flowers. This activity was a vital aspect of both of their daily lives and its absence was causing demonstrable distress among them both. In response, Alice’s personalised protocol identified this as a core activity that would be engaged in as part of her enhanced visitor status with a view that this would lead to an improved quality of life for Alice and her mother. It was also agreed that, subject to review, other activities would be gradually added under the Safe Choices model, with the agreement of the care home, Alice and her mother.
Speaking of her experience with the Safe Visits protocol, Alice said:
“It has been very hard for my mother and the rest of the family to be apart during Covid-19 and we have all been worried by the effect of this isolation on their wellbeing.
“However, the home has worked impressively with family members to understand the issues that lockdown has brought and has worked with us to develop a meaningful protocol that will help. I am looking forward to being able to spend more time with Mum, engaging in small activities which will make the world of difference to her. Hopefully this will mean that she once again starts to look forward to each day and that we can spend time talking and sharing experiences.”
Alice’s story is just one of many at Gracewell that reveal the importance of developing methods that enable residents and their families to see one another in these difficult times. And, as demonstrated by our Safe Visits protocol, it is indeed possible to protect the mental health of those we have a duty of care for, while minimising the risk of Covid-19 entering our care homes.
To see our latest updates on Covid-19, click here: www.gracewell.co.uk/latest-updates
*Names have been changed for the purposes of this article