Protecting residents in care homes during the Covid-19 pandemic is an absolute key priority for everyone working in health and social care and the wider community.
Our nursing and residential care homes are at the forefront of the battle against COVID-19. We want to pay tribute to the hard work and dedication of staff working across the care sector at this very challenging time. It is vital that we continue to support care homes and their staff to keep themselves, and the vulnerable people they care for, safe and well.
On Monday 27th April, Health Minister Robin Swann announced £6.5m in additional funding for Northern Ireland’s care homes, as part of a series of measures to support the sector during the Covid-19 pandemic.
The Minister also confirmed a further expansion of testing and the publication of updated guidance for care homes, aimed at strengthening infection prevention and control and protecting residents:
The guidance provides advice on areas such as the use of PPE, testing for staff and residents, staff redeployment and caring for residents in a care home setting. Importantly, the guidance sets out a new approach to managing discharges from hospital.
As at 30 April 2020, there were 483 registered care homes in NI of which 248 are nursing and 235 residential care.
The total number of registered beds is 16,095.
A residential care home provides residential accommodation with both board and personal care for people in need of personal care due to old age and infirmity; disablement; past or present dependence on alcohol or drugs; or past or present mental disorder. They do not provide nursing care.
A nursing home provides nursing care for people suffering from illness or infirmity. Some homes are registered to care for both people in need of residential or nursing care.
Care home residents are more at risk because of individual vulnerabilities, shared living space and frequent close contact with others who can unwittingly spread Covid-19 within and between settings.
The Covid-19 dashboard on the Department of Health’s website provides daily updates on the number of confirmed outbreaks in NI care homes. This dashboard is the responsibility of seconded NI Statistics and Research Agency (NISRA) statisticians within the Department of Health.
The live dashboard can be accessed at:
NISRA is responsible for the weekly bulletin, providing comprehensive statistics for confirmed and suspected Covid-19 related deaths across hospital and community settings, including care homes.
Further information can be accessed at:
Northern Ireland has moved before other parts of the UK to increase testing in care homes.
Health Minister Robin Swann announced on May 18 that Covid-19 testing will be made available to all care home residents and staff across Northern Ireland.
The Minister said it is intended to complete the roll-out of testing to all residents next month. In addition, a rolling testing programme for all staff will be put in place.
At present in Northern Ireland, care home staff and families have access to testing if they have symptoms. All staff and residents are also tested in homes when two or more people – staff or residents – have symptoms, as this is a possible outbreak scenario.
Testing is underway for all residents and staff in homes where there have been previous outbreaks that have not been resolved.
The next phase will involve commencement of testing for all residents and staff in care homes which do not have and have not had an outbreak, with the aim of helping to keep these homes free of Covid-19.
This ongoing expansion of care home testing will involve:
Ensuring that care homes continue to have sufficient supplies of free PPE is an absolute priority, and Health and Social Care Trusts are working closely with care homes in their local areas to ensure that each home has a buffer of PPE stock.
HSC has been providing over a million items of PPE to care homes every week.
The Minister and HSC officials continue to maintain regular contact with the sector in consideration of the challenges it continues to face in providing care to some of the most vulnerable members of our society.
A regional HSC Care Home Surge Plan has been devised in response to Covid19 involving the Health and Social Care Board, Public Health Agency, HSC Trusts, Primary Care and the Regularity Quality Improvement Authority (RQIA).
The plan has been developed to provide support to care homes, help slow the spread of the virus and to provide competent and dignified care to those who need it.
Health and Social Care Trusts are working closely with the RQIA Support Service Support Team and the Care Home Providers to protect older people in care homes from Covid-19.
A number of the actions are being undertaken relating directly to prevention and shielding which are designed to prevent outbreaks in homes from occurring. Actions include:
Visiting restrictions include:
Infection prevention and control measures include:
Testing has been stepped up as follows:
Staff and workforce issues are regularly monitored and steps have been taken:
All patients/residents being transferred into a care home from any setting, whether that be from hospital, supported living or directly from their own home, will be tested 48 hours prior to admission to the care home. This will help care home staff to understand each resident’s status and to plan their care effectively.
The updated guidance makes clear that all patients discharged from hospitals into care homes should be subject to isolation for 14 days in line with infection control advice. Where a home is unable to isolate a patient the local Health and Social Care Trust will make arrangements for isolation in a suitable setting until they can be admitted to the care home.
Health and Social Care Trusts will continue to work in partnership with care home providers to help deal with staff shortages. Where people have responded to our Workforce Appeal, those with the right skills will be prioritised for deployment with independent care home providers. Trust staff has already been redeployed to care homes and will continue to be.
Essential to this is the provision of nursing care and we want to in particular encourage registered nurses who have transferable skills, expert knowledge and experience of caring for older people in a range of other settings to come forward and play their part in keeping vulnerable people out of hospital and in their own home.
Health and Social Care Trusts have stepped in to provide thousands of hours of free staffing time in homes. The staff redeployed has included support service staff or professional staff e.g. nurses, occupational therapists, physiotherapists etc. from both community and hospital settings. Trusts will ensure that appropriate medical input is available to the homes.
Support and expertise has also been made available from the RQIA’s Service Support Team and in the event of an outbreak support has been provided from the Public Health Agency.
In addition, 76 dentists have come forward to work in care homes and training is being provided.
The COVID-19: Guidance for Nursing and Residential Homes in NI (April 20)
https://www.health-ni.gov.uk/sites/default/files/publications/health/guidance-for-nursing-residential-care-homes.pdf outlines the support Care Homes will receive from the RQIA’s Service Support Team and Trusts in relation to business continuity issues which include staffing matters.
Measures aimed at safeguarding the financial resilience of care home providers by guaranteeing a level of income have been in place since mid-March.
Health Minister Robin Swann announced £6.5m in additional funding for Northern Ireland’s care homes, as part of a series of measures to support the sector during the Covid-19 pandemic.
This will help ensure homes can increase the level of cleaning undertaken and bring in any additional staff they need to help support the isolation of residents when this is necessary.
Under the support package, homes will receive a payment of £10k, £15k or £20k depending on their size.
The Minister has also announced the piloting of a new model for care homes: ‘Safe at Home’. This will see the Department working closely with a small number of homes to test an enhanced approach to care delivery and to help us learn lessons that we can roll out more widely. Building on initiatives already taking place in the sector, the approach will include supporting staff to live in the care home – helping to reduce the chances of coronavirus being carried into the home.
The Public Health Agency (PHA) has long-established, well-trusted and robust systems in place to monitor infectious diseases and provide direct advice and support to manage outbreaks and limit onward spread.
While a lot of this work goes on behind the scenes, the public should be reassured that we have well established links with these facilities. Whenever there is evidence of COVID19, or respiratory illness, in a home the PHA works intensively to limit spread.
When the PHA receives a notification of an issue of acute respiratory infection in a care home the agency’s health protection team investigates and supports the provider in managing the outbreak.
A comprehensive risk assessment is completed of the incident, which includes an assessment of each individual resident and the environment, and an ongoing assessment of the severity, spread and context of the incident.
Advice specific to COVID-19 is given regarding isolation, containment, and infection prevention and control practice, including cleaning, testing information, how to manage symptoms, when to request additional medical advice, and PPE.
When a nursing or residential care home outbreak is over, a thorough clean of the facility is advised. The PHA’s health protection team will support the facility through this process, and following this a final outbreak summary report is produced.
We have seen an increase in the prevalence of COVID-19 in care facilities, and anticipate that this will continue. We do expect there will be further outbreaks of COVID19 in the coming weeks and months. The HSC wide system works closely with all partners to reduce the risk of further transmission of the virus.
The work we are undertaking with care homes is what we do with a range of infectious diseases week-in, week-out, and the same processes are being followed to deal with coronavirus.
It can often be difficult to identify the symptoms of COVID-19 in some older people. We are therefore testing more individuals in care homes. When COVID-19 is identified in a facility, all residents and staff are now tested.
Another key role of the PHA is to undertake surveillance of the situation on an ongoing basis.
A range of methods are in place to monitor the course of COVID-19 in case homes and the wider community. The data collated by the PHA is used to monitor the situation as closely as we can.
No. GP visits to care homes have not stopped.
At this time all GPs are operating a ‘telephone-first’ access system where all requests are triaged by a doctor.
It is important that any concerns about the level of care provided to residents in a care home are identified and addressed as quickly as possible.
If you have a concern about any aspect of the care a family member is receiving, you should immediately raise that concern with the manager of the home so that the appropriate action can be taken as quickly as possible.
If the manager is unable to resolve your concern or you are dissatisfied with their response, then you should contact the relevant Health and Social Care Trust and raise your concerns with them.
The Patient and Client Council is also available to assist you if you wish to pursue a concern or make a formal complaint. They can be contacted at: https://patientclientcouncil.hscni.net/
For further information on Covid-19, see below some useful links: