Homecare Workers preparing Hoist

Public Health England (PHE) has issued new guidance about home care provision which sets out key messages to support planning and preparation in the event of a wide outbreak of COVID-19 in the community.

Building on the UK Government’s latest advice on self-isolation, the guidance is aimed at local authorities, clinical commissioning groups (CCGs) and registered providers who support and deliver care to people in their own homes, including community health services.

It may also prove useful for those in the industry carrying out emergency repairs to vital home adaptations and equipment, such as stairlifts, homelifts and hoists. In the government’s advice regarding carrying out work in homes, companies should contact PHE before carrying out work for anyone showing signs of the virus or anyone being shielded.

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Steps for home care providers to maintain delivery of care

PHE outlines that home care providers should:

  1. Review their list of clients and ensure that it is up to date, including levels of informal support available to individuals. Providers could also explore sharing this information electronically with local partners.
  2. Work with local authorities to establish plans for mutual aid and consider arrangements to support sharing of the workforce between home care providers, and with local primary and community services providers, and with deployment of volunteers.
  3. Note the arrangements that local authorities, CCGs and NHS 111 are putting in place to refer vulnerable people self-isolating at home to volunteers who can offer practical and emotional support.

The guide adds that home care providers will routinely be procuring personal protective equipment (PPE).

In addition, there will be a free issue of PPE to support adult social care providers to comply with the updated advice on use of PPE to support management of symptomatic patients, Public Health England notes.

If a care worker is concerned they have contracted COVID-19

As with any other person who is worried that they have coronavirus, staff members are advised to follow NHS advice if they’re concerned they have COVID-19. If they are told to self-isolate, PHE says they should follow Government guidelines on staying at home and suspend caring duties until it is safe to resume.

If the individual being cared for has symptoms of COVID-19

The guide says that safe working procedures should minimise the risk of transmission if the person receiving care presents with coronavirus symptoms.

PPE

Care workers should use PPE for activities that bring them into close personal contact. If there is a risk of splashing, then eye protection will minimise risk, the guidance outlines.

New PPE must be used for each episode of care, which must be stored securely within disposable rubbish bags, the guidance stresses. These bags should be placed into another bag, tied securely and kept separate from other waste within the room. This should be put aside for at least 72 hours before being put in the usual household waste bin.

Recently, the AHPF wrote a letter to the Secretary of State for Health and Social Care Matt Hancock seeking greater clarity about the ongoing situation regarding healthcare workers and their access to PPE.

Cleaning

PHE advises care workers use regular household products when undertaking cleaning duties as these are effective at getting rid of the virus on surfaces. The guide adds that touched surfaces should be cleaned regularly.

“Personal waste (for example, used tissues, continence pads and other items soiled with bodily fluids) and disposable cleaning cloths can be stored securely within disposable rubbish bags,” the advice continues. “These bags should be placed into another bag, tied securely and kept separate from other waste within your own room. This should be put aside for at least 72 hours before being put in the usual household waste bin for disposal as normal.”

Laundry

Care workers are advised not to shake dirty laundry before washing as this can increase the chance of COVID-19 spreading through the air but should continue to wash items as per the manufacturer’s instructions.

Dirty laundry that has been in contact with an ill person can be washed with other people’s items. If the individual does not have a washing machine, wait a further 72 hours after the seven-day isolation period has ended; the laundry can then be taken to a public laundromat, the guidance advises.

Items heavily soiled with body fluids should be thrown away safely, with the owner’s consent, Public Health England states.

Individual being cared for does not have symptoms but is part of a household that is isolating

If the individual being cared for and their worker can remain at a safe protected distance from the symptomatic member of the household, then care can be provided without additional precaution, the guidance says.

PHE continues: “Where this is not possible – and this will vary on a case-by-case basis – the same procedures should be adopted as if the person being cared for did have symptoms of COVID-19. Care should continue to be taken to limit contact with any household member that has symptoms.”

If neither the individual nor the care worker have symptoms of COVID-19

In this case, no PPE is required beyond good normal hygiene practices. PHE says that increased cleaning, property ventilation and vigilant hand cleaning are all good practice for care workers.

NHS support for home care provision

CCGs, NHS providers and local community services and primary care will be working with and supporting local authorities and home care providers in the provision of care, the guidance details.

According to PHE, community service providers will take steps to:

  • Ensure their list of individuals in receipt of care at home support is up to date, establish levels of informal support available to individuals, and share lists with local authorities and home care providers to ensure join-up.
  • Consider which teams need to extend operational hours or link to other services in order to deliver high-quality care.
  • Explore options for alternative care models, including telecare models, to provide advice to patients.
  • Take stock of how to maintain viable home care provision during the pandemic. This includes developing joint plans with local authorities, home care and care home providers and primary care colleagues to agree how and when escalation processes can be triggered.
  • Support local authorities in planning around resilience, including plans to share resources locally in an outbreak of COVID-19.
  • Consider how voluntary groups that currently support NHS services could also support teams and specific individuals.
  • Steps for local authorities to support home care provision
  • According to PHE, local authorities 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
  • Map all care and support plans commissioned by the local authority to inform planning during an outbreak. Support providers similarly to map those packages that are self-funded
  • Contact all home care providers in the local authority area and facilitate plans for mutual aid across the area
  • Consider the need to draw on local community services and primary care providers to support home care provision and draw up a plan for how and when this will be triggered
  • Consider how voluntary groups can support home care provision
  • Take stock of how to maintain viable home care provision during the outbreak of COVID-19, including financial resilience

Recently, the government passed the Coronavirus Act, enabling a wave of new powers to help the country fight the pandemic, including potential changes and suspensions of responsibilities outlined in the Care Act.

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