Support for Care Homes during Covid-19

Support for Care Homes during Covid-19 2020-06-25T07:45:07+00:00

What is Covid-19?

Coronavirus, SARS-COV-2 or COVID-19? 2020-05-04T00:39:21+00:00

Name of the virus is SARS-CoV-2

Name of the clinical disease is COVID-19

Other strains of the Coronavirus which we have already seen are:

  • SARS-CoV – this occurred in 2002-2003
  • MERS-CoV – this occurred in 2012. Still circulating in some countries
  • SARS-CoV-2 – Now known as COVID-19 – high probability that it originated in bats
What is Covid-19? 2020-05-13T16:22:45+00:00
  • First identified in sample cases in January 2020, COVID-19 is the clinical disease caused by a new strain of coronavirus (novel): SARS-CoV-2
  • There is no known population immunity meaning that potentially everyone is susceptible
  • There is a still a lot that we are learning about the virus
  • There is currently no vaccine and no treatment
  • Part of a large family viruses – including the common cold

Websites: NHS England, NHS Improvement

Symptoms of Covid-19 2020-05-21T08:59:27+00:00

Main reported symptoms

  • Cough (dry) or chest tightness
  • Fever (≥37.8°c)
  • Dyspnoea (difficulty in breathing)
  • Loss of or changes in smell or taste

Other symptoms include

  • Fatigue / drowsiness
  • Confusion
  • Headache
  • Diarrhoea
  • Muscle ache
  • Sore throat
  • Runny nose
  • Nausea & vomiting
Incubation, Infectivity and Recovery 2020-05-06T11:21:09+00:00

How is Covid-19 transmitted? 2020-05-04T04:41:22+00:00

Which bodily fluids transmit COVID-19? 2020-05-04T04:43:02+00:00

Further links and resources 2020-05-13T16:25:21+00:00

WHAT IS COVID-19

About coronavirus (COVID-19)

Author: NHS England, NHS Improvement

  • Symptoms, mode of transmission, case/contact definition and situational reports.

Website: NHS England, NHS Improvement

Coronavirus (COVID-19) advice for social care

Author: SOCIAL CARE INSTITUTE FOR EXCELLENCE
Date: April 2020

  • Advice for councils and care providers during this period of sustained transmission of COVID-19.
  • Provides residential care, supported living and home care guidance.

Website SCIE

Coronavirus (COVID-19): adult social care guidance

Author: Department of Health and Social Care, Public Health England

Date: 27th April 2020

  • This document brings together coronavirus (COVID-19) guidance published for the adult social care sector and other relevant guidance.

Website: DHSC, Public Health England

Translated Covid-19 resources – https://www.doctorsoftheworld.org.uk/coronavirus-information//

https://www.gov.uk/government/publications/coronavirus-covid-19-information-leaflet

Infection, Prevention and Control

Please see the latest guidance below.

Covid 19 transmission methods SCIE 2020-05-04T04:45:08+00:00

Key prevention activities to protect staff and residents 2020-05-13T16:28:51+00:00

Keep a minimum of 2m whenever possible.

Hand hygiene before every episode of care and after any activity that may result in hands becoming decontaminated Hand hygiene guide

Follow good Respiratory hygiene practice.

Avoid touching your face with your hands at all times.

Follow standard infection prevention and control precautions. NICE guidance

Do not wear nail varnish or use false nails and keep nails short and use moisturiser after hand washing to keep skin intact.

Clean surfaces frequently. There is potential for widespread contamination of patient rooms or environments, so effective cleaning and decontamination is vital.

Good handwashing technique 2020-05-04T05:06:25+00:00

Hand washing

As often as possible for at least 20 seconds:

  • Ideally soap and warm water
  • Alcohol gel otherwise (allow to dry)

Essential:

  • Before and after resident contact
  • After coughing/sneezing
  • After removal PPE
  • After waste handing
  • After equipment decontamination
  • Before food preparation
  • After toileting

Correct technique essential

  • Include wrist and forearm

Source:https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881489/COVID-19_Infection_prevention_and_control_guidance_complete.pdf

Areas most often missed during handwashing 2020-05-04T01:01:06+00:00

Respiratory Hygiene – ‘Catch it, bin it, kill it’ 2020-05-13T16:30:27+00:00

Do

  • Use disposable, single-use tissues to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose.
  • Put used tissues promptly in the nearest waste bin.
  • Have tissues, waste bins (lined and foot operated) and hand hygiene facilities for patients, visitors and staff.
  • Clean hands (using soap and water if possible, otherwise using ABHR) after coughing, sneezing, using tissues or after any contact with respiratory secretions and contaminated objects.
  • Encourage patients to keep hands away from the eyes, mouth and nose.

 

Source:  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881489/COVID-19_Infection_prevention_and_control_guidance_complete.pdf

 

Decluttering and cleaning surfaces 2020-05-04T06:39:56+00:00

Reducing the risk of transmission from resident’s rooms with COVID – cleaning / decontamination 2020-05-13T16:31:44+00:00
  • Before entering the room, clean hands, then put on a disposable plastic apron and gloves. If a risk assessment indicates that a higher level of contamination may be present or there is visible contamination with body fluids, the need for additional PPE such as a fluid resistant surgical mask and eye protection should be considered.
  • After cleaning with neutral detergent, a chlorine-based disinfectant should be used, in the form of a solution at a minimum strength of 1,000ppm available chlorine.
  • Dedicated or disposable equipment (such as mop heads, cloths) must be used.
  • Reusable equipment (such as mop handles, buckets) must be decontaminated after use with a chlorine-based disinfectant as described above.

Patient care equipment should be cleaned according to manufacturer’s instructions, and where possible with chlorine-based disinfectant, 70% alcohol or an alternative disinfectant that is effective against enveloped viruses.

Source  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881489/COVID-19_Infection_prevention_and_control_guidance_complete.pdf

Care Home workers clothing / uniform 2020-05-04T15:05:08+00:00

Wear your normal work clothes or uniform at work 

Do not wear your uniform when going home:

  • Transport it in a plastic bag and store / wash it safely.

Cleaning work clothes/ uniform at home:

  • Clothes should be cleaned after every shift separately from other clothes.
  • If not, store separately from other clothes until washed.
  • Use the maximum temperature possible and in a wash cycle of at least 10 minutes.
  • Do not overload the machine.
  • A suitable detergent should always be used.
  • Clothes should be ironed or tumble dried after washing.
Laundry and Waste Management 2020-05-04T15:08:34+00:00

Personal and cleaning waste

Do:

  • Store personal waste of suspected cases (e.g. used tissues, continence pads, other items soiled with bodily fluids) and disposable cleaning cloths securely within disposable rubbish bags.
  • Place these bags into another bag, tied securely and kept separate from other waste within the room.

Put bags aside for at least 72 hrs before being disposed of as normal.

Source:  https://www.scie.org.uk/care-providers/coronavirus-covid-19/infection-control#laundry-management

Linen

Do:

  • Handle potentially infected linen with appropriate PPE.
  • Package line in the residents room in an appropriate bag.
  • If required, linen should be sorted before bagging / transport.
  • Linen must be washed and prepared in an appropriate manner.

Do not

  • Place dirty laundry on the floor or other surfaces to prevent contamination.
  • Do not shake linen.
  • Linen should be handled in accordance with Health Technical Memorandum 01-04 (2016).
Further links and resources 2020-05-13T16:33:02+00:00

COVID-19: infection prevention and control guidance

Authors: PHE,NHS
Updated: 27th April 2020

Access: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881489/COVID-19_Infection_prevention_and_control_guidance_complete.pdf

Website: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

 

Coronavirus (COVID-19) infection control for care providers

Author: Social Care Institute for Excellence
Date: 28th April 2020

This quick guide sets out best practice for care providers to remain safe and prevent COVID-19 from spreading.

Websites: SCIE

Personal Protective Equipment (PPE)

For information about what PPE should be worn and when, including links to videos for how to put on and take off PPE.  You can also view latest PPE guidance here. Please continue to pursue your own supply lines and only contact the NSDR via the 24/7 helpline: 0800 915 9964 (Freephone number in the UK) or Mutual Aid on 02033223912 if you are unable to secure through usual channels.  You can also contact the Council at PPErequests@croydon.gov.uk if you have less than 3 days of PPE supply and have exhausted all other options.

Types of PPE 2020-05-13T16:34:51+00:00

As there is sustained transmission of COVID-19 we recommend use of PPE regardless of whether residents in your care home have symptoms.

Please see the next slide for details about what PPE to wear and when. Click here for more guidance.

Please click here for a list of Aerosol Generating Procedures

PPE use, re-use and disposal 2020-05-13T16:36:55+00:00

PPE – Change and dispose of between each resident

  • Apron
  • Gloves
  • If Aerosol generating procedure all PPE single use only

PPE – Continuous use until you need to take a break or otherwise remove it.

  • Fluid repellent face mask (can be worn for up to 8 hours and then disposed of)
  • Eye protection

Damaged / soiled, damp face masks and eye protection

  • Should be discarded and replaced. Click here for more information

Disposal of PPE

  • Used PPE should be put in clinical waste and disposed of as per local policy

Re-using PPE

  • Some eye protection is re-usable and should be cleaned according to manufacturers instructions after use

Re-using PPE when there is a shortage

 

Source: https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-care-homes   27.4.2020

What Personal Protective Equipment (PPE) to use 2020-05-04T06:42:36+00:00

The correct way of putting on PPE 2020-05-13T16:38:08+00:00

Click here for further guidance and videos for putting on and removing PPE in care homes

Before putting on your PPE:

  • Make sure you drink some fluids,
  • Tie hair back,
  • Remove jewellery,
  • Check PPE is the correct size and
  • Ensure you are at least two metres away from the person you are caring for and any resident with a cough.

Use a buddy system to observe putting on and taking off to prevent mistakes.

Source: https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-care-homes

 

The correct way of taking off PPE 2020-05-13T17:04:56+00:00

Do’s and Don’ts of PPE 2020-05-04T01:53:00+00:00

DON’T   Remove PPE and then put it back on:
e.g for a coffee break, drinking water, smoking a cigarette, toilet breaks

DON’T   Hang your mask on your neck or on your head
If the mask is removed from your mouth it must be disposed of and replaced

DON’T   Touch your face especially if wearing gloves

DO          Wash your hands often

DO          Organise breaks to minimise removal and replacement of PPE
*Ensure ALL PPE is removed when you take a brea
*Make sure you eat and drink enough – wearing PPE can be hot
*Ensure you use the toilet during your breaks

Source: COVID-19 and Care Homes IPC training (2) April 2020: PHE London working with ADPH London

Sourcing PPE and emergency PPE supplies 2020-06-25T08:08:43+00:00

Wherever you can we would encourage you to:

Continue to try and secure PPE supplies through your usual supply routes. We know stocks are being delivered through everyday orders and this should continue in the first instance.

National PPE Portal for care homes with 24 beds or fewer

  • Following your invitation last week, there is now a guidance page on the PPE portal, to help provide information to those invited to register and order emergency PPE through the site: https://www.gov.uk/guidance/ppe-portal-how-to-order-emergency-personal-protective-equipment 
  • This portal aims to replace the council’s emergency PPE route for smaller providers, however Emergency PPE will still be available from council in meantime via the PPE inbox. You will only be able to order small quantities to top up supplies of PPE via the portal (100 masks, 400 aprons and 400 pairs of gloves), however if you are interested in sourcing larger orders of PPE (up to 6 weeks’ worth) at cost prices please contact pperequests@croydon.gov.uk

If you are unable to secure through business as usual channels please contact:

  • National Supply Disruption Line (NSDR) via the 24/7 helpline: 0800 915 9964 (Freephone number in the UK) or email:  supplydisruptionservice@nhsbsa.nhs.uk  or
  • Mutual Aid on 02033223912
  • New national PPE portal for emergency orders – A new national online PPE portal is being rolled out this week which will allow care homes with 24 beds or fewer to order online and receive deliveries of emergency PPE at no cost.  Further information can be found on the portal: https://www.gov.uk/guidance/ppe-portal-how-to-order-emergency-personal-protective-equipment This portal aims to replace the council’s emergency PPE route for smaller providers, however Emergency PPE will still be available from council in meantime via the PPE inbox. You will only be able to order small quantities to top up supplies of PPE via the portal (100 masks, 400 aprons and 400 pairs of gloves), however if you are interested in sourcing larger orders of PPE (up to 6 weeks’ worth) at cost prices please contact pperequests@croydon.gov.uk

Contact the Council at PPErequests@croydon.gov.uk if you have less than 3-days of PPE supply and have exhausted all other options.

 

Further links and resources 2020-05-13T16:44:41+00:00

COVID-19: putting on and removing PPE – a guide for care homes (video)

COVID-19: how to work safely in care homes

Author: Public Health England

Date 27th April 2020

  • PPE recommendations for care home staff
  • Useful frequently asked questions on the use of PPE in care homes
  • examples which help to identify the correct use of PPE when undertaking activities that require physical contact or activities which do not require physical contact but are carried out in close proximity to residents
  • guide to putting on PPE for care homes
  • guide to taking off PPE for care homes

Websites: PHE

Looking after your residents

Guidance to support you caring for residents with symptoms can be found here

Covid-19 Outbreak preparedness 2020-05-06T09:49:50+00:00

Key actions to help you manage:

  • Ensure soap, water and paper towels by each sink
  • Ensure residents have access to tissues and bins and are supported to look after their hand and respiratory hygiene
  • Alcohol based hand rub available in every room/communal areas
  • At least 72 hours of PPE available
  • Adequate staffing numbers and reserve staff in case of illness
  • Staff health and wellbeing is addressed and supported

 

Source: COVID-19 and Care Homes IPC training (2) April 2020: PHE London working with ADPH London

Covid-19 Outbreak definition and initial actions 2020-05-13T17:24:55+00:00

Outbreak: One symptomatic case within 14 days of each other

  • Inform the London Coronavirus Response Cell (LCRC) on 0300 303 0450

When calling LCRC have the following information at hand:

  • Number of residents affected.
  • Dates of first and most recent affected resident.
  • Number of residents admitted to hospitals.
  • Date and number of any COVID related deaths.

Inform the Council on:  enquiriesBC@croydon.gov.uk

Close the home to visitors (except for end of life visits)

Source: COVID-19 and Care Homes IPC training (2) April 2020: PHE London working with ADPH London

Source: COVID-19 and Care Homes IPC training (2) April 2020: PHE London working with ADPH London

All residents in care homes now being tested for COVID-19 2020-06-02T08:11:49+00:00

New online portal for care homes to arrange Covid-19 testing

  • As the national testing capacity has increased, the government is prioritising testing for care homes and other areas with the greatest needs.  A new online portal has been launched this week for care homes to arrange coronavirus testing.  All symptomatic and asymptomatic care home staff and residents in England are now eligible for testing, with priority for those in homes that look after the over-65s.
  • We would encourage all eligible care homes to register on the portal and take the opportunity to test all staff and residents.  For further information please click here. Rachel Flowers, Croydon’s Directors of Public Health and her team can also refer local care homes in line with their local prioritisation of need. Tests will be available to all care homes over time, but this digital portal service is currently available to those which primarily look after older people or people with dementia.

When should I access this portal?

  • You can apply whether or not any of your residents or staff have coronavirus symptoms.  At the moment, you can only get tests if your care home looks after older people or people with dementia. Please let us know when you have registered for the portal by emailing enquiriesBC@croydon.gov.uk

How do we carry out the tests?

  • Detailed guidance has been produced for care home managers. A tutorial video is also available to guide staff through the swab collection process.  Please click here for the Coronavirus test tutorial for care homes.

When will I get results?

  • It is unlikely that you receive these instantly, results will probably take a few days

What happens when I the get results?

  • Continue your Infection Control and Prevention approach
  • Contact London Coronavirus Response Cell if you have your first case (see below)
  • Please inform us via enquiriesBC@croydon.gov.uk  as soon as you get the results.  Homes may find you have asymptomatic residents and staff which may impact on staffing levels and number of residents that need to isolate. We can help you with any actions that have to be taken.

Please click here for a summary of the guidance issued by the Department Health and Social Care.  We would encourage all eligible care homes to register on the portal and take the opportunity to test all staff and residents.  For further information and to access the portal please click herePlease let us know when you have registered for the portal and as soon as you get the results by emailing us on enquiriesBC@croydon.gov.uk.  We can help you with any actions that have to be taken.

Guidance for care home staff on testing

Coronavirus outbreak – If you think your care home has a coronavirus outbreak (now only one case) but no one has been tested yet, please contact the London Coronavirus Response Cell on 0300 303 0450 immediately or email lcrc@phe.gov.uk or phe.lcrc@nhs.net .   They will send test kits and provide infection control support.

Further information on staff testing can be found in the Care Home Staff and Covid-19 section of this webpage.

 

How to care for residents with suspected COVID-19 2020-05-13T17:28:10+00:00

Record observations where possible

Adapted from: Suspected Coronavirus pathway – Residential and Nursing Home residents – London

Isolate and monitor

  • If a resident has COVID-19 symptoms notify the London Coronavirus Response Cell immediately on: 0300 303 0450
  • Isolate the resident for 14 days in a single room
  • Consider bathroom facilities. If no ensuite available:
  • Designate a single bathroom for this resident only
  • Use commode in room
  • Care for the resident using PPE
  • Use additional protection for Aerosol Generating Procedures (AGPs)
  • Use correct hand washing and surface cleaning technique
  • If you have the Telemedicine service, please contact the Telemedicine service immediately for a video assessment and consultation  
Isolating and cohorting residents and staff 2020-05-13T17:22:56+00:00

Symptomatic residents must be isolated for at least 14 days from onset of symptoms. If unable to isolate the individual, then this should be documented.

Ideally this should be a single room with a bathroom.

If single rooms are not possible, then symptomatic residents should be cohorted together. However residents should not be cohorted together if their COVID  status is known to be different (confirmed, suspected, symptomatic)

Staff should ideally be cohorted to either confirmed, symptomatic or asymptomatic residents

Source: Adapted from: COVID-19 and Care Homes IPC training (2) April 2020: PHE London working with ADPH London

Managing admissions from the community 2020-05-06T10:31:32+00:00

Residents discharged from hospital: Scenario 1 2020-05-06T10:32:14+00:00

Residents discharged from hospital: Scenario 2 2020-05-06T10:33:03+00:00

Residents discharged from hospital: Scenario 3 2020-05-06T10:33:51+00:00

Who to call if you are worried about a resident? 2020-05-13T16:17:13+00:00
  • For the majority of nursing home residents hospital admission is unlikely to provide benefit and the focus should be on managing the resident in the care home setting.
  • Telemedicine should be used as a first point of call for any concerns about a resident (even if they seem minor) and particularly if the resident is unwell. They can offer advice and support you to manage your residents appropriately.

Please call the Telemedicine Hub immediately – do not wait for your resident to get worse

  • If the Telemedicine Hub thinks that an ambulance is necessary, they will attempt to contact resident’s GP or the OOH GP in the first instance so that a final decision regarding transfer to hospital can be made with the GP. Of course there may be circumstances when this is not possible or appropriate and in such cases an ambulance will be called as deemed necessary
  • Please bear in mind that paramedics can make use of the Telemedicine Hub when they are called out to a care home
  • The Telemedicine Hub can support with verification of death and should be contacted for any EXPECTED death of a resident
  • For homes that do not have telemedicine they should follow their usual process – in hours would be GP or if more urgent then they should call NHS111*6. OOH = NHS111*6
Telemedicine Service details 2020-05-06T10:35:37+00:00

 

Please ensure the laptop is ALWAYS plugged in and charged and available to receive video calls – we have given laptops to other providers in the community so they will be able to video conference in for advice and assessment e.g. Rapid response, St Christopher and Croydon University Hospital.

 

 

 

GP support 2020-05-06T10:36:29+00:00
  • GP “ward rounds” will continue but will be done via video link. Please prepare in the same way as for your usual ward round and have available a list of patients who require review and details of any new residents admitted to the care home.
  • GPs will be trying to update advance care plans for all residents where possible and ask for your support with this
  • Requests for home visits will be reviewed by the GP and if possible will be done via phone or video link as appropriate
Talking to relatives 2020-05-06T10:37:02+00:00

Conversations with relatives about COVID-19 can be challenging.

Think

  • What information do I need to tell the relative
  • How can I keep the language simple

Ask

  • If the relative is ok to talk
  • What the relative already understands about their loved one
  • If they have any questions or need any other advice or support

Do

  • Introduce yourself
  • Comfort and reassure
  • Allow for silence
  • Talk to colleagues afterwards
Links and resources 2020-05-06T10:38:07+00:00
  • Immedicare Relationship Manager: Gareth Archer – 07779 427456 or GArcher@immedicare.co.uk
  • Immedicare Tech Support – 0330 088 3312
  • LD Pharmacist Tom Lee – Thomas.lee5@nhs.net
  • Rapid Response Team – 07768 376832

Residents with Dementia

Information about considerations for people with dementia.  Includes support and advice from the Care Homes Intervention Team (CHIT) on wandering, behavioural strategies and social engagement.

Dementia – overview 2020-05-06T14:00:20+00:00
  • People with dementia are much more prone to develop delirium (a confused state) if they develop an infection
  • Going into hospital is frightening enough and particularly so for someone with dementia. Avoiding unnecessary hospital admissions is important.
  • Some people with dementia may have difficulty understanding complex instructions about self-isolation or handwashing – keeping information accessible and repeatable is key.
  • People with dementia may lack awareness of and be less able to report symptoms because of communication difficulties – people should be alert to the presence of signs as well as symptoms of the virus (“look beyond words”).
Dementia – health 2020-05-06T14:02:50+00:00

People with dementia may have swallowing difficulties which could put them at increased risk of developing chest infections and dehydration – a swallowing assessment may be helpful.

Older adults with dementia who have COVID-19 may not always present with typical symptoms:

  • As well as monitoring for cough and fever, we recommend considering possible COVID-19 in residents who are excessively sleepy, do not want to get out of bed (if this is unusual for them), have diarrhoea or have a sudden deterioration in their oral intake
Dementia – ‘wandering’ 2020-05-06T14:01:14+00:00

Some residents are likely to not understand the need to self-isolate and may wander.

  • The evidence suggests that cross infection may be more likely from asymptomatic staff than from wandering residents.
  • The risks can be reduced by trying to divert and occupy the residents, and guiding them away from other vulnerable residents.
  • It is likely they will benefit from having a staff member allocated to them who wears PPE during their time with this resident.
  • 1:1 activities, family and friend contact via technology, and things to occupy themselves with, are increasingly important during this lockdown period.

Routine sedation of residents with COVID-19 who wander is not recommended, and the degree of sedation likely to stop wandering is likely to cause harm to that resident, and may inadvertently make them more confused and likely to wander.

  • Non-medication strategies should still be considered as first line treatments.
  • The Care home intervention team (CHIT) can help you develop non-medication strategies for these patients.
  • For residents who are significantly agitated and / or delirious, medication may be indicated to reduce their agitation and distress.
  • Speak with the GP in the first instance about prescribing. GPs have been sent the Maudsley Management of COVID-19 related delirium for further advice and can contact the CHIT directly for medication advice.
Dementia – behavioural strategies 2020-05-06T14:02:00+00:00

If a person with dementia is unable to comply with safety measures ( ie self-isolate , walking about , restlessness):

  • Try to understand behaviour and provide practical help by breaking things into manageable steps.
  • Remind residents of protective measures. Consider supporting verbal communication with pictures.
  • Encourage and provide reassurance to promote sense of accomplishment.

If mood or behaviour deteriorates (e.g. withdrawn, tearful, aggression, increased restlessness):

  • Check for COVID-19 symptoms
  • Rule out other underlying physical causes: Check bowels, urine, food and fluid intake, and pain
  • Contact GP
  • Document behaviours using ABC charts
  • If behaviours persist, contact CHIT Monday-Friday 9am-5pm
Dementia – social engagement 2020-05-06T14:03:56+00:00

Social Support and engagement

  • Relatives and friends not being allowed to see a person in a care home could have a detrimental effect on residents with dementia – use of technology may help improve communication between families both at home and in care homes.
  • Use of video calling might be a good medium for some.
  • There are lots of activities and resources online. For example, the Health Innovation Network have put together a lot of resources from online, or that can be done on handheld devices like tablets.
  • The Alzheimer’s Society have pulled together activity ideas you can access for free.
  • Life Story: Support residents to feel connected to themselves, and others during this time of isolation. Complete ‘This is Me’ with the person and/or family to help activity planning, life story work and reminiscing with them
  • Family may like to email photos which you can laminate; write the occasion and people in photo.
Links and resources 2020-05-13T17:33:02+00:00

https://healthinnovationnetwork.com/wp-content/uploads/2020/04/Maintaining-Activities-for-Older-Adults-during-COVID19.pdf

ALZHEIMER’S SOCIETY
Date: 16 April 2020

  • Advice and practical tips for people living with dementia and those supporting them – either in the same household or from a distance.
    Website: Alzheimer’s Society
  • ‘This is Me’ Life History Information:

https://www.alzheimers.org.uk/sites/default/files/2020-03/this_is_me_1553.pdf

  • Azheimers Society Activity recources:

https://www.alzheimers.org.uk/get-support/coronavirus-activity-ideas-people-living-dementia

Dementia UK advice for people with dementia and their families, regarding the coronavirus

Author: Dementia UK

Date: 17th April 2020

  • Advice from Dementia UKs Admiral Nurses on looking after yourself and a person with dementia throughout this period of time.

Websites Dementia UK

COVID-19: Dementia and cognitive impairment

Author: BRITISH GERIATRIC SOCIETY

Date: 7th April 2020

  • This short paper attempts to summarise some of the key issues around people with dementia and their carers in relation to COVID-19 (coronavirus).
  • It provides ten key points have been devised which reflect clinical advice and specific information about dementia. It may be helpful to clinicians and planners.

Website: British Geriatric Society

Useful Contact:

Croydon Care Home Intervention Team
Email:  CCHIT@slam.nhs.uk
Tel: 02032286429

 

End of Life Care

Here you’ll find information and support available to home care staff. Please share with your staff and enable them to access this support.  Information on the IAPT support line is available here. There is also free support from qualified and trainee psychotherapists and psychotherapeutic counsellors from the Southern Association for Psychotherapy and Counselling (http://www.safpacfrontline.co.uk/). Up to three phone or Skype sessions of 30-50 minutes are being offered. If you are interested please email info@safpacfrontline.co.uk and a therapist will contact you to make arrangements.

You will also find information on support available from St Christopher’s including how to access free training for you and your staff.

End of Life Care Directory of Services 2020-05-13T17:34:08+00:00

Please see Croydon’s End of Life Care Directory of Services updated as of 07/05/20

 

End of Life Care Support 2020-05-15T10:31:26+00:00

Marie Curie night sitting service can be found here

General Practice Services: Provide advice and anticipatory medicines to manage patients.

  • Video consultations
  • Early level support

Community Nursing: Review patient guaranteed response within 2-4 hours if urgent.

  • PRN Charts
  • Symptom control
  • Syringe pump managements

GP Out of Hours:

  • Remote review (phone/video link)
  • Home visits only if clinically necessary after triage by GP

Rapid Response

  • Can give advice over the phone and via the Telemedicine laptop.

GP Out of Hours Prescribing

  • Prescribing and emergency medications as required.

Medicines Management

24/7 Community Pharmacy

  • Croydon Community Pharmacy Out of Hours Service Mayday Community Pharmacy  514 London Road, CR7 7HQ

Telemedicine

  • Virtual Support for End of Life care

St Christopher’s

Support for Care Home colleagues by helping to care for residents who are unwell, deteriorating or dying. Through their direct professional line (020 8768 4582), open 24 hours a day, they can accept phone referrals from any member of care staff as well as offer advice and support on:

  • recognising deterioration
  • caring for those imminently dying
  • symptom control including pain, nausea and breathlessness
  • advance care planning and Coordinate My Care records
  • best interest decisions
  • mobility and strengthening exercises from our Rehabilitation Team
  • admissions to our Inpatient Unit at St Christopher’s Hospice
  • bereavement support for Care Home staff and their residents.
Advanced Care Planning (ACP) 2020-05-13T17:37:06+00:00
  • The COVID-19 pandemic is an important opportunity for care home staff to revisit, or visit for the first time, advance care planning, including plans about escalation to hospital, for all residents.
  • ACPs must be recorded in a way that is useful for healthcare professionals called in an emergency situation.
  • A paper copy should be filed in the care home records and, where the facility already exists, MyCMC should be utilised.
  • There should be discussion about how the COVID-19 pandemic may affect residents with multiple comorbidities and also consider whether people want to be admitted for other long term conditions, such as COPD or heart failure.
  • Where care home staff feel unable to explore such issues, they can be supported by GPs and primary care teams, Community Geriatricians and or palliative care, to do this with residents and their families
  • ACPs should include decisions about whether hospital transfer would be considered (for oxygen therapy, intravenous fluid and antibiotics) for COVID-19-related illness.

Training by St Christophers for ACP

The FREE bite size sessions (https://www.stchristophers.org.uk/stc_education_event/virtual-learning/) may also be of interest, and are gradually expanding. These are aimed at a number of professional groups (including GPs and care homes). The following sessions are available so far:

  • Advance Care Planning
  • Challenging Conversations
  • Terminal Agitation
  • Wellbeing, resilience and self-care (includes 4 short videos) 

Webinars are also available here

ECHO – 1hour:

  • Thursday 14th May – 2.30pm: ‘How to work at the frontline and survive’ for the Croydon communities of practice
  • Thursday 21st May – 2.30pm: ‘Supporting people with dementia in the light of Covid-19’ for the Croydon communities of practice

NURSE VERIFICATION OF EXPECTED DEATH:

https://www.stchristophers.org.uk/course/nurse-verification-expected-death/

Marie Curie

  • All Care Homes have been contacted by Marie Curie to ensure Advanced Care Panning is taking place.
  • Marie Curie will also complete Coordinate My Care on behalf of GPs.

General Practice

  • Providing support to create and update Advanced Care Plans.
Coordinate My Care (CMC) 2020-05-07T14:22:54+00:00

Croydon University Hospital:

  • Hospital palliative care team (HPCT) responsible for accessing, creation, update and support of Coordinate My Care records and dissemination post discharge including paper copy for care homes

St Christopher’s:

  • Training dates TBC

Marie Curie:

  • Will complete Coordinate My Care on behalf of GPs

Bereavement support 2020-05-13T17:37:57+00:00

Croydon University Hospital:

  • Hospital Palliative Care Team will provide a follow up bereavement call to relatives. (REFER TO DOS)

St Christopher’s:

Marie Curie:

Staff support 2020-05-15T10:38:42+00:00

St Christopher’s:

Staff Support Clinical Advice Line

  • Single Point of Contact Team for Colleagues in the Community: 020 8768 4582 – 24/7

Care Home Staff Emotional Wellbeing Support – Hear For You

  • Free confidential support service for Care Home staff who wish to talk known as Hear For You. Experienced staff and counsellors are available on 020 8768 4688 (9am-5pm, Monday to Friday). Please email us at hearforyou@stchristophers.org.uk if you prefer, or if you want to book in a call outside of these times.

Please refer to End of Life Directory of Services for more information.

Verification of death 2020-05-13T17:39:32+00:00
  • In the event of an expected death of a resident, the care home should contact the Telemedicine service for the process of verification (unless they have a member of staff who has the relevant competence). For homes who do not have the Telemedicine service please follow your usual process
  • If the death is unexpected or if the care home is not sure – you can contact Telemedicine for advice but will ultimately need to contact the GP or 111.
  • If no telemedicine: for expected deaths occurring in hours contact GP as usual and they will conduct verification remotely if appropriate, you can also contact NHS 111*6 if necessary. If the death was unexpected or occurs out of hours  you should call NHS111*6

St Christopher’s:
Verification of Death Training and Support in COVID pandemic

 

Support for End Of Life Care from St. Christopher’s 2020-05-13T17:40:26+00:00

Professional phone line for support with residents in your care

  • If you need advice please contact our direct support line on 020 8768 4582.

St Christopher’s free resources library

  • An online library of resources accredited by our clinical team to help you manage end of life care during Covid-19. This online resource will collate best practices in the current climate, visual guides for using PPE, printable forms for medicines management, and guidance to help you better support families where they are having to provide care in the home.

Free critical training to help you and your staff

  • The St. Christopher’s Our End of Life Care webinar series is free to all care homes. In this three-part weekly series, we share our expertise in Advance Care Planning, Coordinate my Care (myCMC), and Challenging Conversations – covering the important aspects of communications around death and dying during Covid-19. For Registered Nurses we have also developed an online version of our Verification of Expected Adult Death course to support the urgent need for expertise in this area during this time.
  • For more information on this please email the Education Team: education@stchristophers.org.uk
Visitors and End of Life Care 2020-05-14T08:11:55+00:00

Care Homes should be closed to visitors except in exceptional circumstances.

End of life visits qualify as exceptional and should be permitted by:

  • Limiting one visitor at a time to a room
  • PPE as appropriate when visiting resident
  • Physical distancing
  • Strict hand hygiene
  • Contact with other staff and visitors minimised

Visitors should only attend the room of the resident on arrival and then leave immediately after.

End of life visits are emotional events and can be devastating for family and friends. 

 

Links and resources 2020-05-13T17:42:41+00:00

Coronavirus and End of Life care

Author: Marie Curie

Date: 17th April 2020

  • Brings together the latest guidance on coronavirus and palliative and end of life care

Websites: Marie Curie


COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community

Author: National Institute for Health and Care Excellence

Date: 22nd April 2020

  • This guideline provides recommendations for managing COVID‑19 symptoms for patients in the community, including at the end of life. It also includes recommendations about managing medicines for these patients, and protecting staff from infection.

Websites: NICE

St Christopher’s:

Care Home staff and Covid-19

Information on how we can support you and staff including information about staff health and wellbeing, self-isolating and testing.

Supporting the Wellbeing of Care Home staff – Hear For You 2020-05-21T09:18:27+00:00

Confidential support for individual Care Home staff

  • Hear For You offers confidential telephone and email support to all care home staff, provided by experienced staff and counsellors at St Christopher’s.
  • A ‘check in’ service to support your wellbeing. You may want to talk about a difficult moment at work, worries about your family or friends or simply offload for a few minutes.

How do I access support?

  • Simply email hearforyou@stchristophers.org.uk or call us on 020 8768 4688. Let us know which CCG you work in, and where possible the care home you work for. This will remain completely confidential. We will be available between 9am and 5pm, Monday to Friday. If you want to book in a call outside of these times simply email us and we’ll do our best to fit this in for you.

Is this support confidential?

Please rest assured that everything you share will remain confidential unless we have a concern that falls within our safeguarding protocol.

Staff Wellbeing – links and resources 2020-05-27T15:30:34+00:00

Support is available for you:

SHOUT free text message service –text FRONTLINE to 85258

PHE Mental health and wellbeing during COVID-19

NHS Every Mind Matters website

Samaritans and NHS –confidential support line for NHS workers in England

NHS Care home psychological wellbeing guidance guidance for staff

NHS Wellbeing of care home staff guidance for managers and leaders

Health Wellbeing Info for Social Care Staff

Action for Happiness – has good tips on being kind to others (and to their staff).  It is a movement of people committed to building a happier and more caring society: https://www.actionforhappiness.org/

Financial Support –The Care Workers’ Charity was founded in 2009 with the objective of supporting current and former care workers with one-off crisis grants.  They provide crisis grants to people have worked in a paid role in the UK’s care sector and are involved in or support the provision of care. This includes people who have been involved in residential social care, home care, supported living care or day care.  Staff can apply for financial support from : https://www.thecareworkerscharity.org.uk/

Croydon Talking Therapies (IAPT) is providing immediate support to front line/key workers in the Borough. Simply call 020 2338 4040 and state you are a staff member and you will be connected to a clinician who you can talk to, confidentially, about how you’re feeling.

Psychological First Aid principles  – freely available if any managers are not sure how to approach support for all their staff, it is an idea to give them in terms of facilitating staff group sessions or for 1:1 use when a distressing events happen.

Death of a co-worker – The Department of Health and Social Care (DHSC) are asking all employers to tell them about the deaths of all types of workers in the adult social care sector, regardless of role or employer, and including volunteers.  Please click here for guidance informing DHSC of the death of a worker in social care.

 

National Mental Health resources

There are a range of resources that have been designed specifically for Covid-19:

The range of support packages is being constantly expanded, so please keep an eye out for further information.

Click on the Croydon Council COVID wellbeing pages for further information

Care Home Staff with COVID-19 symptoms 2020-06-02T10:43:51+00:00

Staff MUST remain off work and inform their manager if:

They have symptoms; OR

Someone in their home has symptoms.

Staff should be monitored for symptoms every day

Staff with symptoms must remain off work for 7 days:

Must have improved before returning to work.

Must have been fever free for the last 48 hours –if not continue self isolation until fever free for 48 hours.

If your symptoms worsen contact NHS 111

Staff who have previously tested positive should still self-isolate and be tested again if they become symptomatic.

Staff with someone unwell in their household must remain off work for 14 days:

If a staff member develops symptoms during their 14 day isolation they only need to self-isolate for 7 days from onset of symptoms.

This may mean they finish before or after the 14 day period

Source: COVID-19 and Care Homes IPC training (2) April 2020: PHE London working with ADPH London

COVID-19 Testing for Care Home staff 2020-06-04T08:52:57+00:00

Care home workers are key workers on the list of essential workers prioritised for testing and are being tested with or without symptoms.(29.4.2020) Please click here for more detail

  • The test needs to be done in the first 5 days of having symptoms and is most effective within 3 days of symptoms developing. It’s best to apply for the test in the first 3 days as it may take 1 or 2 days to arrange.
  • To apply for a test for yourself click here.
  • There are three ways to get a test via the self referral portal. Click here for user guide:
  1.       Book an appointment at a regional testing site
  2.       Book an appointment at a mobile testing unit
  3.       Request a home delivery test
  • The test is only an indication of whether a person has the virus at that point in time, it is not a test that will show whether a person has developed immunity to the virus.
  • Employers are able to refer essential workers who are self isolating (themselves of member of households. In order to obtain a login, employers of essential workers should email portalservicedesk@dhsc.gov.uk with:
  1.     organisation name
  2.     nature of the organisation’s business
  3.     region
  4.     names (where possible) and email addresses of the 2 users who will load essential worker contact details

https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#arrange-a-test

Croydon University Hospital

  • If you would prefer a hospital appointment at Croydon University Hospital – which can either be drive through or walk up, please complete a Hospital Referral Form for yourself or for members of their household who have symptoms.
  • Send the completed referral form to: providertesting@croydon.gov.uk
  • This will then be forwarded direct to the hospital and the individual named on the form will receive a call to book them in for an appointment.
  • The appointment will be either later that same day or the next day and the results come through 24-48 hours later direct to the individual.
  • It is up to the individual to communicate the results of that test to their employer.

Guidance for Care Home staff on testing

Track and Trace – Care home workers that are identified by the track and trace team will be contacted by Public Health England and advised what action to take. The latest guidance for Health Care Workers and others working in health and social care setting can be found here (COVID-19: management of exposed staff and patients in health and social care settings).

Care Home Staff Return to Work criteria 2020-06-02T10:53:10+00:00

Staff who test negative for Covid-19 and who were asymptomatic at the time of the test can:

  • Remain at work or return to work immediately as long as they remain asymptomatic if they were tested as part of routine testing
  • If they were tested as part of contact tracing investigation then they should follow instructions from the local Health Protection Team

Staff who test positive for Covid-19 and who were asymptomatic at the time of the test must self-isolate for 7 days from the date of the test

  • They can return to work on day 8 if they remain well
  • If, during the 7 days isolation, they develop symptoms, they must self-isolate for 7 days from the day of symptom onset
  • In order to return to work, symptoms must have improved and must have been fever free for the last 48 hours (without medication) –if not continue self-isolation until fever free for 48 hours
  • If your symptoms worsen contact NHS 111.

Source: COVID-19: management of staff and exposed patients or residents in health and social care settings

Risk Assessment for Care Home Staff exposures 2020-06-16T08:38:45+00:00

Exposure within the care home

  • Care Home staff should inform their line manager if they come into close contact with a confirmed COVID-19 resident or a symptomatic resident suspected of having COVID-19, while not wearing PPE, or had a breach in their PPE while providing personal care
  • In assessing whether the staff member has had a breach of PPE, a risk assessment should be undertaken in conjunction with local infection prevention and control (IPC) policy. Click here for further guidance
  • If the risk assessment concludes there has been a significant breach or close contact without PPE, the staff member should remain off work for 14 days.
  • If a staff member is notified that they are a contact of a co-worker who has been confirmed as a COVID-19 case and contact with this person occurred while not wearing PPE, the 14-day isolation period also applies.

Exposure outside the care home

  • Staff who have been notified through the NHS England Test and Trace that they are a contact of a confirmed case of COVID-19 in the community (outside their place of work) should inform their line manager and self-isolate for 14 days, in line with the Test and Trace guidance.
  • This advice should be followed regardless of the results of any Covid-19 antibody testing. A positive antibody result signifies previous exposure, but it is currently unknown whether this correlates with immunity, including protection against future infections.

Source: COVID-19: management of staff and exposed patients or residents in health and social care settings

 

Staff rewards and discounts 2020-06-02T10:51:12+00:00

Below are links for discount cards your home care staff can access. We would really encourage you to make your staff aware of the benefits that are available them:

Links and resources 2020-06-02T10:52:04+00:00

Coronavirus (COVID-19): getting tested

Author: Department of Health and Social Care

Date: 29th April 2020

  • Guidance on coronavirus testing, including who is eligible for a test, how to get tested and the different types of test available.

Websites: DHSC

Looking after your mental health during the coronavirus outbreak

Author: MENTAL HEALTH FOUNDATION
Date: April 2020

  • The Mental Health Foundation is part of the national mental health response providing support to address the mental health and psychosocial aspects of the coronavirus outbreak
  • Provides tips and guidance on the things we can do to support and manage our wellbeing during such times.

Websites Mental Health Foundation

Coronavirus (COVID-19)

Author: CARE PROVIDER ALLIANCE

Date: April 2020

  • Care providers play an important role in the national response to stop the spread of the COVID-19 outbreak amongst vulnerable adults.
  • Collates and signposts to the latest guidance and advice

Websites Care Provider Alliance

Social Care support for Care Homes

Additional information

NHS Mail 2020-05-05T08:46:05+00:00

Benefits

  • Secure/ easier communications across health and social care e.g. with GPs and other healthcare services such as Telemedicine
  • Increased collaboration over hospital admissions, appointments and discharges by giving you quicker access to accurate information
  • Enhances your ability to deliver the best care to your residents
  • Send information securely and easily through emails and video calls
  • Demonstrates compliance with GDPR and assurance that your organisation is practising good data security and handling data correctly.
How to set up and get started on NHS Mail 2020-05-13T17:47:43+00:00

To get your NHS mail account, please complete this form for :

  • setting up NHS mail
  • on observation equipment

Please email the completed form back to Olu Odukale (olu.odukale@swlondon.nhs.uk) so that the CCG can proceed in opening up a NHS mail account for you.

For the NHS mail to be successfully set up, the 2 people need to be set up and different mobile phone numbers are required for each care home. The mobile numbers are where the passwords will be sent to within 2-3 working days of emailing the form.

Webinars 2020-05-27T15:53:14+00:00

Croydon Council

Care Home Providers Covid-19 Information Session – Thursdays from 1pm to 2pm

These sessions will provide updates on COVID-19, infection prevention and control, death verification, PPE, etc.

To be added to the invite please email: enquiriesbc@croydon.gov.uk

 

St Christopher’s will be hosting a free webinar ‘Re-use of medicines in care homes’ on Monday 1st June, 2-3pm –. The webinar will provide simplified guidance on how to run a safe and effective medicines re-use scheme in care homes during the coronavirus outbreak. To register your place and for further information please follow this link: https://www.stchristophers.org.uk/course/reuse-medicines-webinar

 

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