Last reviewed 4 November 2020

The Adult Social Care: Our COVID-19 Winter Plan 2020 to 2021 included a commitment to deliver a designation scheme with the Care Quality Commission of premises for individuals leaving hospital who have tested positive for Covid-19 and were transferring to a care home. Deborah Bellamy investigates.

The Department of Health and Social Care (DHSC) requested that local authorities “identify designated accommodation” and subsequently notified CQC of such to ensure compliance with Infection Prevention Control (IPC) protocols. By establishing dedicated Covid-positive care homes, the intention is to ensure lessons learnt from the first wave of the virus are implemented thus preventing spread of the virus.

There was a tight deadline for every local authority to identify access to at least one CQC designated home by the end of October. Local authorities identified homes which could potentially be used and liaised with CQC inspectors to enable them to verify robust infection prevention processes and controls are established.

Local authorities will be able to use more than one care home setting to respond to the “geographical spread and size” and “increasing demands”. Measures must be designed to keep everybody, including both those who work in and receive care services, safe and avoid spread of infection. Given the diversity of existing provision and arrangements, it is acknowledged there needs to be flexibility to meet local circumstances.

It has been estimated around 500 facilities, which have been referred to as “hot homes”, in a similar way to “hot hubs” in general practice, could be designated by the end of November equating to one or two homes in each council area.

To help meet projected demand in England as quickly as possible, the Government was aiming for each local authority to have designated access to at least one CQC designated accommodation by the end of October 2020.

It appears this is intended to free up hospital beds, as designated homes will not be used for people who contract Covid-19 in their existing care homes or at home.

Requirements of designated accommodation for care settings

The scheme relates to care homes that provide accommodation for service users who need personal or nursing care and includes registered residential care and nursing homes for older people, people with dementia and people with learning disabilities, mental health and/or other disabilities.

The designated homes are expected to be “standalone units” or care homes with “separate zoned accommodation and staffing”. In some areas, councils are recommissioning old care homes, NHS facilities or council buildings back into use that have similar features. Local authorities and directors of adult social services along with care home managers are key to identifying designated accommodation, and DHSC, the Association of Directors of Social Services and Public Health England, will collaborate to identify areas that need additional designated accommodation.

The new requirements include the following.

  • Anyone with a Covid-19 positive test result being discharged into or back into a registered care home setting must be discharged into an appropriate designated setting (with policies, procedures, equipment and training in place to maintain infection control and support the care needs of service user) and cared for there for the remainder of the required isolation period.

  • These designated accommodations will be inspected by the CQC to ensure they meet the latest CQC infection prevention control standards.

  • No service user will be discharged into or back into a registered care home setting with a Covid-19 test result outstanding or without having been tested within the 48 hours preceding their discharge.

  • All service users being discharged into a care home must have a reported Covid-19 test result and this must be communicated to the care home prior to discharge from hospital. The care home registered manager should continue to assure themselves that all its admissions or readmissions are consistent with this requirement.

Groups that are not included

The designation scheme does not apply to the following.

  • People who have contracted Covid-19 within the care home setting are not required to be transferred to designated accommodation if safe isolation and care are sustained.

  • Individuals attending emergency departments who have not been admitted to hospital do not need to be transferred into designated accommodation.

  • Those living in their own home, including sheltered and extra care housing or living in supported living do not need to be transferred from hospital into designated accommodation.

Funding

There will not be any additional funding. The costs of the designated facilities are currently expected to be met through the £588 million discharge funding and sufficient accommodation must be available to meet expected needs now and over the winter period.

CQC assurance process

All designated accommodation must be registered with the CQC and comply registration requirements.

The CQC process would provide assurance that each designated accommodation has the underpinning policies, procedures, equipment and training in place to maintain infection control and support care needs of service users while adhering to CQC inspection guidance.

Once this assurance is received, premises would be able to receive Covid-19 positive individuals discharged from hospital, prior to their admission to a care home.

What does this mean for care home providers?

It is essential that homes do not become forced to accept Covid-19 hospital discharges, due to financial pressures and large volumes of deaths and reduced admissions following the first phase of the pandemic.

Close collaboration between councils and care providers is vital to identify the most appropriate care homes. While a few care homes that opened in recent times may be only partially occupied so, theoretically, could be transformed into Covid step-down facilities, others will have more of challenge.

Earlier in the pandemic some councils struggled to obtain indemnity insurance so practical issues such as this will need addressing. Councils will be required to provide alternative accommodation for the service user to isolate in if a care home does not have appropriate facilities.

Concerns for care home staff, service users and their families

Some care home managers have expressed concern over the proposals — namely that service users being discharged, albeit having a positive Covid-19 diagnosis, may be reluctant to enter a “hot home” and be fearful that they may not be allowed out again. This scheme could also potentially mean existing service users have to move out of their home or room, which many would find unacceptable.

Care England is calling for further information as it is imperative providers have a greater degree of detail on areas such as information on leaving the facility, care functions on offer, refusal of visits, role of the CQC and funding.

There is concern for care staff who have been stretched beyond capacity that the risk of spread is considerable. Adequate or enhanced PPE, arrangements for staff isolation or non-movement, protection from viral overload, sickness pay, and clinical treatment are major considerations that must be addressed in advance.

Families may also feel anxious. If a service user has dementia, for example, transferring them to another home with different care staff could be very unsettling, even if just for the isolation period. Ongoing transfer arrangements will be crucial as this may be complex to arrange.

There are also key questions around how care for the multiplicity of needs will be managed in one setting. Staff may have all the IPC training but lack other skill sets needed so support training and assurances will be important.

What next?

The DHSC is currently developing further detailed guidance to resolve the many practical concerns, which will include further information on:

  • clinical pathways for service users being discharged from hospitals to care homes

  • further information on working with providers and funding processes

  • further details on data management

  • caring for service users with specific care needs, aligned with Covid-19 ethical principles, the relevant requirements of the Care Act 2014 and hospital discharge service guidance

  • additional support available to implement these new arrangements.

Further details are available on the GOV.UK website.