Hundreds of dedicated Covid-positive care homes are to be set up in an effort to keep patients discharged from hospitals from spreading the virus more widely, as happened in the first wave of the pandemic.
The Department of Health and Social Care (DHSC) has instructed councils to identify homes in their areas that could be used and to have them checked by inspectors to assure infection prevention controls are in place. As many as 500 facilities – sometimes known as “hot homes” – could be designated by the end of November, the equivalent of one or two in each council area.
But one leading care home boss said many in the sector had been “blindsided” by the demand and Care England, which represents the largest chains, said participation depended on the government providing more detail about funding, the safety of staff and whether people being discharged from hospital with the virus would have a choice about whether they are sent to Covid-only facilities.
The move was first flagged in September in the government’s winter plan for adult social care when it said it was developing a designation scheme with the Care Quality Commission (CQC) “for premises that are safe for people leaving hospital who have tested positive for Covid-19 or are awaiting a test result”.
The letter to local authority directors of adult social care, seen by the Guardian, says the Covid homes should be “stand-alone units or settings with separate zoned accommodation and staffing”.
It adds that “given the diversity of existing provision and arrangements, it is acknowledged that there needs to be flexibility to meet local circumstances”.
Before anyone is discharged into one of the homes from hospital with a positive Covid test result, the unit must be registered with the CQC and the regulator will check it has the “policies, procedures, equipment and training in place to maintain infection control and support the care needs of residents”, the DHSC said.
In a clear sign the policy is aimed at freeing up hospital space as well as reducing cross-infection, the homes will not be used for people who contract Covid in their existing care home or at home. Councils have been asked to supply locations by the end of this week and the Department of Health wants every local authority to have access to at least one CQC-designated accommodation by the end of October.
Some care bosses have reacted with concern to the proposal, with some suggesting patients being discharged, albeit with a Covid diagnosis, will be reluctant to enter a hot home and that staff, many earning the minimum wage, will be asked to risk their health by working in one.
The DHSC said councils needed to “ensure that there is repeat testing, PPE, arrangements for staff isolation or non-movement, protection from viral overload, sickness pay and clinical treatment and oversight”.
While a few care homes that opened recently may be only partially occupied and so could be transformed into Covid step-down facilities, the instruction will require others to try to separate staff and residents. Earlier in the pandemic some councils struggled to get insurance to reopen closed care homes to be used for Covid-positive residents.
What the UK government said on Covid testing
1 September 2020
“Not only are we getting the pandemic under control, with deaths down and hospital admissions way, way down, but we will continue to tackle it, with local lockdowns and with our superlative test-and-trace system.”
9 September 2020
“NHS Test and Trace is doing a heroic job, and today most people get an in-person test result within 24 hours, and the median journey is under 10 miles if someone has to take a journey to get one … [To Keir Starmer] We make the tough calls – all he does is sit on the sidelines and carp.”
9 September 2020
16 September 2020
“We don’t have enough testing capacity now because, in an ideal world, I would like to test absolutely everybody that wants a test immediately … Yes, there’s a long way to go, and we will work night and day to ensure that we get there.”
17 September 2020
“Of course there is a challenge in testing … We have sent tests to all schools to make sure that they have tests available. But of course I also recognise the challenges in getting hold of tests … Tests are available, even though it is a challenge to get hold of them.”
Sam Monaghan, the chief executive of MHA, the largest charitable provider of care homes in the UK, said he was “highly concerned” about bringing infected people “into close communities where the risk of spread is considerable and you are asking staff to place themselves in the way of potentially contracting the virus as well”.
Mark Adams, the chief executive of Community Integrated Care which runs 260 services in areas under lockdown restrictions, said he did not have any facilities that were sufficiently empty to be used. He warned that the distress of sending people with dementia from hospitals into what would in effect be isolation units for long periods could even lead to deaths.
“If our residents [with dementia] go into hospital, contract Covid and have to go back into a different home, [the impact] could be extreme,” he said. “It could bring forward complicated health problems and in some cases an early demise. There will be massive anxiety for the individuals and their families.”
Martin Green, the chief executive of Care England, said: “We need information on the process by which people will eventually leave the Covid-positive facilities and what assurances their destination homes will get about their Covid status.”
A DHSC spokesperson said: “Our priority is the prevention of infection in care homes and ensuring that everyone receives the right care, in the right place, at the right time. Building on the commitments of the adult social care winter plan, we are working with the CQC and the NHS to ensure that everyone discharged to a care home has an up-to-date Covid test result, with anyone who is Covid positive being discharged to a care home that CQC has assured is able to provide care and support for people who are Covid positive.”