COVID-19 - information and guidance for social, community, and residential care settings
- 2.7 of information and guidance for social, community and residential care settings Show version history
- 24 May 2023 (Latest release)
- Public Health Scotland, ARHAI Scotland
- Coronavirus (COVID-19)
- Health protection
Purpose and scope
This guidance aims to provide a clear, concise, and accessible overview of the public health measures that should be taken to prevent and manage COVID-19 in the settings described below.
Most of the information in this guidance is relevant for all listed settings. Where no specific setting is noted then the guidance is applicable to all settings. For example, sometimes there is specific information provided for older adult care homes. This is explicitly listed throughout.
Most settings are considered 'lower risk' as there is relatively lower risk of direct health harm arising from infection. However, some settings may be considered as 'higher risk' due to the vulnerable population or the configuration of the setting itself. Care homes for the elderly, prisons or other closed settings are considered as higher risk settings. The outbreak management section has more information on higher and lower risk settings.
Settings covered by this guidance include:
- situations where care is provided to individuals in their own home
- adult social care building-based day services
- community-based settings for people:
- with mental health needs
- with a learning disability
- who misuse substances
- rehabilitation services
- residential children’s homes – whether registered as care homes or not
- secure accommodation services for children and young people
- residential settings for adults – including respite services for adults
- residential respite/short breaks services for children
- care home services, registered with the care inspectorate – now including older adult care homes
- services helping those experiencing homelessness
- sheltered housing
- supported accommodation settings
'Service user' is used throughout this guidance as a generic term to denote a service user, resident or patient associated with any of the settings covered within this document. Where guidance is specific to a care home setting, the term 'resident' is used for those living there.
Prisons are no longer covered in this PHS COVID-19: information and guidance for social, community, and residential care settings guidance but in a dedicated prison resource; please see COVID-19 guidance for prison settings.
Using this guidance
The guidance supports, but does not replace:
- individual expert clinical judgment
- local response arrangements
The guidance supports maintenance of agreed health protection principles and national policy in line with the Public Health etc. (Scotland) Act 2008 including:
- exercising functions to encourage equal opportunities
- observance of equal opportunities requirements
Employers should consider specific conditions of each place of work and follow the Health and Safety at Work etc. Act 1974 and other appropriate legislation.
The guidance should be read alongside PHS COVID-19 HPT guidance and Management of Public Health Incidents: Guidance on the roles and responsibilities of NHS led incident management teams.
A COVID-19 care home outbreak checklist is available. It is a supplementary resource for those working in care home settings during an outbreak of COVID-19 infection.
Health protection team contacts
Health Protection Teams in each health board area are the primary team supporting the control of outbreaks in community settings. Local services have access to their local HPT for such operational advice. Public Health Scotland, at national level, does not provide this.
Access up-to-date contact information for local HPTs.
Developing this guidance
This is a Public Health Scotland publication.
The guidance has been developed by PHS in collaboration with various stakeholders, including Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland.
The disease COVID-19 is caused by severe acute respiratory syndrome coronavirus 2, also known as SARS-CoV-2.
SARS-CoV-2 is a ribonucleic acid (RNA) virus.
The first cases of COVID-19 in the UK were detected on 31 January 2020.
The World Health Organization (WHO) declared COVID-19 as a pandemic on 12 March 2020. COVID-19's status as a Public Health Emergency of International Concern (PHEIC) was removed in May 2023; its status as a global pandemic remains unchanged.
SARS-CoV-2 is spread by respiratory particles. This occurs mainly through close contact with infectious individuals.
Transmission risk increases when:
- people are close to each other (usually within 2 metres)
- people are displaying symptoms
- in indoor, poorly ventilated environments that are not regularly cleaned
There is limited evidence of long-range aerosol transmission. Further research is needed to better understand aerosol transmission of SARS-CoV-2 virus.
SARS-CoV-2 virus can survive on surfaces from a few hours to days.
The amount of virus on surfaces is not always enough to cause infection.
SARS-CoV-2 can be transmitted even if the infected person does not have symptoms. This is called asymptomatic transmission.
Infectious and incubation periods
Studies show that the highest risk of transmission occurs a few days before and within the first 5 days after symptom onset but can be up to 10 days after symptom onset.
The average incubation period is between 3 and 6 days, with a range from 1 to 14 days.
The cardinal symptoms, as outlined by NHS inform, are:
- new, continuous cough
- change in or absence of sense of smell or taste
Symptoms of COVID-19 can vary in severity.
Some people have:
- sore throats
- general weakness
- muscular pain
- acute respiratory distress syndrome and other complications
Mortality is an unfortunate potential outcome in those with severe disease.
Atypical symptoms of COVID-19 are more likely to present in:
- older adults
- very young people
- people with underlying health conditions
- immunocompromised individuals
These atypical symptoms can include:
- increased confusion
- reduced appetite
- vomiting and diarrhoea
- shortness of breath
- excessive sleepiness
- difficulty in breathing (this is an important symptom to be aware of in older adults)
Most people recover quickly, usually starting to feel better in a few days. Some people take longer and symptoms can affect the whole body.
SIGN has produced a booklet for anyone with ongoing signs and symptoms of COVID-19.
NHS inform provides a variety of useful information on long-term effects.
General prevention measures
This section outlines a range of measures that are recommended to reduce transmission of SARS-CoV-2.
Each setting is strongly advised to continue to follow and regularly review the implementation of COVID-19 mitigation measures to minimise transmission of SARS-CoV-2 and other infections.
Advice on enhanced COVID-19 infection and prevention control (IPC) measures for health and care settings is available in the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
Care homes can also obtain IPC advice in the Infection Prevention and Control Manual for older people and adult care homes which is not specific to COVID-19.
Additional measures may need to be introduced when there are localised clusters or outbreaks. The HPT/Incident Management Team (IMT) will advise in these instances.
Refer to NHS inform for general advice on COVID-19.
Evidence for vaccination across adult age groups shows protection against:
- symptomatic disease
- infection (including in healthcare workers and in care home service users)
- hospitalisation due to severe illness and mortality
Vaccination also plays a role in reducing transmission.
View a summary of the most recent data on real-world effectiveness, schedule and other relevant information in the Green Book, chapter 14a (COVID-19).
COVID-19 vaccinations and boosters offer the best protection against the virus. Where possible, staff and service users should be assessed for vaccine status and offered COVID-19 (and other) vaccinations at the earliest opportunity.
The Joint Committee for Vaccines and Immunisation (JCVI) provides details on the groups that are to be prioritised for vaccination.
Refer to The Green Book, chapter 14a (COVID-19) for the most up to date advice.
Find more information about vaccination boosters on NHS inform.
Services should aim to vaccinate service users before admission to a residential setting, or as soon as feasible after admission. Sometimes vaccination may not be possible if there is a sudden need for admission or due to medical exemption. Vaccination should not delay admission.
Vaccination of staff and service users, particularly in care homes, has altered the COVID-19 mitigation measures, making these less restrictive – for both vaccinated and unvaccinated people. When vaccination uptake rates are not satisfactory, this presents a potential risk to everyone in the setting.
Vaccination is strongly recommended, including of those who are pregnant, breastfeeding or planning a pregnancy, where the safety profile for COVID-19 vaccination remains good.
Additional sources of information for the COVID-19 vaccination are available.
Public Health Scotland
We provide materials to:
- promote the COVID-19 immunisation programme to:
- guidance for care home managers on consent in care homes in Scotland
- guidance for health protection teams
Workforce education materials
Access these on the Turas Learn site.
NHS inform provide information about:
- the vaccine
- invitations and appointments
- after the vaccine
- leaflets and other languages and accessible formats
Advice for contacts
Routine identification of contacts of COVID-19 cases is no longer undertaken nor indicated.
Those with symptoms or confirmed COVID-19 should:
- follow the NHS inform stay-at-home guidance
- inform other household members or people they have had contact within the previous 48 hours that they are symptomatic or have tested positive
This ensures that contacts are vigilant of respiratory symptoms that may develop.
Definition of a contact
There is no formal definition of a contact.
The transmission risk for any respiratory illness, including COVID-19, increases with length of exposure and proximity to the infected individual.
The risk is also greater in indoor, crowded settings as opposed to outdoor activities.
Individuals at the highest risk of infection are those who have spent significant time with a case, such as household members and overnight contacts.
Find out more information about what to do in the event of contact with a COVID-19 case for:
Physical distancing is no longer required for staff, service users or visitors. Some health and social care services may choose to continue with physical distancing measures, in particular if there is a risk of overcrowding.
The Scottish Government guidance for safer workplaces and public settings remains available.
See the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings for more information on physical distancing in specific circumstances.
Those who are isolating should keep a 2 metre distance from other service users and staff, where possible.
The HPT or IMT may recommend a temporary reintroduction of physical distancing as a control measure during an outbreak.
Personal protective equipment (PPE) and face coverings
PPE is used to provide the wearer with protection against risks associated with the care tasks they are doing. All staff undertaking a procedure should assess any likely exposure to blood or bodily fluids and ensure PPE that provides adequate protection is worn.
Staff within health and care settings should continue to apply Standard Infection Control Precautions (SICPs) at all times to minimise transmission of infectious organisms.
Additionally, transmission-based precautions (TBPs) – in other words, enhanced precautions – should continue to be applied when caring for individuals who have suspected or known infection or colonisation.
The National Infection Prevention and Control Manual (NIPCM) and the Care Home Infection Prevention and Control Manual (CH IPCM) provide more details on TBPs to be applied depending on the route of infection.
A poster from the NIPCM describes the safe methods for donning and doffing PPE.
Staff should undergo regular PPE training.
Face masks and face coverings
There is a difference between face masks and face coverings.
- Face mask - definition
The use of the term 'face mask' means surgical or other medical grade masks.
For example, fluid resistant surgical masks (FRSM) used in certain health and social care situations.
- Face covering - definition
The use of the term 'face covering' means something that is made from cloth or other textiles that covers the mouth and nose, and through which you can breathe.
For example, a scarf.
Face masks - use
Continuous use of face masks in social care settings, including care homes, is no longer required nor advised routinely. This is due to the effective combination of natural and vaccine immunity in protecting populations at this stage of the pandemic and the risks that covering the face can present to social interaction, particularly for vulnerable individuals.
The Scottish Government extended use of face masks and face coverings guidance in healthcare and social care settings has been withdrawn (DL  11). In the absence of this guidance, health and care settings are advised to follow the IPC guidance on the appropriate use of PPE for SICPs and TBPs as detailed in the NIPCM:
- chapter 1 – standard infection control precautions
- chapter 2 – transmission-based precautions
- Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings
Local HPTs can support complex risk assessment, if needed.
If a staff member or resident cannot tolerate a face covering or a face mask when this is indicated, a local risk assessment must be completed and other mitigations considered, such as change in work role.
Hand, respiratory and environmental hygiene
Follow hand and respiratory hygiene advice in the National Infection Prevention and Control Manual (NIPCM).
Ensure that workplaces and work areas are cleaned regularly.
Follow the advice on safe management of the care environment in the National Infection Prevention and Control Manual (NIPCM).
Further advice is available on NHS inform's COVID-19 general advice pages.
Good ventilation in indoor spaces can reduce the transmission risk of SARS-CoV-2 and other respiratory infections.
Maximise fresh air entering a room through:
- natural ventilation – opening windows, vents and doors (excluding fire doors)
- mechanical ventilation systems – minimising the recirculation of air in rooms and throughout buildings.
Maintain the safety and thermal comfort of service users and service providers by ensuring adequate room temperatures.
The UKHSA COVID-19 ventilation of indoor spaces guidance advises to keep room temperature to at least 18ºC as temperatures below this can affect health.
This is especially applicable to those who:
- are 65 years or older
- have a long-term health condition
Find out practical steps on improving ventilation in the HSE ventilation in the workplace guidance.
Using fans in residential care settings and care homes
The below advice is not directly applicable for individuals receiving care in their own home but may be used to inform good practice if fan use is required.
A fan may be used in a service user's own private room if they are feeling too warm after turning off the heating and opening windows.
The fan must be:
- directed away from the door
- well maintained
Fans in communal areas of the residential setting – outside the service user’s private room – should only be used following a risk assessment and during very warm weather.
Staff should turn off the heating and open windows and doors (if possible) to reduce the temperature before using a fan.
Using fans should be an exception and not routine.
Use of fans during an outbreak
Fans are permitted in the private room of a service user who is symptomatic or COVID-19 diagnosed, using the above guidance.
The window should remain open when in use.
Fan use is not advised in communal areas if a setting has:
- COVID-19 cases
- an ongoing outbreak of COVID-19 or any other infectious pathogen
If extra temperature control measures are needed, the service manager can complete a risk assessment with support from their local HPT.
If the risk assessment results in use of fans, it is essential that fans are:
- cleaned regularly (including the blades)
- not pointed directly at service users
Advice for people at highest risk
Some individuals are at higher risk of severe illness if they are infected with SARS-CoV-2, even when fully vaccinated.
This includes those with a weakened immune system.
View the Scottish Government COVID-19 advice for people who are immunosuppressed.
Scottish Government ended the highest-risk list of individuals in Scotland on 31 May 2022.
View further information on COVID-19 and pregnancy on:
COVID-19 vaccines are recommended in pregnancy.
Providing care for service users
This section covers providing care for service users during the COVID-19 pandemic.
Advice varies between settings in some parts of this section.
Staff should remain vigilant to service users developing any respiratory or COVID-19 symptoms.
Older adults may have atypical symptoms.
- If a service user is unwell
Seek advice on NHS inform.
- If they need clinical assessment
Contact the GP (or NHS healthcare team in certain settings).
Call NHS 111 by telephone or online for more urgent matters or if the GP practice is closed.
- If they need urgent ambulance or hospital care
Tell the call handler that the unwell person may have COVID-19.
Service users who have had contact with a COVID-19 case
Contact tracing is no longer indicated routinely.
Find out more in the advice for contacts section.
Service users who have been in contact with a COVID-19 case and who are asymptomatic do not need to self-isolate or test – exceptionally they may be advised otherwise by the HPT/IMT.
Notify staff if symptoms develop.
Service managers should check there is no one else with symptoms and that all NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings are in place.
Where appropriate, management can communicate with service users in residential settings when a new case of COVID-19 has been identified in their area. This is to promote symptom awareness and provide advice for other service users.
Service users who are symptomatic or have a positive COVID-19 test
Symptomatic or COVID-19 diagnosed service users should self-isolate immediately and follow the stay at home advice on NHS inform.
- when to stay at home
- how to reduce risk of onward transmission to other people
- how to protect people at higher risk of harm from COVID-19 infection.
Some service users may also be eligible for specific COVID-19 treatments.
Find out more about COVID-19 treatments on NHS inform.
For older adult care home residents - see advice in Older adult care homes: residents who are symptomatic or have a positive COVID-19 test.
Older adult care home residents who are symptomatic or have a positive COVID-19 test
In addition to the advice in the service users who are symptomatic or have a positive COVID-19 test section, symptomatic residents in older adult care homes should be tested for SARS-CoV-2 as well as self-isolate immediately for at least five days if they have any of the following:
- cardinal COVID-19 symptoms
- other respiratory symptoms
- confirmed COVID-19
Day one is the day after symptom onset or the day after a positive test (whichever was earlier). Medical advice should be sought if needed.
Find out more information on managing self-isolation in care homes or other social care settings.
If an outbreak has been declared in a care home, further testing of residents will only be needed for individual clinical purposes. See the outbreak management section for more information on testing during an outbreak.
Testing of residents without symptoms is no longer advised and can lead to unnecessary restrictions if applied – see testing recommendations for service users.
When a resident is symptomatic and COVID-19 PCR negative
If an older adult care home resident is symptomatic and their COVID-19 PCR is negative, then consideration should be given to:
- testing for different organisms, e.g. flu
- further clinical assessment of the symptoms, if they remain unwell
- repeat testing in case this is a false negative result (for example, the test being taken too early after symptom onset)
Residents who are symptomatic may be able to be released with a negative result, before their self-isolation period ends if:
- they are well and have no fever for 48 hours, without using medication (such as paracetamol)
- the sampler was adequately trained and the sample was not deemed unsatisfactory
- they are not completing a period of self-isolation following hospital discharge
If respiratory symptoms in several residents lead to suspicion of an outbreak and COVID-19 testing is negative, other organisms will need to be considered and tested for.
The local HPT can discuss this with their local laboratory service and provide advice.
Care at home and supported housing setting service users who are symptomatic or have a positive COVID-19 test
All symptomatic or COVID-19 diagnosed service users should follow the NHS inform stay-at-home guidance. Testing is not generally indicated unless there is clinical concern and a diagnosis is needed to support further clinical management.
They should self-isolate immediately until they are:
- absent from fever, without the use of medication (such as paracetamol)
- no longer feeling unwell
Cough and loss of, or change in, taste and smell may persist for several weeks and is not an indication of ongoing infectiousness when other symptoms have resolved. However, cough and fever can be symptoms of other infectious and non-infectious conditions. These may require GP investigation if they do not improve.
Service users living in shared housing should follow NHS inform stay-at-home guidance.
Care at home and supported housing workers should report possible or confirmed cases of any respiratory illness amongst service users to their managers.
Providers should work with community partners and the person receiving care to review and assess the impact on their care needs.
Care should not be discontinued if a service user has tested positive for COVID-19. For information on PPE use and additional IPC measures - see the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
Symptomatic or COVID-19 diagnosed household members
Symptomatic or COVID-19-diagnosed household members of a service user should be encouraged to remain in a separate area of the service user's home whilst isolating.
This is to reduce the risk of transmission to staff and household members.
Open windows to increase ventilation and reduce the risk of transmission.
Sometimes it may be inappropriate for household members to leave the service user.
For example, due to:
- distress of the service-user
- issues of personal safety
A risk assessment to minimise the risk of onward transmission should be carried out by the service manager.
Contact the HPT if needed.
Managing self-isolation in care homes or other residential settings
Service users who are self-isolating are advised to:
- remain in their single room with en-suite facilities where possible
- keep their room door closed
- avoid using shared spaces within the facility where possible
Staff can support service users with this.
The Scottish Government COVID-19: living with dementia in care homes guidance provides information on supporting people to remain safe especially those who may find self-isolation difficult.
Staff should assign specific staff to provide care during the service users' self-isolation.
Arrange dedicated toilet facilities or a commode if en-suite accommodation is not available.
Decontaminate these immediately after use by following either:
- advice in the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings
- cleaning arrangements for communal facilities
Symptomatic or confirmed COVID-19 service users should have their own personal toiletries.
Consider a rota for showering and bathing, placing the symptomatic service user last.
Find out more information in the the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
Communication with key relatives (and other regular visitors, when relevant) should be in place to inform them of changes in management of their loved ones. This includes when visiting arrangements are altered.
Managing self-isolation as households
Some residential care settings are managed as households with varying levels of support.
This includes supported housing services.
If complete self-isolation is unmanageable, advice can be sought from the local HPT.
Placing a service user in an unsupervised or isolated area may not be in their best interests in some circumstances.
This may be due to:
- safety concerns
Seek advice from the local HPT on the management of individuals with special requirements if needed.
- individuals with:
- mental health conditions
- certain physical or learning disabilities
Provide meals for the individual to eat within their room.
Communal spaces can be used if risk assessed to be the most appropriate arrangement, especially in household-type services.
Carry out all necessary care within the service user’s room, where possible.
Accessing outdoor space during self-isolation
Service users can take daily exercise outdoors during their self-isolation if staff can assist with this.
This needs a local risk assessment by staff to ensure appropriate infection control precautions are in place.
While self-isolating, service users should:
- not leave the grounds of the setting
- minimise contact with other service users and staff as far as possible
- wear a FRSM during this activity – if service user cannot wear a FRSM, a risk assessment should take this into account
This advice also applies during an outbreak where staffing capacity allows.
Transferring to hospital during self-isolation
Service users may need to go to hospital during their self-isolation period.
Staff must inform the ambulance service and ward staff in advance that the individual has respiratory symptoms or confirmed COVID-19 and of the need for self-isolation on arrival.
Service users who are symptomatic should follow the stay at home advice on NHS inform.
They should do this until they:
- are absent from fever without the use of medication such as paracetamol
- no longer feel unwell
When other symptoms have resolved, a cough or change to taste and smell is not a sign of ongoing infection.
These symptoms can persist for weeks.
Read more about managing self-isolation in care homes or other residential settings.
Higher risk settings (including care homes)
Residents can end self-isolation if they meet all of the following criteria:
- five full days of isolation completed
- have been without fever for 48 hrs without use of medication (such as paracetamol)
- no longer feel unwell
When other symptoms have resolved, a cough or change to taste and smell is not a sign of ongoing COVID-19 infection. Further testing is not usually needed. These symptoms can persist for weeks in people who have had recent COVID-19. However, cough and fever can be symptoms of other infectious and non-infectious conditions and may require GP investigation if they do not improve.
Further testing is not required, if the person is otherwise well.
On some occasions, the HPT may extend self-isolation.
Guidance on discontinuing IPC precautions in community health and care settings for COVID-19-positive service users can be found in the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings and from the local HPT.
Measures for staff
To reduce the spread of SARS-CoV-2, staff should follow measures in this guidance.
Plan ahead to prepare for extra demands on staffing needs due to outbreaks or staff absence.
This is known as resilience planning.
It should include:
- encouraging a high uptake of COVID-19 vaccine and annual flu vaccine amongst all staff
- a regular review of resources needed to support service users when they are unwell or in self-isolation
- resource to support named visiting during outbreaks
- time and resource required to follow NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings – this includes:
- PPE use
- good hand hygiene and cough/respiratory etiquette
- increased cleaning
- staff cohorting
- training updates
- guidance review
Carefully consider using clinical staff from other care homes, residential settings or healthcare services to replace care home staff as part of resilience planning.
Workplaces and their staff should risk assess the infection risk, both within and outwith the workplace.
This is particularly important for small departments where even a few staff absences could have significant impacts on resilience arrangements.
To enable home working, hybrid working and safer office working, follow the Scottish Government advice in COVID-19 safer businesses and workplaces.
Staff who have contact with a COVID-19 case
Staff who come into contact with a COVID-19 case are no longer automatically required to self-isolate. However, a risk assessment may need to be conducted.
The service manager should check appropriate infection prevention and control measures are in place, if the contact occurred in the workplace.
Staff need to be vigilant to COVID-19 symptoms at all times. This is very important during the incubation period after contact with a COVID-19 case.
If symptoms develop, see the measures for staff who become symptomatic or have positive PCR or LFD test.
The service manager should risk assess the placement of staff who may be contacts of a case if there are any extremely vulnerable individuals in the setting. This includes those who are severely immuno-suppressed. Risk assessment may result in a temporary change to location or tasks of work.
This applies regardless of where contact with a COVID-19 case occurred.
Staff who become symptomatic or have a positive COVID-19 test
Staff who are symptomatic should not attend work.
If symptoms develop at work, they should put on a FRSM and return home immediately.
Staff not eligible for testing
See Table 2 for testing eligibility.
See the stay-at-home guidance on NHS inform for more information. It also provides advice on other actions to take outside of the work environment.
Return to work
You can return to work when you feel better and no longer have a high temperature.
Staff with persistent symptoms should be risk assessed by their line manager when returning to work. This would be part of a return to work interview, as per usual processes. Particular consideration should be given to the placement of staff working with individuals at higher risk of serious illness.
Follow all relevant infection control precautions on your return.
Staff eligible for testing
See Table 2 for testing eligibility.
Staff should report the test result to their line manager.
If the test result is negative, they can attend work if they:
- are well enough to do so
- do not have a high temperature
Positive LFD test result
If the LFD result is positive, the staff member should:
- stay at home
- not attend work
- avoid contact with other people for a minimum of 5 days after the day they took the test
Tests should only be taken by staff that are both:
- eligible for testing
Situations should no longer arise whereby staff return positive results even when they are advised not to test, since asymptomatic testing is no longer indicated except under the conditions outlined in Director's Letter (DL) (2022) 32. See Scottish Government social care and community-based testing guidance for more information on testing eligibility.
Symptomatic LFD test positive staff who are not eligible for testing should avoid contact with other people for a minimum of 5 days after the day they took the test, regardless of the presence of symptoms. Follow the advice on NHS inform.
Household members of the case should follow the advice on NHS inform.
Returning to work
The Director's Letter (DL) (2022) 32 outlines the requirements for HSCWs returning to work, in particular if they work directly with service users. Further testing is advised in these circumstances.
Risk assessing return to work when symptoms persist
As outlined in Director's Letter (DL) (2022) 32, if symptoms persist, line managers are advised to:
- undertake a risk assessment and;
- consider redeploying some staff members until 10 days after their symptoms started
- if staff did not have symptoms, this would be 10 days after the day of their first positive test.
This may apply to staff who work with individuals at higher risk of serious illness, despite vaccination.
For HSCWs returning to work, HPTs should have oversight of how risk assessments are being used to inform these decisions. They do not need to undertake the risk assessments.
Continue to support professional visits. These can be essential to wellbeing.
Ensure a renewed focus on anticipatory, preventative and rehabilitative care for all service users.
Plan professional visits in advance to manage footfall – this minimises the risk to the service user population and the burden on staff.
Support visiting clinical staff to attend in person for essential clinical assessments and treatment of service users.
Methods such as telephone and telemedicine remain useful.
All visiting staff should follow the COVID-19 guidance and all control measures implemented in the facility. This includes the IPC advice in the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
Visits from non-clinical services may pause during an outbreak unless the local HPT deems them essential.
New staff or agency staff
Service providers need to ensure that new and agency staff are adhering to processes applicable to service staff, including training and advised vaccination. A documented risk assessment of the use of agency staff can support good governance.
Proof of a negative SARS-CoV-2 test result is not needed prior to starting work.
Staff should not start work if they are symptomatic. They should follow the measures for staff who become symptomatic or have positive LFD test.
Infection Prevention and Control
Agency staff should follow the same NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings as permanent staff.
In general, staff should not work across two facilities if one has an ongoing outbreak. This is at the discretion of the local HPT managing the outbreak in collaboration with service providers.
Support all staff to become fully vaccinated as soon as possible to protect service users and other staff. Vaccination status should not be a barrier to staff starting work in the setting. It is strongly advised and work placements should be risk assessed.
This section focusses on the eligibility for COVID-19 testing.
Vaccination status does not change the relevance of testing.
There are various tests available to detect SARS-CoV-2 (the virus that causes COVID-19 disease).
More information on PCR, LFD and Point of Care Tests (POCT) is available in our COVID-19 guidance for HPTs.
Testing is not mandatory for individuals or staff.
It needs consent or provision made otherwise, for those without capacity.
See Adults with Incapacity (Scotland) Act 2000 principles for more information.
Purpose of testing
The main purpose of COVID-19 testing has changed from population-wide testing to reduce transmission to targeted testing to support clinical care.
Routine asymptomatic testing is only recommended for specific groups and purposes.
This is line with the Scottish Government's Test and Protect transition plan.
PCR testing can be used as a diagnostic tool or as part of surveillance.
The COVID-19 page on NHS inform provides information on accessing COVID-19 tests for those who are eligible.
For service users
The respiratory screening questions in Appendix 3 of NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings should be asked to all admissions/transfers to inform a risk assessment.
This is especially important when testing is not possible.
|Status||Symptomatic||Asymptomatic||Asymptomatic but known contact with a COVID-19 case|
|Older adult care home residents||PCR test||No testing required||No testing required|
|Older adult care home residents - admission from hospital||Clinical risk assessment if symptoms develop prior to discharge, including PCR or LFD test.||One negative LFD result should be available preferably within 48 hours prior to discharge from hospital||One negative LFD result should be available preferably within 48 hours prior to discharge from hospital|
|Older adult care home residents - admission from hospital (COVID-19 recovered)||Clinical risk assessment advised if new symptoms develop prior to discharge, including PCR or LFD test. If symptoms are resolving from known COVID-19 infection, no testing required if 10-day isolation||No testing required if 10-day isolation completed in hospital OR one negative LFD test before discharge (preferably within 48 hours prior to discharge), if 10-day isolation not complete||Not applicable as they are a recovered COVID-19 case.|
|Older adult care home residents - admission from the community (including from other care homes and hospices)||One negative LFD test or PCR if available (taken within 3 days prior to admission date). See new admissions from the community.||One negative LFD test, taken within 3 days prior to their admission date (where testing is not possible before, testing on admission to the care home is acceptable). See new admissions from the community.||One negative LFD test, taken within 3 days prior to their admission date (where testing is not possible before, testing on admission to the care home is acceptable). See new admissions from the community.|
|Service users in community and residential settings (non-older adult settings)||No testing indicated - follow stay at home advice for the general population. Unless advised otherwise by HPT or clinician.||No testing required. Unless risk assessment by HPT or clinician advises otherwise.||No testing required. Unless risk assessment by HPT or clinician advises otherwise.|
|Service users in residential settings - admission from hospital (COVID-19 recovered) (non-older adult settings)||No testing required. Unless risk assessment by HPT or clinician advises otherwise.||No testing required. Unless risk assessment by HPT or clinician advises otherwise.||Not applicable as the service user is a recovered COVID-19 case.|
|Service users in residential settings - admission from hospital (non-older adult settings)||No testing indicated - follow stay at home advice for the general population. Unless advised otherwise by HPT or clinician.||No testing required. Unless risk assessment by HPT or clinician advises otherwise.||No testing required. Unless risk assessment by HPT or clinician advises otherwise.|
|Service users in residential settings - admission from the community (non-older adult settings)||No testing indicated - follow stay at home advice for the general population. Unless advised otherwise by HPT or clinician.||No testing required. Unless risk assessment by HPT or clinician advises otherwise.||No testing required. Unless risk assessment by HPT or clinician advises otherwise.|
Find out more information on managing symptomatic or test positive service users.
Refer to moving between settings section for supporting information for admissions.
Local HPTs can advise in complex situations.
Testing for hospital discharges
See advice in moving between settings section for more details on transferring service users from hospital to the relevant setting.
With no test result
It is possible to discharge a service user without an available test result from hospital to a setting where admission testing is advised - see Table 1. A risk assessment will outline whether self-isolation is needed
Find out more information in the ARHAI Scotland respiratory screening assessment.
Recovered service user
Discharging a COVID-19 recovered service user to the receiving setting before their 10-day self-isolation period in hospital has ended is possible. This should be risk assessed.
See the testing advice outlined in Table 1 for the receiving service.
The testing advice in Table 1 still applies even if the service user is not required to self-isolate on admission to the setting.
Staff should maintain symptom awareness and continue to follow NIPCM community IPC COVID-19 measures.
|Status||Symptomatic||Asymptomatic||Asymptomatic but known contact with a COVID-19 case|
|Staff working in care homes for older adults||Take a LFD test immediately (see advice in DL (2022) 32)||No testing indicated||No testing indicated|
|Staff included in the social care and community based testing guidance||Take a LFD test immediately (see advice in DL (2022) 32)||No testing indicated||No testing indicated|
|All other staff not included in the social care and community based testing guidance||No testing indicated - follow stay at home guidance on NHS inform for the general population||No testing indicated||No testing indicated|
Some NHS health workers attend community settings as part of their clinical role. The Scottish Government COVID-19: Staff testing in NHS Scotland guidance has more information.
Further information is available in measures for staff who become symptomatic or have positive PCR or LFD test.
For visitors to the setting
Friends and family visitors
No testing advised.
More advice for visitors is available in visiting arrangements in residential settings.
No testing is advised for professional visitors who are not HSCWs.
DL (2022) 32 applies to HSCW professional visitors.
Maintain symptom awareness and continue to follow NIPCM community IPC COVID-19 measures (including on PPE).
Further information on testing
Symptomatic testing is only retained for eligible groups:
- in table 1 and table 2
- outlined in COVID-19: guidance for HPTs
Testing advice following confirmed COVID-19 infection
If staff or service users have had a diagnosis of COVID-19 either via positive LFD test or positive PCR test – they should not:
- use LFD tests for 28 days
- use PCR tests for 90 days
Day one is the day after symptom onset or the day after a positive test (whichever was earlier) if asymptomatic or displaying other non-cardinal symptoms.
The advice for symptomatic staff or those that have a positive COVID-19 test or symptomatic service users or those that have positive COVID-19 test should be followed if either
- new symptoms of COVID-19 develop during the time periods defined above
- a positive test is returned after the time periods above
Contact the HPT for advice in complex situations.
Definition of a COVID-19 outbreak
Two linked cases of COVID-19 over a 14-day period within a defined setting.
COVID-19 outbreak management should follow existing, well-established public health principles and practice.
Find out more information in the management of public health incidents – guidance on the roles and responsibilities of NHS-led incident management teams.
HPTs do not need to identify and manage outbreaks in all settings.
HPTs should use a risk-based approach to focus their limited resources on the highest priority settings. Services can contact HPTs for such support, if needed.
Outbreak management and risk assessment
The outbreak management process is overseen by the local HPT, led by an appointed Competent Person under the Public Health Etc. (Scotland) Act 2008.
The HPT lead outbreak management in care homes or residential settings using a dynamic risk assessment approach.
This can be via the IMT or directly by the HPT.
The situation is continuously assessed and the control measures are reviewed by the HPT or IMT, if formed.
Identifying higher and lower-risk settings
There may be outbreaks that do not fall into either higher or lower risk setting categories.
The HPT may choose to take a closer management approach if there is potential for severe disruption to health services or critical infrastructure.
There are some settings where there is a lower risk of direct health harm arising from COVID-19 than in other settings e.g. settings mainly comprised of younger or working-age populations.
These are considered as lower-risk settings.
There may be some individuals with higher vulnerability in lower-risk settings. These individuals should follow the advice provided by their clinician during an outbreak.
Care homes for older adults are considered higher-risk settings for outbreak management purposes. HPTs should be notified when a cluster of cases is identified. This is due to:
- the population being older and likely to have more underlying health conditions
- this puts them at greater risk of more severe illness in comparison to most younger people
- opportunities for infections to spread quickly throughout the facility due to the communal nature of the setting
Service providers can contact the local HPT if they need further advice.
Staff shortages can quickly become an issue during an outbreak due to the size and nature of some services.
Management teams should complete their resilience planning in advance for this eventuality.
Local authority and Care Inspectorate input during an outbreak may provide useful in finding solutions to staffing shortages based on a risk assessment approach led by the HPT.
This risk assessment considers the vulnerability to COVID-19 of service users balanced with the risk of suspending important services and the wider harms this could pose.
Some settings may have obligations to report clusters or outbreaks to other agencies, for example:
- Care Inspectorate
- Environmental health departments
- Health and Safety Executive
Reporting to HPTs
There is no obligation for lower-risk settings to report clusters of confirmed COVID-19 cases or unusually high levels of absence thought to be associated with COVID-19 – in other words, possible cases – to HPTs.
It is expected that most of these situations will be managed via standard working practices in place in each setting for sickness and absence at work. HPTs can be contacted for support in complex situations.
HPTs should engage and support setting to manage the outbreak proportionate to their assessment of the risk to public health if approached for advice.
HPTs may make the decision to engage in the handling of any individual cases, clusters or outbreaks at their discretion.
Service providers should undertake a rapid internal review of the setting's risk assessment and mitigation measures in response to an outbreak.
Consider any improvements made to their implementation as a priority.
See the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings for IPC guidance.
Issues may arise in services when implementing mitigations is challenging.
For example, isolation of young children or those with learning disabilities – especially if they create distress for the individual.
The local HPT can be contacted in situations where applying the guidance is challenging.
Higher-risk settings: initial assessment
If one confirmed service user case arises or two or more linked individuals develop symptoms of COVID-19 within 14 days in a higher risk facility, the service provider should:
- alert the local HPT who will carry out a risk assessment and investigate whether an outbreak is occurring – the level of response to an outbreak from the HPT will be based on the HPT’s risk assessment
- undertake a rapid internal review of the setting's risk assessment and mitigation measures. Consider any improvements to their implementation as a priority – see the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings for IPC guidance
Where indicated, the HPT may ask to review the services’ COVID-19 workplace risk assessment or other outbreak management plan.
These steps should be undertaken collaboratively with the setting and be used to develop an individualised action plan for outbreak management.
Identifying linked cases
The assessment of linked service user cases when considering any potential outbreak should include those individuals who are present in the location where a case has been identified. It should also include service users who have either been transferred from the setting to hospital, or elsewhere, or died within the same time period of 14 days.
Continue with symptom vigilance in staff and service users and robust application of IPC measures.
In many cases, service providers do not require to contact the HPT following a single confirmed staff case if there are no further staff or service users that are symptomatic or confirmed cases. A documented risk assessment should support that decision. Local policies can be implemented for notifying a single staff case in discussion with local HPTs.
When investigating COVID-19 transmission in a setting and implementing mitigation measures, this should be decoupled from the identification of staff cases if no links are found.
Declaring an outbreak
Declaring an outbreak is the responsibility of the HPT.
IMT may be convened and led by the HPT.
If not, support will be provided directly by the HPT, when indicated.
Higher-risk settings: testing
Asymptomatic service users who are were in close contact with a case and are well do not require to be tested. They should be monitored for the development of symptoms. Testing in this circumstance can lead to unnecessary restrictions and is at the discretion of the local HPT.
A service user with fever and/or new respiratory symptoms should have a PCR sample submitted for SARS-CoV-2 and if indicated, a wider respiratory panel of tests. Service users and their families should be advised of the possibility of wider testing if this is needed as part of outbreak investigation.
This can include influenza and other organisms, in line with local diagnostic laboratory protocols.
PCR is the preferred test for symptomatic service users. LFD tests can be used to support an initial risk assessment under direction of the HPT during suspected outbreaks.
When a cluster of symptomatic cases arises, it is now good practice to submit samples for up to five symptomatic service users to confirm the pathogen.
Additional cases matching the outbreak case definition do not all need to be tested once the pathogen is identified.
There can still be a clinical need to test further cases – for example, to confirm the diagnosis in individuals with other respiratory illnesses or to determine eligibility for some treatments. See COVID-19: guidance for HPTs for more information.
Testing arrangements during an outbreak is at the discretion of the local HPT.
The HPT has autonomy to deviate from the guidance according to local circumstances and risk assessment.
Mass testing is now unlikely to be justifiable in most circumstances since it can have unintended consequences. For example, prolonged periods of unnecessary self-isolation.
Any mass testing should be based on a risk assessment by the HPT/IMT. If undertaken, PCR testing is strongly advised, rather than LFD testing. This is due to increased sensitivity and potential to test for other respiratory viruses. However, when indicated, both may be able to be used effectively in combination, under the direction of the HPT.
Any cases identified should be cared for in line with advice provided in providing care for service users who are symptomatic or have a positive COVID-19 test.
If an asymptomatic service user tests negative but then becomes symptomatic, they should self-isolate. If an outbreak has already been declared and the organism identified, no further testing is likely to be needed.
Consideration should be given regarding the need to inform local microbiology laboratory services where it is anticipated there will be a large volume of samples received.
More information on testing those with recent COVID-19 infection can be found in further information on testing.
Higher-risk settings: outbreak management measures
Local HPTs lead on the management of outbreaks in the community, when indicated, including care homes, prisons and other closed settings, according to their statutory duties under the Public Health Etc. (Scotland) Act 2008.
The local HPT has a duty to support these settings in the management of the outbreak.
They make decisions on outbreak control using a population-based risk assessment approach. This considers the circumstances of the outbreak, the setting itself, and the individuals involved.
Self-isolation will be in place for service users who are symptomatic or confirmed COVID-19 cases.
Some service users may find restrictions on their movements difficult to follow during an outbreak. For example, service users who walk with purpose. They often need increased support during an outbreak. The Scottish Government COVID-19: living with dementia in care homes guidance has more information.
Non-residential services should consider pausing activity for a few days in discussion with their local HPT.
Infection prevention and control measures
A number of outbreak management measures are available, as advised by the HPT.
These include, but are not limited to:
- regular monitoring of resident's symptoms
- isolation of cases
- appropriate PPE use
- enhanced cleaning
- changing from routine visiting to named person (and exceptionally, moving to essential visiting)
- cohorting of service users and staff
- a temporary reintroduction of physical distancing
See the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings for advice on these measures.
See visiting arrangements in residential settings when a service user is symptomatic or COVID-19 diagnosed.
Using communal spaces
Sometimes it is possible to manage selected areas of a residential facility as a separate unit or units, with no shared activities or staff.
Unaffected services can continue with normal arrangements, with increased vigilance for any contact links or symptoms in their service users or staff.
Communal areas may need to be more closely supervised to ensure service users who are symptomatic or confirmed cases do not mix with others.
Keep communal areas open for use by service users who are not identified as cases or symptomatic of COVID-19 – this is the default position during an outbreak if it can be arranged by staff.
If outbreak measures prove particularly challenging to implement or staffing capacity is low, communal areas may not be able to be used temporarily.
They should be reopened as soon as practical.
Transfers of service users in and out of the setting during an outbreak must be risk assessed.
- service user's tested or presumed COVID-19 status
- size of the outbreak
- spread within the setting
- units which are affected
- physical layout of the building
- vaccination status of the individual and coverage at the setting
Seek support from the local HPT managing the outbreak.
Advise any receiving service, for example a hospital ward or ambulance or residential facility, of the IPC measures needed for each service user they support.
Service user transfer across services may benefit from a multi-agency approach for challenging service user movements.
This could involve having a conversation between key services when needed.
Declaring an outbreak over
- For HPT to declare an outbreak over
There should be no new linked symptomatic or confirmed COVID-19 cases for a minimum period of at least 14 days from last possible exposure to a case, whether in a service user or staff member.
The HPT should also consider whether:
- existing cases have been isolated or cohorted effectively
- guidance on IPC and other interventions is being applied appropriately
Sufficient staff to enable the setting to operate safely using PPE appropriately are needed.
Staff working in the service should enable the return to routine visiting once the outbreak has been declared over by the HPT.
Moving between settings
This section covers:
- admissions to settings
- visits away from settings
Prior to admission, respiratory screening questions should always be asked of the service user or their carer.
These are outlined in the Appendix 3 of NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
This also provides further information on individual placement and assessment of infection risk.
Protecting those at highest risk
Residential facilities should also conduct a risk assessment for their facility to determine if there are service users who are at highest risk of severe illness.
Consider whether additional measures are needed to protect these individuals if COVID-19 cases arise in the setting.
Admissions from the community
Service users admitted from the community (including from other residential settings) should complete the respiratory screening questions in the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
This will inform the admission risk assessment.
No self-isolation is required on admission where there is not an increased risk of infection identified through completion of the respiratory screening questions.
For older adult care homes, a decision on admission and any self-isolation requirements must involve the care home manager. It may be subject to local processes as guided by the local Partnership oversight group. A clinical or health protection view may also support this.
If a service user is known to have recently been in contact with a COVID-19 case - see our advice for providing care for service users who have had contact with a COVID-19 case.
Symptomatic or COVID-19 cases
Follow our guidance for providing care for service users who are symptomatic or have a positive COVID-19 test if a new admission is either:
- a confirmed COVID-19 case
- answers 'yes' to any of the respiratory screening questions
Consider whether delaying the admission is appropriate.
If admission to the care home or residential setting is in the best interests of the service user's health and wellbeing, then this should be supported.
This is provided the care home or residential setting can isolate and care for the service user appropriately.
See testing recommendations for service users for guidance for admission purposes.
Admissions from hospital to non-care home services
COVID-19 recovered admissions
If self-isolation has been completed in hospital, then no further self-isolation or testing is needed for service users being admitted to a setting.
COVID-19 recovered service users should follow the advice in providing care for service users – managing self-isolation in care homes or other residential settings if discharged before their self-isolation period in hospital has been completed.
Service users should do this until they are absent from fever without the use of antipyretics and no longer feel unwell.
No self-isolation or testing is required prior to admission to a setting for service users that are asymptomatic and have not tested positive for COVID-19.
The HPT may advise testing prior to admission if the setting provides care to clinically vulnerable individuals.
A local risk assessment should be undertaken by management of the setting in communication with the hospital team.
Service managers undertaking such risk assessment should refer to the respiratory screening questions in Appendix 3 contained within the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
Older adult care homes: admissions from hospital
COVID-19 recovered admissions to older adult care homes
The self-isolation period in hospital is 10 days.
COVID-19 recovered residents who have completed 10 days of isolation in hospital can be discharged to the care home (10 days after symptom onset or first positive test, if asymptomatic) without further testing or isolation.
This is providing the resident is both:
- clinically stable
- fever free for 48 hours without using medication such as paracetamol
Any decision to discharge should be made in collaboration between the healthcare setting and the receiving care home manager. It is good practice to involve the family of the resident.
To inform a risk assessment, use:
- responses to the respiratory screening questions in Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings
- clinical judgement
Returning residents to their homely environment, rather than a continuing stay in a clinical setting, is encouraged for their recovery and general wellbeing.
This process for COVID-19 recovered patients who have completed 10 days of isolation in hospital applies to both returning and new residents being discharged from hospital into the care home.
Discharging before completion of the self-isolation period in hospital
If a COVID-recovered resident has not completed their self-isolation period in hospital, then they can do so in the care home.
They do not need to start a new period of isolation.
No further testing is needed once this isolation period is completed.
The self-isolation period for hospital inpatients and care home service users differs.
Inpatients require a minimum of 10 days.
Residents self-isolating inside the care home require a minimum of 5 days.
Residents do not need to continue with self-isolation on admission to the care home if they have completed a minimum of 5 days self-isolation whilst in hospital and they are fever free for 48 hours without the use of medication.
Day 1 of isolation is counted as the day after the date of their positive test/symptom onset.
See testing recommendations for residents for guidance for admission purposes.
Non-COVID-19 admissions to older adult care homes
Residents do not need to self-isolate on admission to the care home if they:
- are not a COVID-19 case
answered 'no' to Appendix 3 of the respiratory screening questions in Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings before transfer to the care home
Support residents that are fit for discharge from hospital to the care home to return home.
Returning to their homely environment is important for recovery and general wellbeing.
This should be agreed with the care home. Rarely the risk assessment may determine the resident should self-isolate upon return to the care home – for example, if there are new symptoms.
See testing recommendations for service users for admission purposes.
Hospital contacts of COVID-19 cases
Residents identified as a contact by the infection prevention and control team (IPCT) during their hospital stay do not need isolation in the care home upon transfer, but monitoring for symptoms should be in place, as planned.
Children being moved between or to new care facilities
Children admitted from the community (including from other residential settings) should complete respiratory screening questions as advised in Appendix 3 of the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
If the child has symptoms of COVID-19 or another respiratory infection, their placement should take account of the health protection and IPC requirements of others in that setting but should not delay it unnecessarily.
Communication is key between service providers and the child or their guardian or carer.
Effective communication and explaining why decisions are being made and what to expect is important to promote wellbeing and reduce distress.
There is no need to test children prior to their admission.
If the setting has clinically vulnerable children or if there are complex circumstances identified, then advice on testing can be sought from the local HPT.
The decision to test and the results must not impact on the urgency of responding to the needs of the child and ensuring their safety and wellbeing.
Residential respite or short breaks services
Scope of respite guidance
The respite advice included in this guidance applies to:
- residential respite facilities for children (including those registered as care homes)
- stand-alone residential respite facilities for adults and older people (settings registered as care homes)
- respite-providing care homes for older people that are not considered stand-alone facilities
Facilities that are unsure about which guidance applies can contact the Health and Social Care Partnership Oversight Group or local HPT.
They will advise based on the characteristics of the setting.
Complete the respiratory screening questions in Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings for service users admitted from the community for respite or for a short break.
If the individual answers 'yes' to any of the screening questions they should follow the advice in providing care for service users who are symptomatic or have a positive COVID-19 test.
If they answer 'no' to all the questions, self-isolation is not required.
Individuals being admitted for respite or short break in care homes for older adults or services with older or clinically vulnerable individuals are recommended to have one negative LFD test within twenty-four hours before arrival or on arrival.
No testing is recommended in settings mainly comprised of younger or working-age population.
Service providers can contact the local HPT if they need further advice.
Operating the respite service
Individual services must identify and set out the capacity for their setting.
Consider this through a risk assessment for the service.
The risk assessment can include factors such as:
- outbreak status of the premises
- implementation of staff training and IPC measures
- size and layout of the setting
- clinical vulnerability of those attending the setting
- vaccination uptake in staff and service users
- staffing levels
- arrangements for hand hygiene facilities and environmental cleaning
- the ability to maintain physical distancing if implemented by the service
- whether the respite area is part of, or separate from, a care home which may or may not provide care to clinically vulnerable individuals
Further information relating to IPC and communal areas can be found in the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings.
The measures taken will need to be tailored to the specific residential/short break service and to the individual needs and considerations of those who use the service and of their carers. This will need regular review and should be documented by the service.
Residential/short break services can use some of the contents of this guidance alongside their local protocols and arrangements.
Service users who temporarily leave the residential setting or care home
The advice in this section applies to service users who temporarily leave the residential setting or care home for the following purposes:
- to attend hospital appointments
- an overnight stay in hospital
- outings planned by visitors
- outings arranged by staff
- day visits away from the care home or residential setting
- overnight stays away from the care home or residential setting
Advice for outings
Care homes and other residential settings are encouraged to enable personal and social outings, and routine visiting when there is no outbreak.
Information on the Scottish Government visiting policy is available in Open with Care: supporting meaningful contact in adult care homes-principles.
Service users and visitors are advised to follow the Scottish Government guidance on staying safe and protecting others.
A brief risk assessment can assist in preparing for community visits.
Symptom vigilance amongst service users and their friends and family when planning outings away from the care home or residential setting is an important measure.
Anyone with new respiratory symptoms should not participate in a social outing.
It is good infection control practice to increase ventilation by opening windows during shared vehicle journeys.
Service users and their visitors should be made aware of this risk during the planning of outings – particularly when the course of vaccination has not yet been completed.
Returning from outings
Service users do not require the same measures as a new service user admission on return to the setting.
Testing is not needed if the service user remains asymptomatic.
Service users or their carers or relatives have a duty to report to staff:
- any symptoms that developed during the visit away
- potential exposures to COVID-19 cases that have occurred
Service users should be asked the respiratory screening questions in Appendix 3 of NICPM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings on return from overnight stays.
During an outbreak
When a cluster or outbreak of cases arises within a residential service, visits for essential healthcare reasons – for example, hospital attendance – can continue to be arranged. The destination service and transport should be advised there is an outbreak in the residence. Any queries can be discussed with the local HPT.
Service users not identified as cases can also be supported to go on an outing with their relatives using a risk assessment approach. This is providing the residential facility can accommodate this without adversely impacting the management of the outbreak itself.
This applies to older adult care home residents also.
Outings should be in line both with the service users' care plans and the management of the outbreak.
Staff resource will be prioritised on managing the outbreak and providing safe care.
Service users and their friends and family should be made aware of this.
This means care staff sometimes cannot accommodate outings for a temporary period of time.
If an outbreak develops in the residential facility whilst the service user is away, the service user can choose to remain away or return to the facility.
This recognises the setting is their place of residence and home.
The local HPT can advise on decisions which need to be discussed and agreed between the service manager and the service user, and their family.
This should consider the restrictive conditions in the setting for outbreak management purposes upon their return.
Visiting arrangements in residential settings
This advice does not apply to people receiving care in their own home.
Supporting people in residential settings to remain connected with their loved ones is important for their general health and wellbeing. View the staying connected section for advice on different ways to visit.
Residents will have different needs or preferences for visiting.
These should be supported wherever possible to help residents maintain their health and wellbeing.
Each resident should have visiting needs and preferences included in their individualised care plan, balanced against the needs of everyone in the care home. For example when an outbreak is declared.
Vaccination of visitors
Vaccination is strongly encouraged for all visitors but is not obligatory for visits.
Visitors should not visit any care home or residential setting if they:
- are a COVID-19 case
- have any COVID-19 symptoms or if they have any other symptoms of infection, e.g.
- sickness or diarrhoea
- respiratory symptoms
Visitors with symptoms of COVID-19 or have tested positive for COVID-19 should follow the NHS inform stay at home guidance.
Visitors who have recently been in contact with a COVID-19 case should be extra vigilant to the development of symptoms and should consider delaying their visit to any communal residential setting.
Visitors should avoid visiting the setting if they live with someone who has been diagnosed with COVID-19 following the stay at home guidance for people with respiratory symptoms.
Infection prevention and control
Visitors should be informed of, and adhere to, IPC measures that are in place.
Length of visit
There are no public health limits on length of visit or how often service users can receive visitors in the care home settings during routine visiting.
Size of group
There are no restrictions on group sizes, but crowding should always be avoided. An assessment should consider the built environment of the care home or residential setting, including factors such as ventilation.
Scottish Government guidance
The Scottish Government have published Open with Care: supporting meaningful contact in adult care homes – principles.
Further information for visitors is available in our sections on:
Community group visits
Community group visits are now permitted into the residential setting or care home to engage with service users and enhance wellbeing. These are part of routine visiting arrangements. They should be planned and risk assessed ahead of time.
Individuals in community groups should not attend if any of the criteria in the symptom awareness section apply to them.
Use the respiratory screening questions in Appendix 3 of the NIPCM Appendix 21: COVID-19 Pandemic IPC Controls for Health and Social Care Settings to check for wider symptoms before any interaction with service users.
Size of group
Consider the number of people that can use an area so that it allows individuals to have their own space.
Some service users may want to take part but feel anxious about COVID-19 risks (or other infection risks). You can offer them a face mask and their own dedicated space. Others may choose not to participate, and this should be respected.
Frequency of visits
The frequency of community group visits should be manageable by service providers.
Choirs and singing groups
If a choir or singing group is performing, a minimum of a 2-metre distance is advised between the choir and the service users while performing.
If there is an outbreak
Postpone visits from community groups if there is an outbreak in the setting.
Visits when a service user is symptomatic or COVID-19 diagnosed
If there is no outbreak and a service user has tested positive for COVID-19 or has symptoms consistent with COVID-19 infection, visiting can be supported.
The local HPT can support a risk assessment for this, if needed.
Service users can receive one visitor per day, the named person, in their private room during the self-isolation period.
The named person should not be symptomatic of COVID-19, or a confirmed case themselves when they are visiting.
If an outbreak has been declared by the local HPT, use the guidance on visiting during an outbreak (named person initiative).
Infection prevention and control
The visitor must adhere to IPC measures and only enter the service user's private room.
Avoid other areas of the setting and minimise time spent passing through corridors as much as possible.
Visiting during an outbreak (named person initiative)
Named person initiative
During a COVID-19 outbreak, when routine visiting is temporarily suspended, the named person initiative is to be used for visiting. This person-centred approach can also be considered for visiting arrangements during outbreaks of any organism to support the health and wellbeing of residents as much as possible as long as this does not interfere with effective outbreak management. This is at the discretion of the HPT supporting management of the outbreak.
Staff can support service users to choose 'named persons' who may visit them during a COVID-19 outbreak, when this initiative is in place.
Staff will advise on whether the visit can take place in communal areas, or if it must be in the resident’s own room.
Having a named person to visit during a COVID-19 outbreak can avoid service users experiencing periods of isolation from their loved ones.
It recognises the benefits to service users' health and wellbeing that visiting brings.
Service users have different needs or preferences for visiting. Some may wish to not receive any visitors during an outbreak, and this should be respected. The resident's needs and preferences for visiting should be included in their care plans from the outset of admission to the care home.
Having named persons during an outbreak in the care home or residential setting carries a degree of risk for the visitor as well as the resident, as they may themselves be vulnerable to infection or not vaccinated.
Named persons need to use PPE when visiting during an outbreak – see NIPCM for further information on PPE for visitors. They must also follow all other IPC measures in place.
Older adult care homes still remain vulnerable settings due to their closed nature, communal living and the susceptibility of the service user population to infectious disease.
Choosing named persons for outbreak visiting
Care homes and residential settings should:
- support service users to nominate up to three named persons
- keep an updated record of each service user's named persons
- involve family members, friends and advocates in this task, as appropriate
Service users can have up to three named persons but only one named person should visit each day.
Exceptionally, two named persons can visit at one time if support is needed by one of them, for example, an elderly spouse.
Exceptions remain at the discretion of the care home or residential setting and/or the HPT.
Named person eligibility
The named person should not attend if they meet any of the criteria outlined in the symptom awareness section.
The named person is strongly encouraged to be fully vaccinated, though it is not obligatory.
Named persons should be made aware and understand the exposure risks to themselves when visiting during an outbreak.
The named person must be able to follow the advised infection prevention control procedures on the day, as advised by staff.
If your named person is unavailable
If none of the named persons can visit – for example, if they are self-isolating, on holiday, ill – the care home or residential setting should facilitate an alternative individual that can act as the named person.
Frequent changes in named person are not practical for this initiative and should be avoided.
Helping with care
Care staff have a professional duty of care to the people they care for and this needs to consider the resident's wishes.
Named persons may, with agreement of the service user (or representative) and the care home or residential setting staff, provide day-to-day basic care to support service users’ health and wellbeing.
This is complementary to the care from staff.
It could include encouragement to eat and drink.
Length of visit
Care homes or residential settings have a range of extra caring tasks during outbreaks.
Relatives and care home or residential setting staff should work together to support named persons on factors such as the time and length of visits.
Visiting someone with COVID-19
Named persons can visit a COVID-19-positive service user who may require some comfort in what can be a stressful time.
The local HPT's can support risk assessing whether 'named person' visits to someone with COVID-19 can continue, considering the:
- service users' needs
- nature of the outbreak at that time
- health status/clinical vulnerability of the visitor
The named person must wear appropriate PPE – see NIPCM for further information on PPE for visitors.
Care home or residential setting staff can support and supervise the donning and doffing of the PPE.
Service users who are neither symptomatic or confirmed COVID-19 cases and their named person may continue to use communal areas if the whole setting is not being managed as a household.
Possible or confirmed COVID-19 cases should not use communal areas.
This is to ensure that those individuals identified as, or working with, COVID-19 cases do not mix with individuals who are not cases of COVID-19.
Supporting essential visiting (outbreak)
Use of essential visiting
The named person initiative is the default visiting process during care home outbreaks.
Exceptionally, however, the HPT may risk assess that it is necessary to move from named person to essential visiting for a few days. This is a more restricted form of visiting. Essential visiting should be supported regardless of outbreak status.
Moving to essential visiting could happen if there is uncertainty in the effectiveness of outbreak management or serious concerns are identified and effective outbreak management is at risk. Examples of factors to consider include:
- PPE shortages
- concerns with staffing levels
- low visitor compliance with IPC advice
- higher levels of severe illness and poor outcomes than would be expected
- concerns reported by the Care Inspectorate
Duration of essential visiting arrangements
Moving to essential visiting is most likely to arise at the start of an outbreak, albeit rarely and short-lasting.
The HPT reviews (at least twice weekly) any move to essential visiting in their regular dialogue with care homes with an outbreak. Essential visiting will be in place for the shortest possible period.
It is the responsibility of Care Home staff to communicate any short-term changes to visiting to service users and their families, including if essential visiting is in place for a few days.
The two main reasons qualifying for essential visiting are for end-of-life visits and to avoid distressing situations.
Visitor numbers for essential visits for service users receiving end-of-life care are generally not limited.
Essential visits need to be agreed between the service user, the visitor and service manager. The service manager can contact the local HPT for advice in complex situations.
If it is anticipated that even a few days without visiting would have a significant negative impact the service user's physical, emotional, or psychological wellbeing causing distress, this can be recorded in their care plan as a likely reason for essential visiting.
At the time of an outbreak, further person-centred assessment of those service users who may require essential visitors may be needed, even if this has not be been previously recorded. For example, this would include providing support to someone with a mental health issue, a learning disability or autism, where not being present causes distress to the service user.
Staff are encouraged to ensure care plans are current and reflect the preferences and needs of service users.
Essential visits are not typically restricted in frequency and duration but by their nature need to be agreed with service managers.
Staff should assist service users to stay connected with their loved ones. This can be particularly important during an outbreak, especially when visiting arrangements change.
In addition to visiting, digital methods of communication can be explored. For example, using technology to make video-calls, phone calls and send messages.
Window visits can also be supported wherever possible.
The local Health and Social Partnership Oversight Team (working alongside the local HPT) have a role in supporting care homes or residential settings to implement visiting effectively.
NHS inform provides useful information from the Care Inspectorate to the public for clarification on visiting if the care home management are not able to provide this.
Death Certification during COVID-19 pandemic
Details on death certification during the COVID-19 pandemic were outlined in the Chief Medical Officer (CMO) letter dated 20 May 2020.
This was updated in April 2022.
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