Indoor and outdoor visiting – reconnecting residents and loved ones

Learn about the coronavirus (COVID-19) safeguards when going to see someone in an adult care home.

Care homes have a range of protections against coronavirus including:

These protections mean care home residents and their loved ones can now begin having more regular time together. Meaningful contact between residents and loved ones will be more common, as care homes now Open with Care. Continuing with the range of protections will help keep everyone safe. This new approach should become the usual practice in care homes in all but exceptional circumstances.

This guidance is based on the best available advice from a wide range of clinical and professional experts. Family and friends of care home residents have also contributed to the guidance.

As we learn more about coronavirus, advice may change.

How care homes can put the new guidance in place

It's recommended that care homes incrementally resume meaningful contact. There will be a gradual increase in how often and for how long you can visit care home residents, as long as it’s safe to do so. There will be a short period of time for care homes to plan and put in place arrangements to do this. 

Care homes can take advice from local oversight arrangements. This will ensure that conditions locally and in the care homes are suitable and safe. 

Visiting loved ones in care homes for longer and more often

Seeing loved ones indoors

Broadly, care homes will be working towards increasing time together.

Initially, up to two designated visitors will be able to visit weekly (one person at a time, and up to two visits per week per resident).

Then, indoor visiting will increase gradually to daily visits with two or more designated visitors if desired (and still one person at a time).

In time, multiple loved ones will be able to visit residents at once. The number of visitors will be in line with wider coronavirus restrictions.

Seeing loved ones outdoors

Time together outdoors should also increase gradually when it’s safe to do so. Garden and window visits might continue, depending on each individual resident’s wishes.

Initially, having meaningful contact with loved ones outdoors may include:

  • going for walks
  • outings using a wheelchair

The group size would follow wider coronavirus restrictions.

In time, residents and one designated visitor can take trips out in the car as long as they:

  • avoid public indoor spaces
  • adopt infection prevention and control measures
  • follow safety measures

Then, visits can progress to overnight stays in the resident’s own home or designated visitor’s home. This would be risk assessed and discussed with oversight arrangements.

The table shows how contact between residents and loved ones will increase over time.

 

Seeing loved ones inside the care home

Seeing loved ones outside the care home

Initially

Up to two designated visitors per week visiting one at a time (or two visits per week) at all Levels

Meeting outdoors  

Leaving the care home            

Next

Increasing frequency of designated visitor visits, towards daily visits

Meeting outdoors               

Leaving the care home

Then

Increasing number of designated visitors per visit

Overnight stays

The frequency and duration of contact should increase gradually. The advice is illustrative rather than firm, so care homes can be flexible.

Visits may take place in a resident’s own room or a dedicated visiting space. Care homes may ask that this is in a designated visiting space when they first resume visits.

Coronavirus protection levels and care homes

Under the Strategic Framework, each local council has a protection level. There are different restrictions for each level.

From February 2021, contact between care home residents and loved ones will not usually be tied to the local level.

Changes to visiting arrangements

Visiting arrangements may change at times, depending on conditions within the care home or the local area. For example, if there’s been a case of coronavirus in the care home in the 14 days before your visit, you would not be able to see residents until the outbreak is declared over. The care home will keep you up to date with these changes.

Essential visits should always continue.

Garden and window visits are also likely to always be supported.

Travelling to visit a loved one

Travel into and out of levels 3 and 4 to see a loved one living in a care home is classed as essential travel. This travel is exempt from coronavirus travel restrictions.

Read more about coronavirus protection levels

COVID-19 vaccinations

Coronavirus vaccines are safe and effective. They’re being offered to care home staff and residents as a priority.

It’s important to still try to maintain physical distancing even if you or your loved one has been vaccinated. This is because we are still learning about the COVID-19 vaccine.

Read more about coronavirus vaccines

Designated visitors

A designated visitor is a named person who can visit the care home resident indoors if conditions are right in the care home.

There can be up to two designated visitors to the care home per resident initially. At first, each designated visitor attends on their own. Visits are agreed with the care home in advance.   

The designated visitor can spend time in the resident’s own room.

As long as safety advice is followed and the resident wishes, designated visitors can help with parts of the resident’s personal care. This could include hair care for example.

Essential visitors

Essential visitors are any family members or friends who visit a resident in pressing circumstances.

Pressing circumstances include:

  • a need to prevent or respond to a deterioration in health and wellbeing
  • times of distress
  • circumstances approaching end of life

People providing spiritual care are also essential visitors, in urgent and non-urgent circumstances.

Essential visits should be supported at all stages of the pandemic, including in lockdown. Care homes are asked to generously support these visits.

The care home manager should support essential visits in these circumstances. Or you can ask the care home manager/senior staff member for essential visits if you’re really concerned about the wellbeing of your loved one.

Circumstances that allow for an essential visitor include:

  • where there is concern that the resident’s health and wellbeing is getting or will get worse
  • where visiting may help with communication difficulties
  • where visiting will ease significant personal stress or distress for the resident and/or their family
  • other pressing circumstances – for example, where there is concern that the resident may be approaching end of life

If there’s serious concern for the resident’s health and wellbeing

When there is a serious concern for the health and wellbeing of the resident, and/or they are approaching end of life, care home managers should discuss this with family members. They can then make a plan for the length of visits and how many people can visit at once. This will include ensuring that safety measures are in place including:

  • personal protection equipment
  • symptom awareness
  • infection prevention and control

If the resident is in distress

If the resident is in distress, an essential visitor may be needed. Distress means that the resident is showing signs of being depressed or withdrawn. It can also mean they are showing signs of anxiety – being anxious or restless. This applies whether or not the resident has a condition like dementia, or a learning difficulty.

If the resident may be approaching the end of their life

This is the time before a resident sadly passes away. This time isn’t limited to a few hours or the same day that the resident is expected to pass away. It could be a period of days, weeks, or months.

Children and young people visiting

Initially, children under 16 would not normally be a designated visitor for indoor visits.

When restrictions ease and care home residents can have more visitors, children under 16 should be considered. Children should remember to follow safety advice.

Young people 16 and above can be designated visitors.

Outdoor visits

Children and young people can be part of outdoor meetings with care home residents. They should be included in group size limits.

Essential visits

Children and young people should be supported to attend essential visits, where desired.

During essential visits, children and young people should follow advice from the care home on:

How decisions are made about visiting in care homes during the coronavirus pandemic

A group of experts in each local area make recommendations about visiting safely in care homes. This is known as local oversight arrangements. The group includes experts in:

  • public health
  • nursing
  • infection prevention
  • health protection
  • social work

The care home manager makes decisions about visiting for their individual care home. They work to balance the safety and needs of the entire group of residents, and the safety and needs of each individual resident.

The care home manager considers factors such as:

  • current national advice for preventing coronavirus infection – for example, guidance around physical distancing
  • advice from public health – for example, whether an outbreak is ongoing in their area
  • the type of care home – for example, whether or not the residents are mostly older people
  • the circumstances of individual visitors and residents

Raising concerns around visiting

If you’re unhappy with the visiting arrangements in your loved one’s care home, the first step is to raise your concerns with the care home.

Complaints processes

You may still have concerns after discussing the issue with the care home. In this situation, you should ask for your concern to be considered through their existing complaints processes. The care home will be able to tell you what these are.

Care Inspectorate

You can contact the Care Inspectorate if:

  • you have any concerns about the care itself
  • your concern is not resolved through the complaints process

Read more about making a complaint to the Care Inspectorate

Access further advice and support

For many people, reconnecting will be an emotional time.  A new Action on Rights team has been set up to help anyone with a loved one living in a care home to have meaningful visits under the Open with Care guidance. They offer practical and emotional support to anyone who needs it.

This support is not solely for families and friends of people living with dementia – it is for anyone needing support. The team will also work with care homes to help facilitate visits where appropriate.

You can reach the Action on Rights team by phoning the free 24 hour Alzheimer Scotland helpline on 0808 808 3000.

These helplines can provide information on visiting your loved ones in care homes. They can also give specialist advice on particular conditions:

Find more information

Read guidance on keeping everyone safe when visiting an adult care home

Read the latest Scottish Government guidance on care home visiting

Read the Care Inspectorate’s information for care home services 

Read information from Alzheimer Scotland on how care homes can support residents and their loved ones during the coronavirus pandemic