Managing admissions, readmissions, discharges and transfers within the Care Sector

Published 26 May 2020

We have been considering some of the key guidance and publications relating to admissions, readmissions, discharges and transfers affecting the care sector during the current pandemic.

1. Escalation of care of a COVID-19 resident to the NHS

The Admission and Care of Residents during COVID-19 Incident in a Care Home, published jointly by the Department of Health and Social Care, NHS England, Public Health England and CQC states that residents with COVID-19, whether symptomatic or not, can be safely cared for in a care home if the guidance is followed. There is no expectation that all care home residents who present with possible symptoms of COVID-19 will receive medical review or be transferred to hospital. Escalation may need to be considered if symptoms worsen during isolation or do not improve and all decision making must be person-centred.

In the case of ambulance attendance, Public Health England has also issued guidance for NHS ambulance Trusts, COVID-19: Advice for Ambulance Trusts. The recommended advice for possible and confirmed COVID-19 residents with mild symptoms is for them to stay in the care home until they are well. However conveyance to hospital is clearly anticipated for certain COVID-19 suspected residents and where an ambulance is called, the ambulance service must assess the resident and determine whether a conveyance to hospital is warranted on the basis of assessment and the apparent gravity/severity of symptoms. The key in every circumstance is decision making based on individual assessment.

2. Safe discharge from the NHS and individuals coming from the community

On 17th March 2020, the UK Government and the NHS set out its plans to free up NHS capacity via rapid discharge into the community and reduced planned care. The COVID-19: Our Action Plan for Adult Social Care, published by the Department of Health and Social Care on 15 April 2020, confirms that any patient, including those recuperating from COVID-19, who do not require an NHS bed will continue to be discharged, in line with discharge requirements and with due regard to the safety of those with whom they have contact after discharge. The Action Plan confirmed a “move to institute testing all residents prior to admission to care homes. This will begin with all those being discharged from hospital”. Patients may still be discharged before test results are available and in the same way residents may be admitted from the community into care homes without the availability of test results. The guidance confirms that where a test result is awaited, the resident should be isolated in the same way as a COVID-19 resident will be. The guidance also states that for people discharged asymptomatic into a care home with negative tests or entering from the community with a negative test, 14 days isolation is recommended. The acceptance of a resident into a care home must always only be done as long as by doing so, the provider can still ensure the ongoing safety and wellbeing of the resident, other residents and care home staff.

3. Transfers and movements between care homes

In the Government publication “Our plan to rebuild: the UK Government’s COVID-19 recovery strategy” updated on 12 May 2020, there is reference to the plan for protecting care homes. In this publication the Government states that it “expects all care homes to restrict all routine and non-essential healthcare visits and reduce staff movement between homes, in order to limit the risk of further infection”. Any staff movements will need to be limited, necessary and risk assessed with appropriate mitigation implemented. We anticipate that providers who operate services at multiple locations may be considering transferring residents to a different care home within the group, in particular where staff shortages may be affecting the provision of the service within a care home. Such measures would be extreme and would need to be taken in compliance with the Fundamental Standards and in consultation with commissioners and the CQC to ensure that risks are appropriately mitigated.

In our view, the acceptance of a resident into another care home (even if it is into a service in a different location operated by the same registered provider) must only be done as long as by doing so, the provider can still comply with the Fundamental Standards and ensure the ongoing safety and wellbeing of the resident, other residents and care home staff.