How people in supported living can see family and friends and stay safe with their support and care workers.
This guidance applies to the whole of Wales during the national measures in force and should be read in conjunction with the FAQs on the Welsh Government website.
If any additional restrictions come into force, such as national restrictions, the legislation, guidance and FAQ relating to those restrictions will take precedence over this guidance.
Who this guidance is for
This non-statutory guidance is provided for people who are tenants in supported living, their families, housing, care and support providers, and commissioners of services, including, but not limited to, local authorities and health boards.
This guidance has been developed in partnership with a range of stakeholders, including organisations representing people in supported living; organisations representing care and support providers; organisations representing the families of people in supported living; the Welsh Local Government Association; Cymorth Cymru; ADSSC; and Community Housing Cymru.
The primary purpose of this guidance is to help people in supported living, their families, housing, care and support providers and their workers comply with The Health Protection (Coronavirus Restrictions) (No. 5) (Wales) Regulations 2020 and stay safe.
People in supported living are tenants with social care needs. This is different to receiving both accommodation and care through a licence and/or support contract arrangement as a “single package”, such as that provided in a care home. The difference is important as different guidance applies to those living in a care home. The regulations apply to tenants in supported living in the same way as all other tenants.
Some people in supported living may own or part own their properties rather than renting as tenants. This guidance applies to those circumstances also.
Restrictions in place during the coronavirus outbreak can lead to significant negative impacts on people’s physical and mental health and well-being. These are particularly acute for those less able to understand the necessity of a change in routine, such as people with a learning disability, autism, or a mental health condition. Safely connecting with family and friends should be encouraged and supported, in order to improve well-being, and reduce loneliness and isolation.
People in supported living have the same rights as everybody else to meet and visit other people, and the same responsibilities for their own and other people’s safety. See the guidance provided at Alert Level 0 for more information. However, the situation in supported living can be more complicated. People in supported living receive care and support, without which they may not be able to live independently. Some people may have a reduced capacity to make their own decisions and other people may have responsibility for taking decisions in their best interests.
Supported living often provides accommodation for a number of individuals together, each with their own tenancy. Each tenant living in supported living is an individual household. The type of accommodation can vary: people may live in a shared house with shared facilities (such as a toilet, washing, dining or cooking facilities) or in separate flats with communal areas.
Where residents living in supported living accommodation share a toilet, washing, dining or cooking facilities, you should be aware of the increased risks and take appropriate precautions to minimise that risk (see Public Health Wales guidance on infection prevention and control, including cleaning standards for further information).
Rights and responsibilities
It is essential that people have voice and control over their housing, care and well-being. Professionals must ensure that tenants in supported living and, when appropriate, their families and carers, are engaged in assessing any risks as a result of coronavirus, and that any risk mitigation is proportionate to the level and impact of risk. Where issues of mental capacity are engaged, whilst considering a public body’s responsibility to keep people safe, it is imperative also to consider people’s individual rights and protections, including under the Human Rights Act 1998 and Equalities Act 2010.
Care providers should ensure consideration is given to ethical values and principles when organising and delivering social care for adults. The Welsh Government considers the ethical framework set out in the Department of Health and Social Care’s, ‘Responding to COVID-19: the ethical framework for adult social care’, to be a useful checklist to ensure ethical considerations are taken into account within the context of Covid-19. The framework is clear that in all instances, respect and reasonableness should be used as the fundamental underpinning principles which guide planning and support judgements. The Social Care Wales resource, “Positive Risk and Shared Decision Making” may also be a helpful guide, for example providing approaches such as “Ten questions to guide shared decision making about risk”.
Decision making and assessing risk
People living in supported living make their own decisions about their own lives, except where a lack of mental capacity means some decisions are taken by others in their best interest. It is the role of their support provider, any multi-disciplinary team and their families to help them understand any risks to themselves and others, and wherever possible, put measures in place to manage those risks. If tenants with capacity then make decisions which are either unlawful, or could be seen as putting others at significant risk, then there are legal and safeguarding processes already established which should be followed.
All those involved should work together to carry out a dynamic risk assessment to consider the best interest of those in supported living and take all reasonable measures to reduce transmission by following the relevant existing guidance to protect themselves. A ‘dynamic risk assessment’ is a process of continually observing and analysing risks and hazards in a changing, or potentially high-risk environment. This allows for risks to be identified quickly and action taken to reduce/remove risks.
It is essential that people in supported living, their families and carers are all engaged by the relevant health, social care and housing professionals in assessing any risks, and that any risk assessment is proportionate. People in supported living, their families, friends and care and support providers will need to work together closely to ensure people can exercise their rights to meet and visit other people, whilst protecting the health and safety of all tenants.
It may be appropriate to place visible and accessible pictorial reminders, such as posters, or other communication aids around the supported living setting, to reinforce any measures which have been adopted and need to be followed.
In order to meet an individual’s wishes to see people, a personalised approach should be adopted. This means understanding the risks the individual or friend or family member may be exposed to when seeing each other, and how this might affect them and others. Consideration should be given to whether an individual is particularly vulnerable to adverse coronavirus outcomes, due to factors such as age or underlying medical condition(s).
There may be a system of visitor “contracts” in place and a requirement for visitors to complete a health and safety questionnaire prior to visits. This way of working promotes shared understanding and builds trust. A range of useful resources can be found on the Social Care Institute for Excellence website.
People in supported living, visitors and family and friends are advised that their ability to see each other may still be limited following the assessment of risk and subject to specific circumstances. The reasons for any restrictions on visiting should be discussed and agreed with, and clearly communicated to those in supported living and their families and friends.
Some people in supported living may lack capacity to understand and make decisions based on advice about the coronavirus pandemic. Where people do not have capacity, there will already be an agreed process in place for how best interest decisions are made on their behalf, and this should be followed. It is important that all steps are taken to communicate information with people in a way that they are most likely to be able to understand. For example, autistic people and people with learning disabilities, dementia, or mental ill health may have difficulties understanding complex instructions, or forget them. This, and the other principles and requirements of the Mental Capacity Act 2005, must be followed when it is felt a person being supported may lack capacity.
Read the UK Government’s Guidance about the application of the Mental Capacity Act 2005 during the pandemic. Alongside this legislation, it is important to consider the rights of the individual, including under the Human Rights Act 1998 and Equality Act 2010.
Working in supported living
Often, supported living is a workplace for care and support workers including those funded by direct payments recipients, as well as other people that may be employed within the accommodation, or those who are employed to carry out work at the accommodation.
Additionally those people visiting supported living to deliver health and social care should follow guidance provided by Public Health Wales on use of PPE and Infection Prevention and Control.
Those responsible for the provision of volunteers within supported living settings will owe a duty of care to volunteers to ensure that as far as reasonably practicable they are not exposed to risks to their health and safety. Individuals volunteering in supported living accommodation where others are working will be expected to adhere to the measures in place to reduce the risks of coronavirus as required by the regulations and the completed risk assessments.
Testing and self-isolation
People in supported living, their friends and families and people working in supported living should follow the main guidance on how to self-isolate and how to arrange to get a test if they need to. If there are specific approaches for testing or self isolation which apply to people working in supported living those should be followed.
Tenants living in accommodation who share facilities such as a kitchen and bathroom are treated as a single household for self-isolation purposes. This means that if anyone living in your shared accommodation who you share facilities with needs to self-isolate because they have coronavirus symptoms, are awaiting the outcome of a test, have been told to self-isolate by Test Track and Protect, or have tested positive for COVID-19, then everyone in the shared accommodation needs to self-isolate.
Test, Trace and Protect
All people visiting, living or working in supported living settings should engage with Test, Trace, Protect as necessary in the event they are tested positive for COVID-19, or are contacted as part of the TTP process if they are known to be a contact of an individual who has tested positive for COVID-19.
It is important to collect contact information from people (including staff and any visitors) who have been at the supported living setting and to retain this for 21 days. This allows people to be contacted where they may have been exposed to coronavirus at the premises. Separate guidance on the collection of contact details provides further information on collecting contact details.
This guidance may not address all scenarios. All situations should be considered on a on a case by case basis taking into account the relevant legislation and ensuring that the individuals concerned, their families and those representing their best interests are fully involved in any decisions. Public Health Wales can support individual risk assessment and provide advice in relation to infection prevention and control. You can contact them on 0300 00300 32.
This guidance will be kept under review to ensure it remains consistent with wider regulations and guidance.