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 new national measures in force from 21 December 2020 and should be read in conjunction with the FAQs on the Welsh Government website.
This guidance is to be followed when Alert Level 4 restrictions are in force. Revised guidance will be issued when the Alert Level changes.
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.
The 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. Wherever possible, safely reconnecting with family and friends should be encouraged and supported, in order to improve well-being, and reduce loneliness and isolation.
It is important that we all take responsibility for protecting ourselves, our friends and family, other people who live in the same house and people we come into contact with, such as support workers. This means acting safely to protect yourself and others, by following social distancing and good hygiene practice, and by being aware of and minimising risks.
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. 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. However, the type of accommodation varies: 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. Under Alert Level 4 regulations, extended households are not permitted but single adult households may join with one other household to form a support bubble. Each single adult household living in supported living accommodation can form a support bubble with one other household, either with a household outside of the shared accommodation or another household within the shared accommodation.
Where residents living in supported living accommodation share a toilet, washing, dining or cooking facilities, then Alert Level 4 regulations permit up to 4 individuals who live in the accommodation to gather together in shared areas within the accommodation, so long as no person from outside the home is present, apart from any people providing care and support to a person in supported living.
Rights and responsibilities
It is essential that people have voice and control over their 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 assessment is proportionate. 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.
Visiting or meeting a person in supported living
- If the person is in a support bubble, the members of the support bubble can visit, have physical contact and stay overnight with the person in supported living within their accommodation.
- Visits are not permitted unless the visitor is part of a support bubble, or if the visitor is someone who is delivering care and support to a person in supported living. Read our guidance for health and social care professionals.
- Outdoor meetings are only permitted between members of a household or members of a support bubble. This does not include the carer of a person participating in the visit. Social distancing must be observed.
- Workers who visit a supported living setting should consider whether the work can be safely deferred until after Level 4 restrictions are lifted. The exception is if it is to repair a fault which poses a direct risk to people’s safety – for example, emergency plumbing, or carry out an adaptation to allow that household to remain in their property. Workers must ensure social distancing is observed between residents and supported accommodation staff at all times. Read the guidance Keep Wales safe at work and Guidance for working in other people’s homes.
People who live in supported living, staff and visitors all have a responsibility to make visits as safe as possible.
As set out above, extended households are not permitted under Alert Level 4 restrictions but each single adult household living in shared accommodation can form a support bubble with one other household, either with a household outside of the shared accommodation or another household within the shared accommodation. The first scenario will mean that that there is a higher potential for coronavirus to be spread throughout the house. These households should therefore be aware that they are potentially putting themselves, and others, at increased risk, and they should consider carefully the risks of forming of a support bubble with people not living in their house/supported living.
There are other factors which may increase risks in supported living. These include the underlying risk profile of each of the people who live there (e.g. age, underlying medical conditions). All the people who live there should be able to make an informed decision on whether they would accept the increased risk, or a “best interests” decision where appropriate. See the relevant section on risk below.
Visits by a person in supported living to meet or stay with other people
A person in supported living can visit other people in the following circumstances:
- If the person in supported living is a single adult household and they have formed a support bubble with one other household, they can meet (indoors and outdoors), visit, have physical contact and stay overnight with members of their support bubble away from their supported living accommodation.
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. There is useful advice provided by HSE, including a risk assessment template. 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.
In assessing risks associated with support bubbles or shared facilities a range of factors should be considered including:
- the infection control measures that are in place, including arrangements for cleaning any shared facilities;
- the need to ensure the use of personal effects only, such as towels, crockery and cutlery, rather than sharing;
- timetabling visits and activities to minimise contacts;
- measures which promote social distancing; and
- understanding the prevalence of coronavirus in the local area and the areas people are travelling to and from.
It may be appropriate to place visible pictorial reminders, such as posters, or other communication aids around the supported living setting, to reinforce the measures which have been adopted and need to be followed.
In order to meet an individual’s wishes to receive or make visits, a personalised approach should be adopted. This means understanding the risks the individual or visitor may be exposed to when receiving, or going on visits, 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).
Other risks to take into account and mitigate for, include exposure to situations where the risk of coronavirus transmission may be higher, for example:
- travelling on public transport and the requirement to wear a face covering, unless exempt;
- entering public indoor settings and the need to wear a face covering.
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 members of a support bubble are advised that their ability to visit may still be limited following the assessment of risk and subject to specific circumstances. The reasons for any restrictions on visiting should be discussed with, and clearly communicated to those in supported living, their support bubble 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. As a result of being premises where ‘work’ is carried out, supported living is classified as ‘regulated premises’.
The regulations impose duties on those responsible for work carried out on regulated premises to take reasonable measures to minimise the risk of exposure to coronavirus at the premises, or the spread of coronavirus by those who have been at the premises.
In summary, they must:
- take all reasonable measures to ensure that a distance of 2 metres between all persons is maintained on particular premises
- ensure that other reasonable measures are taken to minimise risk of exposure to the virus, in particular by limiting close face to face interaction and by improving hygiene
- provide information to those entering or working at the premises about how to minimise risk.
This duty would apply for example, to those responsible for the delivery of care and support to a person in supported living. The person responsible would be the person arranging the provision. This could be the individual themselves if they arrange their care by way of direct payments or the local authority or agency.
Those responsible for the provision of volunteers within supported living 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 and members of their support bubble should be made aware of the need to immediately self-isolate and arrange to get a test if they develop any of the most common symptoms of COVID-19: a new continuous cough; or a high temperature; or loss of or change to sense of smell or taste. This could also mean that the person in supported living should consider self-isolating with his/her support bubble (in their home), rather than returning to their usual supported living until the outcome of the test is known (where the test result is negative), or until the period of self-isolation ends (if the test result is positive).
Additionally staff, providers of care and support, volunteers and visitors to the supported living setting should be made aware of the need to avoid going to the setting if they have any symptoms of COVID-19 – they should remain at home and immediately self-isolate and arrange to be tested.
If a person is showing no symptoms of COVID-19 when they return to supported living following an external visit or stay, and they have adhered to restrictions such as social distancing, and wearing of face coverings in indoor public places and on public transport, they are not required to self-isolate.
Tenants living in accommodation who share facilities such as 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 and are awaiting the outcome of a test, or have tested positive for COVID-19, then everyone in the shared accommodation needs to self-isolate.
All tenants and staff in supported living and domiciliary care services are able to access a test if they show symptoms of COVID-19.
The Welsh Government has recently agreed to include care workforces related to supported living in the COVID-19 RT-PCR Testing Programme where:
- most residents would be recognised as being of high or moderate risk if exposed to Covid-19 (in line with national definitions) or have a learning disability;
- the setting is a ‘closed’ community with facilities shared between multiple people; and
- most residents receive care regulated by the Care Inspectorate Wales.
Workforce testing in supported living will roll out in early 2021. Other 'floating' domiciliary care services will be part of the Lateral Flow Testing Programme at a later date.
Test, Trace and Protect
All individuals should also 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 essential to keep records of the names and contact details of staff, visitors, volunteers and of members of support bubbles in order be able to respond quickly to support Test, Trace, Protect in the event of a resident/person, visitor or staff member being tested positive for COVID-19, or having been in close contact with an individual who has tested positive for the virus. In keeping with GDPR requirements all residents, staff members, volunteers and visitors to supported living will need to be made aware of the records being kept in relation to personal contact details and the purpose for this.
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.