Coronavirus testing

We’ve been leading the way to embed routine testing into care homes since the start of the pandemic; we’ve been involved in every care home pilot that has been available through various government bodies.
 
We are continuing to work closely with our health partners in England, Scotland and Wales to undertake regular testing in our homes.
 

Routine Colleague testing

All of our care home Colleagues benefit from routine coronavirus testing. Many people who contract coronavirus do so asymptomatically and this has been one of the biggest challenges for care homes as until routine testing became available, it was very difficult to know if a person had coronavirus or not.
 

Resident testing

England

Admission of Residents from hospital, from an interim care facility or transferring from another care home

All people being discharged from hospitals into care homes should undergo a PCR test 48 hours prior to discharge, to receive their PCR test result within 48 hours prior to discharge.
 
An exception to this process is for individuals who have previously tested positive for COVID-19 and are within 90 days of their initial illness onset or positive test date.
 
Anyone who has had a COVID-19 positive PCR test in the past 90 days is not advised to be tested again before being discharged from hospital if they:
 
-  Have a normal immune response.
-  Have completed their 14-day isolation period following the positive test result.
 
They can be discharged into a care home without going to a designated setting first if they:
 
-  Meet the clinical improvement criteria included in the stepdown guidance
-  Have no new symptoms.
-  Are considered by a clinician not to be an infection risk.
 
A person can test positive for COVID-19 for up to 90 days after first being infected, even though they might have recovered and might not be infectious to others anymore. This is because PCR tests can sometimes still detect remnants of COVID-19 (SARS-Co-V-2 RNA) in a person’s system.
 
When Residents are admitted from other care facilities, care home providers should find out whether the person has had a COVID-19 test during the 48 hours before admission and what the result is. If the person has not been tested during this time, care home providers should decide when to test them, using a PCR test and following the care home testing guidance.
 
Care Home Managers will undertake a risk assessment which will consider the need for the Resident to receive in-room care and hotel services for a period of 14 days before they move into the wider care home community. This will consider any monitored self-isolation undertaken prior to admission to the care home, the levels of transmission in the community within which the previous care home or care facility is situated and the COVID-19 management of the previous care home or care facility.
 
Care home managers will receive the COVID-19 test results of anyone admitted to a care home from hospital, or another social care facility.
 

Admission of Residents from the local community

New Residents in England who are admitted from the local community do not need to isolate for 14 days upon admission where they meet certain requirements and specific criteria are met. This includes:
 
-  Where the Resident is fully vaccinated (and the admission is a minimum of three weeks after their 2nd dose of the vaccine to ensure maximum immunity).
 -  Guidance from the local Director of Public Health about community transmission of Variants of Concern is followed.
 -  The Resident has no known contact with a COVID-19 positive individual.
 -  The care home has considered the circumstances at the Resident’s home prior to admission to the care home.
 
The Resident will be subject to an enhanced testing regime consisting of a PCR test before admission (within 72 hours), a PCR test on the day of admission (day 0) and a further PCR test 7 days following admission (day 7) and daily rapid lateral flow testing until the day 7 PCR test has been received.
 
For more information on the Government guidance visit: Admission and care of residents in a care home during COVID-19 - GOV.UK (www.gov.uk)
 

Scotland

 

Admission of COVID-19 recovered Residents from hospital

In Scotland, where a Resident is being admitted from hospital and has recently recovered from COVID-19, as PCR testing can take several weeks to revert back to a negative test result due to persistence of non-viable viral RNA remnants, repeat PCR testing within 90 days of a COVID-19 diagnosis in preparation for discharge must be considered carefully.
 
COVID-19 recovered Residents can be discharged from hospital into the care home after 14 days from symptom onset (or their first positive test, if asymptomatic) without further testing. In these situations, discharge at 14 days is based on clinical judgment of fitness for discharge. This decision will be made in collaboration with the Care Home Manager who will need to agree to the Resident’s transfer before this takes place.
 
If a COVID-19 recovered Resident has completed their 14 days of isolation in hospital, no further isolation should be required on their return to the care home.
 
If a COVID-19 recovered Resident is discharged to the care home before their 14 day isolation period has ended, they will be required to have two negative PCR tests before discharge from hospital. The tests will be required to be taken at least 24 hours apart. If the Resident has not completed their 14 day isolation then they will receive in-room care and hotel services in the care home. They will not be required to start a new period of isolation, nor do they require further testing. Where it is shown to be in the clinical interest of the Resident and negative testing is not possible, a risk assessment a care plan for the remaining period of isolation, up to 14 days in the care home will be agreed upon.
 

Admission of non COVID-19 Residents from hospital

In Scotland, a single negative COVID-19 test result should be preferably available within 48 hours prior to discharge from hospital into the care home. The exception to this is where a Resident is considered to suffer distress or clinical consequence if they were not able to be discharged to a care home. In these situations, the Resident may be able to be discharged to the care home prior to the test result being available (whether the result is positive or negative). However, the 14 day isolation period where the Resident will receive in-room care and hotel services before they move into the wider care home community must be completed in the care home regardless.
 

Admission of Residents from the community

In Scotland, all admissions of Residents from the community, regardless of Protection Level, should have one negative PCR test within 3 days of their admission date.
 
In exceptional circumstances, where testing is not possible before admission to the care home, then testing upon admission to the care home will be considered.
 
Where it is shown to be in the clinical interest of the Resident and providing a negative test is not feasible, an agreed care plan for admission to the care home will document this.
 

Protection Levels 0-2

In Protection Levels 0-2, a risk assessment will be agreed on a case by case basis by the Care Home Manager to determine whether the Resident will receive in-room care and hotel services upon admission to the care home. This decision will be at the Care Home Manager’s discretion, subject to local risk assessment as guided by the local oversight group.
 

Protection Levels 3-4

In Protection Levels 3-4, the Resident will receive in-room care and hotel services upon admission to the care home for 14 days before they move into the wider care home community. A risk assessment will be completed prior to admission to ensure that appropriate isolation facilities are available and will consider requirements for the Resident’s care.
 
The risk assessment will include factors such as the presence of COVID-19 related symptoms, the COVID-19 status of the household they have come from, the Resident’s travel history, the Residents vaccination status, care home Colleagues’ vaccination uptake rate, general Infection Prevention and Control (IPC) and Personal Protective Equipment (PPE) training, supplies and usage in the care home.
 
For more information on the Scottish Government’s guidance visit: COVID-19 - information and guidance for care home settings (adults and older people) - version 2.2 - COVID-19 - information and guidance for care home settings (adults and older people) - Publications - Public Health Scotland
 

Wales

 

Admission of Residents from hospital

In Wales, new Residents who are admitted to a care home from hospital will require Residents to be tested upon being discharged from hospital to the care home unless they fall under the following criteria:
 
-  The Resident has tested positive and was treated for COVID-19 during their hospital stay, more than 20 days have passed since they tested positive and the Resident is now well.
-  The Resident has tested positive for COVID-19 within the last 90 days.
 
As per Welsh Government guidance, Residents will not be admitted to the care home if they are infectious. Whilst testing before admission to a care home is helpful, the most important step to prevent the spread of infection is for the Resident to receive in-room care and hotel services upon admission to the care home for 14 days following discharge from hospital before they move into the wider care home community.
 
Where a Resident has already completed a 14 day isolation period in an alternative facility prior to admission such as a step down service, further isolation may not be essential. A risk assessment will be carried out by the Home Manager which will take into consideration whether a further period of isolation will be required as a precaution or not. Testing before discharge from these settings will still be required.
 

Admission of Residents from the local community

Welsh Government policy is that all Residents should be tested prior to admission or placement unless they have previously tested positive within the last 90 days.

Testing can be accessed through a home test kit; booking a test at a local community testing centre or via the Health Board.
 
If a Resident tests positive for COVID-19 or has symptoms, placement or admission will be delayed for 10 days (14 days for those in clinically vulnerable or extremely clinically vulnerable groups) or until symptoms have resolved whichever is the longer.
 
If a Resident has been identified as a contact of a COVID-19 positive individual or someone with symptoms consistent with COVID-19 infection they should remain in household isolation in their current home until the end of the 14 day self-isolation period.
 
As our homes care for those who are clinically vulnerable or extremely clinically vulnerable, a period of isolation on arrival in the setting is advised, for 14 days, as a negative test result does not rule out infection as an individual can already be incubating the virus at the time of the test or become infected after they were tested.
 
If a Resident has been fully vaccinated then a period of isolation is not necessary after a negative test.
 
In the event of a clinically or extremely clinically vulnerable individual requiring admission without a test result e.g. in a situation where it was unsafe for them to remain at home, they should be admitted to an 'step-up' care facility that is able to provide appropriate isolation and they should be treated as a COVID-19 positive individual until the outcome of any test result is known.
 
Residents do not require testing in advance of discharge from a residential setting back to their own home in the community unless they are in receipt of a social care package.
 
For more information on the Welsh Government’s guidance visit: Care homes and social services: coronavirus | GOV.WALES
 
Ongoing routine testing of Residents varies in our care homes in England, Scotland and Wales due to the different ways that local authorities and NHS operates in each country.
 
Whilst the systems operate differently, the rationale is based on the fact that unlike our Colleagues, Residents are not exposed to the wider community, their main contact is with our Colleagues or with loved ones through safe visits, both inside the home and out of the home.
 
Routine testing has enabled us to ensure that our Colleagues are coronavirus negative. Additional safety measures such as enhanced infection control and the safe and effective use of personal protective equipment worn by all Colleagues adds further protection to Residents so that they live in our homes as safely as possible during this pandemic.