Fears grow of increased pressure on care homes to accept Covid-19 patients

Data shows a third of local authorities do not have a designated setting approved for the safe discharge of hospital patients.

An elderly man at a retirement home in Birmingham (Joe Giddens/PA)
An elderly man at a retirement home in Birmingham (Joe Giddens/PA)

Fears are growing that care homes could come under increased pressure to accept hospital patients with coronavirus, as figures show a lack of settings have been approved to safely receive them.

Data from the Care Quality Commission (CQC) shows that more than a third of local authorities in England had no approved ‘designated setting’ as of January 5.

These are care homes or alternative sites that have been inspected and approved by the regulator for the rapid discharge of hospital patients with coronavirus.

Current Government guidance says that as a “last resort”, Covid-19 positive patients could be discharged into non-designated sites that are willing to receive them.

The latest data shows there are 129 CQC-approved designated settings within 98 local authorities, providing 1,575 beds.

There are a further 32 “alternative settings” with 869 beds, where local authorities have agreed with local partners to make use of NHS settings, such as community hospitals.

The CQC noted that some local authorities will be sharing a designated setting that is located within another area.

In mid-October, when the scheme was launched, the Department of Health and Social Care (DHSC) said it hoped every local authority would have access to at least one approved site by the end of the month.

And the CQC was ready to approve 500 settings by the end of November.

But care provider groups have said many members have chosen not to take part, either because they do not have the set-up to safely cohort positive patients away from other residents, or due to issues with insurers covering them if the virus spreads.

There are fears that, with too few approved settings and rising numbers in hospitals, care homes who have not been approved will come under increasing pressure to accept patients.

It is understood the Treasury has been asked to look at extending indemnity cover to care homes that accept Covid-19 patients, which could help boost numbers of approved facilities.

Current Government guidance says no care home will be forced to admit an existing or new resident from hospital if they are unable to cope with the impact of the person’s Covid-19 illness.

Instead, Covid-19 positive patients should be discharged into a designated setting to complete 14 days of isolation.

But alternative arrangements should be discussed if a patient objects, the guidance says.

It is the responsibility of local authorities to ensure there are sufficient settings available to meet expected needs, it adds.

It reads: “Options considered must balance the need to minimise Covid-19 transmission in care homes, and the need to meet individual care needs and preferences.

“Only as a last resort, options could include an individual being discharged to a non-designated care home with sufficient IPC (infection prevention and control) arrangements, that is willing to receive the individual and support their care needs.”

The Independent Care Group, which represents providers in North Yorkshire and York, said the guidance is clear, adding: “We cannot go down this route again.”

Chairman Mike Padgham continued: “Part of the reason more than 20,000 people have died in care and nursing homes is that this guidance wasn’t followed last time.

“If the reason is that we do not have enough designated settings then efforts should be made to create more, but we cannot cut corners on testing.

“Care and nursing homes want to help, and I am sure many more would agree to become designated settings if they had had the promised vaccines and the Government would support them with insurance and by indemnifying them against Covid-19 death claims, as they do NHS healthcare providers.”

Care England said the situation on the ground is “fast changing” and the membership organisation is anticipating additional pressures on care homes to admit patients with coronavirus.

Chief executive Professor Martin Green said: “The key is, at the end of the day, it is for the care homes to decide and hospitals should not put undue pressure on care homes.”

Kate Terroni, chief inspector of adult social care at the CQC, said inspectors are visiting sites nominated by local authorities within 48 hours if they meet the regulator’s minimum requirements, such as having a separate area for people with coronavirus.

She said: “It is our role to ensure that proposed locations for the designate scheme, which is an initiative led by DHSC, are safe for people with a confirmed Covid-19 test result to be discharged into.

“By rapidly inspecting and, where appropriate, approving designated locations for Covid-positive people being discharged from hospital into care settings, we are working to help combat the spread of infection and increase the number of people who can access care by ensuing that people can be safely discharged from hospital.”

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