Stories have hit the headlines recently about relatives being banned from visiting residents in care and nursing homes. In situations like this, emotions are likely to be running high on both sides, with relatives wanting the best for their loved ones in care, and carers often feeling their daily contact with the resident means they know best, and potentially that their competency is being challenged. In reality, situations where one party is purely to blame are going to be rare. We have set out a checklist of considerations for care homes considering banning a relative or loved one.
The contract
All residents (or someone on their behalf if they do not have capacity) will have signed a contract before entering care, and this may contain provisions on the home's rights to restrict access, or whether the resident has any rights as a licensee or tenant. However, many contracts will make it clear that the resident is not a tenant, and as such may not have specific rights to access for visitors. Care homes may wish to clarify the position in their own contracts, and consider including provisions regarding visitors' behaviour.
CQC Regulation
A number of the fundamental standards, set out in the Regulated Activities Regulations 2014, are relevant to allowing care users to have visitors. In particular Regulation 9 requires providers to provide person-centred care, including meeting a service user's preferences, and Regulation 10 requires providers to respect a service user's privacy and support their autonomy, independence and involvement in their community. In addition, Regulation 16 specifically requires service providers to investigate and take proportionate action as a result of complaints. The CQC's guidance on the standards goes into much further detail, including that a service user's relationship with their loved ones and visitors must be respected, and that people making complaints should not be discriminated against or victimised.
Safeguarding and employment
Care homes also have responsibilities to protect all of their residents, both those being visited and their fellow residents. If care homes consider that a visitor may pose a risk to residents, they need to consider how to remove that risk. CQC refers to placing conditions on relatives' visits, but these conditions must be proportionate and the provider must be able to prove that this is not an attempt to punish those relatives lodging a complaint. It is also important to remember that care homes are also workplaces, and providers have a duty to provide to protect their workers' safety.
CQC guidance
CQC has been quick to react to the headlines, and has published brief guidance for visitors and care homes about their respective rights. While the guidance is not binding, given the sensitivity and visibility of the issue, providers should read and follow this closely unless they have very good reasons not to. However, this does not minimise the problems for providers when they have disagreements with loved ones, particularly when these relate to the best way to care for a relative. This becomes even more difficult when a service user is not able to make decisions for themselves, and Deprivation of Liberty Safeguards need to be considered.
Clearly the best approach for all involved is to try to settle disagreements as cordially as possible, by coming to an agreement between the home, the resident and their relatives, if for no other reason than that complaints management will be reviewed as part of CQC inspections, as will information provided by families. If this is not possible, however, care homes need to remember that their primary duties are to their residents and staff.