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Access to hospital care and treatment for older and disabled people living in care homes and in the community during the pandemic
It is vitally important that older and disabled people living in care homes and in the community can access hospital care and treatment for COVID-19 and other conditions when they need it during the pandemic.
If providers are putting in place local guidelines or decision-making protocols on access to care and treatment, these should always ensure that clinical decisions and pathways are not discriminatory and enable equal access to hospital care and treatment for everyone. Providers should communicate these guidelines and any changes quickly and widely and ensure that staff understand and apply them correctly.
Providers should always work to prevent avoidable harm or death for all those they care for. Protocols, guidelines and triage systems should be based on equality of access to care and treatment. If they are based on assumptions that some groups are less entitled to care and treatment than others, this would be discriminatory. It would also potentially breach human rights, including the right to life, even if there were concerns that hospital or critical care capacity may be reached.
As we said in our joint statement on advance care planning, it is unacceptable for advance care plans, with or without do not attempt resuscitation (DNAR) form completion to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need, and with the involvement of the individual or their families.
The guidance on admission and care of residents in a care home during COVID-19, makes it clear that hospitals should enable admission for urgent and essential care and treatment for COVID-19 for care home residents when they want and need it.
- A person, or their representatives, to be involved in DNAR or advanced care plan decisions before a recommendation is made by any clinician, whether in general practice or in a hospital.
- Robust clinical governance must be in place when local guidelines or triage systems are being developed and there may be a risk that people from a specific group or setting (for example care homes) might be excluded from admission to acute care. Any local guidelines or triage systems must be aligned to national guidance on access to care, including how to avoid discrimination in decision-making.
- Any clinical decisions should be made by appropriate clinicians. For example, health professionals making decisions about disabled people living in care homes who are aged under-65 should be suitably experienced and should be operating within their scope of practice.
- Regular, formal reviews of any guidelines and protocols to make sure that they remain fit for purpose, which must include any incidents reported relating to them.
- NICE guidelines on access to critical care should not be used as a measure of whether someone has access to other acute care (for example, oxygen therapy for COVID-19 or other respiratory conditions).
- Regular review of any local guidance or triage systems to understand the impact on, and outcomes for, people living in care homes.
- Last updated:
- 14 August 2020