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coronavirus injection | Care Home Agency Advice

Consent in practice: COVID-19 vaccination issues for care homes

By social care freelance writer Eleanore Robinson

Key among the many issues related to vaccine deployment will be getting consent from residents, particularly those with dementia.

While the Government has issued a standard consent form for care providers to use, there are issues around some residents’ capacity to make the decision to consent to COVID-19 vaccination.

Consultant in human rights and mental capacity in social care, Rachel Griffiths, said: “We need to make sure consent is capacity.”

Griffiths said that, if someone can’t consent to COVID-19 vaccination, it will “best interests” decision.

In most cases it will be in that person’s best interest as receiving the vaccine is comparable with getting the flu jab, she explained.

Partner at law firm Gordon’s Partnership, Neil Grant, added: “In the vast majority of cases, the risk/benefit analysis is likely to be heavily in favour of administering the vaccine to a resident who lacks capacity.

“However, the important point is that the registered provider and manager must ensure the law is applied correctly with a proper record kept of decisions taken.

“This ensures the rights of the resident are upheld, as well as providing legal protection to the care home and its staff.”

Grant added these decisions legally need to be made on an individual basis and “not in a blanket fashion”.

There will be people who won’t consent, for example, as it is against their beliefs or they are scared of needles. “If they say ‘no’ there is nothing you can do”, Griffiths said.

She added that there would be issues about restraint while delivering the vaccine: holding a service user’s arm or hand while the injection is given, that would be considered proportionate.

At Community Integrated Care (CIC) around 70 per cent of residents had given consent at time of going to press.

“This is a situation for individual choices”, said chief executive Mark Adams.  

He said CIC had been involving families of residents with dementia with decision-making, trying to give them as much information as possible.

“We are very sensitive to what the side effects might be”, he added.

These could lead to staff absences and care homes having to manage adverse symptoms in residents.

Care England chief executive professor Martin Green also highlights the uncertainty for care homes managing residents who only receive one dose. “This is an enormous amount of extra work with no recognition from Government”, Green added. “It is going to be an enormous cost burden.”

To vaccinate all residents and staff within the short shelf-life after defrosting, care homes will need sufficient fridges and trained vaccinators.  Being prepared by arranging rotas and transport has ensured 30 Orchard Care Homes’ workers were able to be vaccinated while on duty while maintaining safe staffing levels at its Penwortham Grange & Lodge home in Preston.

An Orchard spokeswoman said: “The timing was a challenge as we were given very little notice.

“However, we acknowledge the importance of acting swiftly in order to be vaccinated as soon as possible and therefore prioritised this above all else.

Being vaccinated puts us one step closer to having visitors back in the home and reduces the risk and severity of Covid-19.”

Adams said situation in UK care homes will only change in three to six months’ time.

“That is what we hope for. We are hoping that the majority of people will have the vaccine.”

Read the SOP for making best interests decisions for COVID-19 vaccination candidates without capacity

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