An issue which can not be ignored - Social Care Reform

 A few weeks ago I was asked to join a panel discussion on Times Radio about social care reform and why it was needed.  Over the last 15 months I have regularly spoken on Times Radio about how our care home was coping with the pandemic.  I’ve had time to reflect on first hand experience of managing and running a care home in these unprecedented times.

Everyone has been keen to hear about the truth behind what it really was like during the pandemic in a care home.  Were the government to blame with the excessive deaths in care homes?  Did we have enough PPE?  Did Covid get into our home?  These type of questions are easy to answer.

 

But in terms of the larger all encompassing subject of  social care reform….. I don’t get asked about it.  I know it is desperately needed, but I believe the possible solutions and the associated costs may be too difficult for the general public to digest and so perhaps this is why in the Queens Speech last month, despite promises by the current and previous Government, there was just 10 words given to social care reform.    

 

The subject of social care reform struggles for public attention.  Social care has a history of invisibility and complacency.  The social care crisis is caught up in a repetitive loop of alarm alternating with apathy.  There are well pulbicised care home scandals which lead to more regulation and inspection and rarely to increased funding.  The public are used to hearing the bad stories of about life in a care home, these are repeated, but the wonderful stories of care are rarely shared.  (Even the interviewer on the Times Radio panel interview even fell into this trap). 

 

 

So what has the experience of owning a care home led me to my belief that social care reform is needed?

1.     FEES - At the heart of this issue is the fact that there is a massive disparity between costs of care (and for the purposes of this article I refer to residential care).  Local Authority funding is being squeezed to untenable levels, infact before writing this I was completing a spreadsheet to justify why I need an extra one percent increase on fees above the two percent increase granted by the local authority,  to justify this extra one percent for two residents who we have not received any fee increase for in three years, I have to explain what I have done to reduce expenditure – they suggest redundancies and fund raising…   We have always wanted to continue to charge the same for a self funder as a local authority placement,  Sadly this is looking like it will become impossible as the Local Authorities can not pay realistic costs for placements .  In the majority of homes that take both Local Authority placements and self funders, this is resulting in self funders (those who earn above the £23,000 threshold to receive local authority funding) “propping up” the industry.

2.     STAFFING - Social Care staff are underpaid, undervalued and currently massively demoralized.  Cost pressures on many homes mean staff are under pressure to perform more tasks leaving less time to actually “care”.    I am currently looking for an additional carer to join our team.  I had 5 applications, not one turned up for an interview.  I am not alone. There is a massive shortage of carers (I believe the situation is the same in nursing).  Coming out of a pandemic, those working in social care are tired and feel undervalued.   The announcement about vaccinations being mandatory for those working in care homes did nothing to motivate an undervalued workforce.  The reason being as follows;  Anyone working in a care home must be vaccinated, carers, cleaners, people working in the kitchen,  the same goes for all working in a care home even if not directly employed – hairdresser, plumber, electrician.  All staff at our home are vaccinated, all agreed, some took a little longer to decide but everyone is vaccinated.  However….  A nurse, paramedic, doctor currently does not have to be vaccinated. They can come into any care home with no requirement to (currently) be vaccinated.  Double standards perhaps?    In the case of any covid outbreak the Department of Health felt care staff did not require the same level of PPE as NHS staff – No full gowns and no enhanced masks.  

3.     PREMISES -Small privately owned homes are closing at a faster rate than other homes due to pressure on them to conform to unrealistic building requirements.  Our care home is a home, in places a home which is over four hundred years old. Beams, wonky floors, individual rooms.  The requirements for our building are increasing almost monthly and some just can not be met.  As an example; we do not have any en-suite bedrooms, the majority of those we care for live with advanced dementia, many are incontinent and many are not mobile.  En-suites would not in any way enhance their quality of life.   I have been warned this may become a requirement for all care homes.  To do this we would have to flatten our home as the drains would need to be entirely rebuilt.  I am told that our exisiting quarry tiled hall may no longer be regarded as acceptable for infection control.   I worry that the future of care homes may only be purpose built clinical, hotel style of homes which are soulless and in no way offer a “home from home” experience.

 

I was asked to speak on the panel interview regarding challenges within in a care home that provides care for “self funders” (those who have finances above the threshold to have care paid for by the local authority) and for those who are funded by the Local Authority.  The weekly rate that we charge whether a self funder or a local authority placement is the same. I believe we are in the minority in this regard and the majority of care homes do not charge the same weekly fees for self funders and Local Authority placements

 

I had been asked to join the panel to talk about the issues in terms of funding of placements primarily but I was aware that this discussion could cover other areas of social care reform.  So a few days before the interview I did some background research.  

 

To put this issue into perspective, the following needs to be understood;

 

·       In 2019/20 1.9 million people requested support from their council, over 100,000 more than in 2015/16

·       Social care budgets have been cut by £8bn since 2010 with 1.4m people living without the care that they require.

·       The Lancet reports that It is believed that the number of over 85’s requiring 24 hour care will double between 2020 and 2035.

·       22% fewer older people were able to access care in 2017 compared with 2010

·       In 2010 – 2018 there was an 8% cut in social care budgets, accompanied with a reduction in beds as so many care homes were closing.  

·       1 in 10 over 65’s are anticipated in having care costs in excess of £100K, often due to dementia.

·       Local Authority savings have been made by tightening the criteria for care and holding down costs paid for residential and nursing placements -  having the result of bringing down wages in real terms or closing homes.

·       There are more than 100,000 vacancies for social care staff.

·       Approximately 10% of care jobs are paid under the minimum wage

·       In March 2017 suicide rates amongst social care staff were twice the national average – this was even before the pandemic.    

·       Public spending on adult social care is less than 1% of GDP in the UK 

 

The future of the care workforce is bleak and is aging.  The average age of a care worker is 47.  Young people rarely aspire to work in care.  Chronic low pay has led to high turnover and vacancy rates and every year nearly half of care workers leave their jobs.  In March 2021 Rishi Sunak described Social care as a “problem” at the same time the department of Health and Social Care at the same time was launching a recruitment campaign… who wants to work for an industry that the Government openly regards as a “problem”?.  Coming out of a pandemic, where care staff have been under enormous amounts of pressure watching ten of thousands die, who is going to want to work in “a problem”?

 

Care is not thought of as a highly skilled job.  From an academic point of view to work in care, grades don’t matter. Empathy, compassion, kindness, strength (emotional and physical), energy, flexibility, teamwork are essential.   There are very very very few people who I met in the last 30 years in my career (prior to working in social care) who I believe could do the job of a carer. 

 

The fall in beds across care and nursing homes is undoubtly due in part because of lack of staff, as rates are driven down, and the national wage increases it becomes increasingly tough to for small homes to remain open.  

 

So.. I did some research into the larger care home operators.  In Madeline’s Bunting book “Crisis in Care” she explains that The number of care homes are growing significantly with an annual revenue of £16.9 billion.  New homes are being built and overseas investors make up 80% of all new homes. The care home market is becoming dominated by large operators owned by private equity companies who are often loaded with large levels of debt which conceals the true costs.  It has been widely reported that a number of large home groups have  gone into administration over the last three years.    The biggest care home company, HC one with 349 homes has and estimated £500 million in borrowing.,  It is part of a Cayman Islands based group of companies.  

 

The financial times calculated in 2019 that the accounts for the four biggest care home companies running 900 homes between them with 55,000 residents had accumulated debt which required £40,000 per bed annually in interest charges alone.  Complex financial instruments underly these operations where property assets are separated from running costs and then used as collateral to borrow money…. The result is deeply unstable. 

 

In 2017 (before the pandemic) commercial analysts estimated that a third of the UK’s bed capacity in residential care was at risk of closing in the next five years.  The surviving care homes may then be tempted to push prices up.

 

In terms of our care home, this gives me sleepless nights.  We want to continue to offer care to those who need it, regardless of whether they are self-funders or LA funders.  But the reality is that in the last four years we have had to fight tooth and nail to get any increase.  This year we were awarded a 2% increase in fees, the last two years we had received no increase.  Whereas fees had increased for self funders on average 3% per year.    Although we have a stable workforce and in the last three years we have had two resignations, we find it increasingly difficult to attract new staff, despite paying competitively.  Regulations increase and infection protection controls mean that the small period style home are becoming impossible to operate within the current guidelines.  Our care home is a 400 year old building, with that come the inevitable maintenance issues.  It’s charm is that it is a home not a purpose built hotel style care setting.   I believe it is part of its appeal, but 

 

I do not believe that the social care system is fit for purpose.  Hight levels of care are unmet and there is a history of underfunding which has in turn driven down the wages and impacted the morale of care staff.  In the majority of care homes which provide care to local authority funded and self funders there are massive differences in fees and local authority fee increases don’t even cover the wage increase.  

 

So… what do I believe?

 

The majority of the general public currently accept that health is a fundamental human right which is state funded via taxation.  I believe care is the same, as a society we need to accept this and in this respect Government needs to be open, honest and brave in explaining this.  It is wholly unfair that the costs of care for someone living with cancer are met by the NHS but someone living with alzheimers has to fund their own care (apart from in very very extreme cases where continuing Health Care and therefore the NHS may fund the placement).  There needs to be a lifetime cap on care costs for those living with dementia.  

 

There needs to be transparency of funding to care homes, including transparency of financial structures behind care homes.  There needs to be a reform of how means testing is conducted at the individual level.

 

Care workers should be recognised for the vital role which they fulfil and need to be upskilled to make the industry more appealing.

 

Additional funding needs to be ringfenced for care, funding can not just be used to reduce pressure on the NHS.

 

It has taken me many months to attempt to get these thoughts on paper.  Social Care is clearly a massive issue for any Government.  But the discussions need to start, the public needs to be made aware of this ticking time bomb.  Every member of society has a need to understand the issue and take responsibility for, what I believe, is a social duty to fund this system which is on it’s knees.

 

The first step I believe is that a dialogue has to be begin between those at the grass routes of care and those who are able to shape policy.  At the start of the pandemic I had a zoom call with our local MP to explain the challenges we were experiencing…. I did not hear back from him.  I would have expected a call…..  A few months later another MP was canvassing, he wanted to know what worried me – I asked him what his party would do in relation to Social Care.  His answer “Integrate Social Care and Care Homes with the NHS”.  “What does that mean?” I asked…. He could not answer, it’s the elephant in the room that no-one wants to address…… he took my details and said he would love to talk to me in more detail……. I am still waiting. 

 

I am not suggesting that either of the MP’s I spoke to didn’t realise that a solution must be found but the continuous largely meaningless platitudes being trotted out by the Government is not addressing the grave problem.  I truly believe that unless the matter is addressed urgently there will be  needless human tragedy of biblical proportions.

 

 

 

 

A look back over the last 15 months

Over the last 8 months writing this blog has not been as frequent as I had planned.  It certainly was not due to the fact that I did not have much to write, I had too much to say!  However, I have always lived by the mantra that if a subject evokes an emotional response, it is best to draw breath and reflect before putting anything in writing.  In this respect I decided not to update this blog for longer periods that I had planned.

I live over an hour away from our care home.  The hour journey gives me time to reflect, wind down and very frequently cry.  Over the last 15 months my journey time has been filled with questions about what is the right thing to do to attempt to remain Covid free.  This has been overwhelming task, ultimately the decisions I took could have had catastrophic implications on the residents and staff.   Whereas guidelines were provided by the Department of Health / Public Health England and other Government bodies the actual decisions about how to interpret the guidelines rested on our shoulders, it was on my head if I got it wrong.

 

Our home is like a family of 43 - The 18 residents and 25 members of staff, as the pandemic continued we became even closer, we supported each other, we wiped away tears, we shared milestones. We had one aim which was to remain Covid free.   S and I would speak many times a day, not always agreeing initially, but making sure we had considered every decision in full.   We supported each other from what frequently felt overwhelming in the extreme.  I feel immensely proud that we achieved that aim to remain free of a covid outbreak.  

 

As restrictions lift I thought now would be an appropriate time to reflect on the lessons learnt (and why I think we may have been successful in keeping Covid out)

 

Hospital Discharges

All care homes were put in a moral dilemma..  Pressure was put on homes to take hospital discharges during the height of the pandemic.  I know I was not alone in wanting to do all I could to support the NHS, we felt we had a moral duty to help.  During the pandemic, due to Covid deaths, sadly many care homes had vacancies fill.  However taking any new residents had to be balanced with the need to do all we could to protect residents and staff.  Significant financial incentives were in place to encourage homes to take hospital discharges.  In my opinon, hospital discharges of Covid positive patients to care homes was a catastophic mistake.  Care Homes were not prepared, PPE was either not in place or inadequate and support was not available.  What makes this harder to digest is that the same thing happened again in February 2021, and yet again significant financial incentives were offered, even the promise of underwriting of insurances for care homes.  I did not take any hospital discharges during the pandemic as I did not believe I would be able to fulfil my promise to do everything in my power to keep residents safe, on reflection I believe that was the right thing to do.

 

PPE

We managed to source PPE early on in the pandemic.  PPE is now provided free of charge to all care homes.   Prior to that time I ensured we had plentiful PPE.   However, I do not believe that it is right that in a care home outbreak the PPE is not the same as hospital level.  I question why this has not been raised and why PPE within a care home experiencing an outbreak is significantly substandard compared to the gowns and facemasks within a hospital setting.  

 

Communication

We created an environment for our residents to have as much access to their family as possible.  The families of our residents have been involved with life in the home.  I have attempted to communicate with all residents, families and staff every step of the way.  Families have been provided with regular (weekly for the majority of the year) video montages of what is happening in the home.   On the other hand communication from the Government has sadly not always been as transparent, and at times communication felt even dishonest.  Announcements have been often made in the press regarding care home regulations (and frequently in relation to visiting) before guidelines are communicated to care homes.  We felt frequently on the “back foot” attempting to clarify (mis)reporting in the press.  Locking down to visitors earlier than the official guidelines was not a decision I took lightly, but one which I believe, with hindsight, lessened the possibility of an outbreak.    

 

Implementing Change Frequently

Visiting policies are reviewed with amended guidelines and change almost weekly, building a visitors pod, which then became a testing pod gave us the additional space we required to ensure visiting and testing could be performed safely.    Testing all staff three times a week has been critical, and it was due to this testing that we were able to identify a staff member with Covid who was asymptomatic and ensure we did not experience an outbreak, the staff member isolated immediately and no other staff or resident became covid positive. I also ensured that all staff received full wages if isolating to ensure that there was no negative financial implication to doing the right thing.  We have a constant dedicated staff, and have never used agency staff, it is down to this consistency of staff and their unwavering support of every change in internal process that also reduced the possibility of Covid entering.

 

Whilst life inside the home for the residents remained unchanged, apart from the lack of in person visits at the height of the pandemic. Life for all the staff changed significantly, PPE, changing clothes entirely at the start and end of every shift, testing multiple times a week and enhanced infection protection control measures.  It is down to the dedication and tenacity of every single staff member that we adhered to these requirements and were able to keep everyone safe.    

 

Visitors are back into the home and have been for a couple of months, whereas we were delighted to reunite loved ones, it has to be remembered that despite those living in care homes being the most vulnerable in society during the pandemic, visitors to care homes having close contact visits took place before carers could see their own families.  This is one of the many things I am so proud of our staff for, they supported the process to allow our residents to meet up with their families before they were legally allowed to see their own family members.

 

Looking back I think we made the right decisions, as a team we worked tirelessly to keep everyone safe. Through this pandemic I can hand on heart, say we have done everything in our power to keep our home a safe, loving, transparent and caring home.  

 

With all residents and staff vaccinated with visitors back in, albeit with testing and PPE, normality is gradually returning.  I hope it won’t be long before the home can be full of multi generational visitors hugging and holding hands.

 

 

Vaccinated and Fake News!

I am delighted to report that all residents and all staff were vaccinated this week.  Other than the one staff member who tested positive for Covid19 and remains asymptomatic, we have remained Covid free.

We are testing regularly and all is well and calm.  Today every resident had a manicure and we have been enjoying singing along to the Sound of Music.  I was able to sit and chat with every single resident today one on one, they are happy, content and as safe as we can possibly keep them all.

As I type this the ITV news is on in the background in one of the lounge areas in our care home. There is a “ special program “ about the challenges experienced by those living with dementia in care homes.  The headlines talk about how the pandemic has had a detrimental impact on residents with dementia due to the lack of visits from family and friends.  

Apparently ITV did an exclusive survey of over 100 care homes to ask whether the physical and mental health of residents had been Impacted, nine of ten said yes.  We were called, by ITV but asked a different question.

The ITV program will cover claims that the use of anti-psychotic drugs for those living with dementia has increased due the lack of family visits during the pandemic.  From our point of view not one of our residents has been put on an antipsychotic drug during the pandemic.  A professor is quoted saying that  ...”“drugging” has become one of the few tools left to treat serious lockdown anxiety and that the best treatments for agitation are human contact, good nursing care - reassurance, a hug”.  The implication is that care homes up and down the country are drugging residents because they are so unhappy and lonely in the pandemic. The implication is that in care homes residents only receive human contact , care, reassurance and a hug from their family members.  The reality could not be further from the truth, carers treat residents as their loved ones, their Own family members.  The pandemic has brought carer and resident even closer.

The program has not yet been on, but I anticipate that it is going to portray a story of life in care homes during the pandemic in a very unfavorable light.  

Life during the pandemic has been tough for everyone, but I don’t believe these claims are true.  I believe it is scaremongering and for the vast majority of care home residents living with dementia the love, care and affection shown by the tens of thousands of carers who have worked tirelessly throughout the pandemic can not be underestimated.

To imply that residents have not had human contact, reassurance and a hug during lockdown is simply incorrect.  It has been really hard on everyone not seeing their loved ones, whether they live in a care home with dementia or not.  

What makes a carers job so much harder in the pandemic is this sort of reporting.  Carers themselves have struggled with not seeing their own families, having the enormous burden of knowing that they are caring for the most vulnerable in society.  Knowing that they will really be on the frontline if there is an outbreak in their care home.  

To every carer who works tirelessly, demonstrating, love, empathy, patience, hard work and ultimate dedication... hold you head up high and be proud.   You are doing a great job.  Ignore the fake news!

The result we didn't want....

On Monday morning a member of staff tested positive when they were tested with the daily Lateral Flow Test.  They were immediately sent home with a confirmatory PCR Test, that subsequently confirmed the positive result.  

It was what we had feared for the last 10 months; our first positive test.  The staff member is asymptomatic and took no risks, she did everything right.  She feels dreadful, when she has done nothing wrong, but being a carer by nature means that her thoughts are of the residents and other staff.

We had planned for this, the next steps have been ingrained for months.  We were ready.  Enhanced Infection Protection Control protocols were implemented, residents were quarantined, in their rooms or in the public areas for those who would not understand the restrictions.  We started testing daily.    All residents were tested.  Alongside that we reassured residents and staff and communicated with families.  Health Protection team were notified.

It is now Friday, all of the test results are back, all of the residents are negative, but we remain in a quarantine situation.  All staff results have been negative.  But we are clear the risk remains, but there were no PPE breaches, so we are hoping that the one positive result was an isolated case.  

All week I have heard of care home after care home suffering outbreaks.  The situation is bleak across the care home community.  

On Wednesday I received the call I had been waiting for - vaccines should be coming at the weekend for residents and staff.  I did not tell the staff, I knew they desperately wanted the news, but I could not risk them being disappointed.  I was right to be cautious, I was then phoned yesterday afternoon after spending all day trying to speak to someone who could confirm we would indeed be vaccinated, to be told that actually we would not be vaccinated this weekend, but hopefully at the end of next week.

In recent months we have been lead to believe by the Government that Care Homes would be the at the forefront of the vaccine program.

In the last month we have seen exponential growth in the virus spreading through the community and we are now constantly hearing of more and more cases in the Care Home community, infact I currently do not know of any local care home which does not have an outbreak.  

There seems to be no consistency in the roll out of the vaccines across care homes, some care homes received vaccinations in December, we are still waiting.

I applaud everyone who receives a vaccine in these terrible times, but was under the impression they would receive their vaccine after the Care Home community.   

As each day passes we are bombarded of images of individuals in the community receiving vaccinations, but the care home roll out of vaccinations has been inconsistent and communication has been too generic regarding timelines.   This situation is a ticking time bomb and yet again I fear that care homes will be let down.   Only last night Boris Johnson announced, proudly, that 40% of care homes have been vaccinated with 45% of over 80's.  I was surprised that this was not higher.

Earlier today I received a letter from our Council and NHS Trust requesting urgently placements for hospital discharges at hugely inflated rates (more than £300 per week than we currently charge a week).  It feels rather like March again, when covid positive discharges were made to care homes.  

This time we totally appreciate the immense pressure that the NHS are under and will do all we can to support the NHS, but it is clear we can not assist in anyway until we have clear direction on when vaccinations for all staff and residents will be in place as promised.    

Sadly I fear that some homes may not have the luxury of being able to turn down these placements, they have wages to pay, businesses to keep a float.    

I made a commitment to all staff, residents and their families I will do all I can to keep them safe.  This I will continue to do.    I do not know what the solution is to discharging people from hospital, but I do not believe that care homes should have pressure put on them to take unsafe discharges.

In the meantime, we will keep our residents safe, happy and loved.  A few days ago I was with a resident in her bedroom, I asked her if she was bored and struggling with being in her room "To be honest she replied, its rather nice to be not quite sooo busy, I'm perfectly content"

Testing, Testing and more testing

 Our residents had a wonderful Christmas.  We would have loved the home to be full of visitors but sadly that was not to be.

On 22nd December I received a call to put all staff on standby for vaccinations to take place on either 23rd or 24th December.  Sadly these did not transpire, but with the news about the Oxford vaccine I am hopeful that our residents and staff will be first in line from next week.

However, we did get a Christmas message from the Department of Health to advise that Lateral Flow Tests should be performed on all staff twice a week in addition to the weekly PCR tests.  This email was received late on 23rd December.  

This is an enormous logistical challenge, but of course we support anything that can be done to minimise the risk of an outbreak coming into the home.  Testing is key to this,  however, the administration that is required alongside this in terms of recording results has not been thought out.  To explain I have made this video.  

Yesterday the Department of Health announced that for two weeks care homes do not have to log in all results - only positive results, but in less than two weeks we are expected to log in all Lateral Flow Tests, for all staff (twice a week) and all visitors.

This video explains the challenges we face...

Lateral Flow Tests ....

What will Christmas be like in Care Homes?

I've talked to Times Radio a few times over the last six months.  This is an interview on December 18th.

From 1hr 41mins

Happy Christmas to everyone. x 

Times Radio Interview

So much to say....

 

It has been a while since I have updated this blog, I have been trying to work out what to write, where to start, what to share.  

Everyone is safe, we have remained Covid free.  Our home is full of laughter, fun, dancing, singing, and pets.  What has been a great success since September is our three times a week zoom calls with a handful of teenagers who are volunteering to speak with our residents and it shows how great it is for young and old to connect with each other.  Some lovely relationships have been built and the residents really look forward to the calls (and so do the teenagers too).  They have also sent some of the most beautiful letters and delicious cakes, which we have all enjoyed reading and eating.  On the quiz front, so far, our residents are winning in the general knowledge stakes, however, the teenagers seem to have the edge on the maths based questions.  Our home is full of Christmas cheers, with fairy lights twinkling everywhere.

Behind the scenes, the analogy of a duck could not be more apt.  On the surface I am definitely not serene like a swan, more busy like a duck, but beneath the surface I am paddling as if my life depends on it... and it really could be life and death for our residents.  But this time I have pond weed pulling me down.  I know that I speak for thousands of people like me working in a care home.

I have written in the past about communication and this continues to be imperative.  No decision that I take is black and white, there is no right or wrong answer, decisions have to be balanced, often taking into account the balance between physical health and mental health.  The balance between trying to avoid Covid-19 at all costs but ensuring our residents are happy and visits from loved ones are possible.

Almost a year ago to the day was our 2019 Christmas Party, then our home was full of visitors, all ages, the home was full of laughter, singing, and the corridors were bursting at the seams.  I long for that to happen again.

We have built a conservatory in the last few months so we now have a visiting pod to enable safe visits to take place.  We then had to put in floor to ceiling doors to segregate the areas.  Next week we being lateral flow testing, quick acting tests for all visitors.  Consent forms for the vaccinations are in place.  It all sounds so positive, and it really is, I have high hopes for 2021.

However, behind every good bit of news, every step forward, the pond weed continues to pulls us down.  Earlier in the summer staff testing was announced, aside from the initial massive delays in getting results, behind the scenes we have to enter every single staff members details every single time we test - name, dob, ethnicity, role, where they work, where they live, mobile number, address.  Every single time.  Upload functionality doesn't work.  We test staff on two different days each week.   This takes in excess of three hours every week, time not spent with the residents or staff.

The Government announced that "visiting is permitted" not explaining that every care home had been sent pages and pages and pages of guidelines to allow safe visiting, things like, one way systems in care homes, separate entrances for visitors, windows open at all times (in winter I know!) (!), again the paperwork is enormous, again it took hours to justify why certain things could not be done - windows open when someone is in their 90's is not possible.  One way systems in a care home for those living with dementia is not feasible etc etc.  

Lateral Flow Testing is being rolled out from next week, this is hailed as an additional defence against an outbreak, I have spent in excess of 12 hours working out the process.  The guidance notes are more than 60 pages long.  Tests have to be "logged online" by the visitor "using an iPhone" - clearly not everyone has an iPhone, and there is no mobile reception where our home is located.  This has not been considered in the guidance.  What is not announced is that the Lateral Flow Tests identify less than 50% of positive cases compared to the PCR tests (this is shared in the Department of Health webinars).  We will of course continue to do everything we can to ensure the safety of our residents but the administration around these tests is enormous.

Vaccinations are clearly going to be the game changer.  Care Home residents and staff are first in line.  We have not received any details about when.  I totally appreciate the massive issues in working out how the vaccinations will be delivered, but some honest communication would be appreciated, and also before the fanfare message is delivered to the general public, some of the underlying processes have been considered. 

I have written before about communication and I continue to be hugely grateful for the support I receive from our residents families.  I have been honest every step of the way, I have admitted I do not have the answers, I am trying my absolute best, I will continue to over communicate with our families and admit that processes are changing daily, sometimes hourly, based on changes to official guidelines.

Infection Control Fund payments have been made to support care homes to enable safe visiting / cohorting of residents, and whilst this is hugely appreciated, we need honesty and we need our opinions to be sought before announcements are made and before unworkable guidance is rolled out.

So the pond weed continues.  This week I am away from the home, S and I decided that I would use this week away to focus on our processes, our controls, filling in the mountain of paperwork that is now required.   I feel like my arm has been removed not being to be with the residents, but I know that the amazing staff are doing everything possible to keep all the residents happy, content and ready for Christmas.

So, apologies for the delay in writing this blog entry.  I will keep on paddling hard and getting through the pond weed..... and then I will go and finish wrapping 18 stockings with individual presents for our residents.

We are committed to ensuring that our residents will have the best Christmas possible.