Friday, April 24, 2020

Part of the Community

We have always felt like part of the community, but during lockdown many of the community based activities have had to stop; weekly school children visiting, monthly coffee mornings, hymns and prayers, holy communion, trips to the coffee shop.  Sadly they have had to stop to ensure the safety of our residents and staff.

But in the last few weeks we have been so grateful for the wonderful messages, and gifts.  Co-op have sent pastries and Costa sent drinks for the staff, laundry bags have been made for staff.  We received extra visors donated by a local company.  Children have written to residents or sent pictures.  And we have been visited by a fancy dress bumble bee, T-Rex and a cowboy.  But last night was something else...   The photo is what appeared outside yesterday afternoon.   And then our wonderful local neighbours gave us a round of applause at 8pm, a video was sent to me which I forwarded to all staff.  The boost to morale, and the overwhelming gratitude from the staff was enormous.  Whoever was behind this, thank you.

The residents have had a busy and happy week.  Although there are some necessary routines we always strive to allow the residents to make as many decisions as possible, it is their home more than the staff’s workplace.  In this respect the menu last week was chosen by a group of the residents... prawns and black pudding featured heavily (not in the same meal),  Zoom Bingo went well, Pe learnt some new rhymes, Pa’s hair has grown so she has been wearing her hair in a bun, earlier this week she was sat quietly plaiting her own hair “ready for school” she said to me, she was very animated and it was lovely to see her reliving a happy memory.

Like anyone with a garden, we have been enjoying the glorious weather and all residents have spent time in the garden.  We now have a knitting group too, I am looking forward to see how far they have got with their knitting of squares for the blanket that the group of residents are making.

We continue to train and communicate procedural changes to the team, particularly in relation  to Covid 19 and the ever changing PHE and NHS guidelines.  All staff have their temperature checked as soon as they enter the building and all staff change into work clothes as soon as they arrive at work, and change before leaving.  The issue of facemasks continues to evolve.   Currently any staff are able to wear face masks at any time if they wish, but this is not mandatory.  If we have any symptomatic residents, full PPE will be used, which will include facemasks.   The guidance from PHE for non symptomatic residents in a care home is unclear.  I have risk assessed the need for face masks and at the current time I feel that staff wearing facemasks at all times would have a significantly detrimental effect on the wellbeing of most, if not all, residents.   For those residents with hearing loss they will struggle to understand, those residents with moderate to advanced dementia are unlikely to understand the reason for the masks and may well be frightened (and living with dementia this fear may be felt every time they see a masked face).  
At the moment we are able to keep our residents calm and content, of course they miss their loved ones, but other than that, things are normal.   If we were to wear masks at all times now, I also have to factor in the very real risk of not being able to get the numbers of additional masks we would require if we were to have an outbreak and had been using masks for a number of weeks  or even months.

Sadly the risk from Covid 19 is likely to remain for some time, my plans have to take into account the long term health of our residents and staff, and that always includes their wellbeing and mental health as well as physical health.


Saturday, April 18, 2020

Robots???

This morning I watched BBC "Click" which had an article about "Assistive Technology" in care homes, particularly in relation to the current crisis.

The clip was about the use of small robots (think a cross between R2D2 and K9) which rolled around a care home with a screen that could talk to residents.  Assistive Technology is recently something which we are asked about by our regulators (Care Quality Commission) a few months ago I had to answer a question about our use of Assistive Technology.  There are some things that have helped no end;  We now have movement mats which plug into the call bell system which can alert us if someone who is unsteady on their feet, gets up at night.  We have pressure sensors in some residents beds.  All care records are recorded in realtime and accessed by all staff (with alerts and incident reports automatically sent to myself and S 24/7).

Assistive Technology has helped no end in recent weeks bringing you all closer to your loved ones.  FaceTime, Whats app videos, Zoom - quizzes, exercise classes, singing.  And we often call on Alexa to help with a crossword clue, or answer a question.

But Robots??  Human interaction can not be replaced by a robot, ever.  Earlier this week I was watching the staff, it was a calm day and carers were sitting quietly just chatting one to one with each resident.  I know how many of you are missing your loved ones, we are keeping them busy, we are keeping everyone entertained, and we doing everything we can to keep you connected.  But rest assured that all our residents have one on one quality time with the staff throughout the day, not scheduled, not planned, just chatting calmly and quietly.

In other news, in the last 48 hours we have had over 100 pages of further guidelines and policy papers following Matt Hancock's update a few days ago.  To be honest there are few changes, we continue to have enough PPE, we are prepared for any outbreak.  I review every single policy document and communicate constantly to the team.    The update a few days ago had two specific updates in relation to care homes.  Firstly that residents should be able to say goodbye's to their loved ones if the situation arose and secondly that residents and social care workers should be able to get tested if they have Covid 19 symptoms.

Within the 150 pages there was no guidance specific to visitor access in terms of end of life care.  Testing for residents would take place and we believe swabs would be taken at the home, and testing for staff........  Yes, that is available.  Lime Tree Court staff, if showing symptoms can get tested at our nearest testing centre.  Our nearest testing centre?  that is Ikea in Wembley.....


Wednesday, April 15, 2020

Matt Hancock’s new guidelines

For the last couple of hours I have been reeling from Matt Hancock’s announcement that “ Close Family should be allowed to say their final Goodbye’s”

End of Life care is the hardest part of our job, but one that all carers take with the upmost respect.  We have experienced the terribly sad situation when a resident has died without their loved one with them.  For this to happen is terribly upsetting for everyone involved.

This evening Matt Hancock has said close family members are able to see dying relatives “wherever possible”.  We have not yet seen the guidelines.

When a resident is provided with end of life care, and we follow end of life protocols end of life may come in a few hours, 8 hours, 72 hours or weeks.  What does Mr Hancock actually mean when he speaks about “dying”?
So where does this leave us?
Can I allow one family member in, two, three?
For just one visit?
What about the risks to other residents?
Who will provide the PPE (and most visitors are unlikely to be trained in donning and doffing PPE)  How long should visitors stay?
What about the other residents who see a visitor (the first visitor in over a month) and ask why their loved one can’t visit?

This is a terribly difficult subject, and what feels like a knee jerk reaction is not helpful.  As soon as the announcement was made staff were contacting me, nervous about the risk to residents and to them if we have visitors, for whatever reason.

We are currently Covid19 free and all our residents are healthy, happy and well.

I have given you and my staff my word that I will do all I can to keep ALL residents and staff safe,

I will be in touch again when we have more clarity.

Tuesday, April 14, 2020

Easter Weekend - it was a busy one

I sat watching the news last night, and the current statistics are that more than 13% of care homes in the UK have a Covid19 outbreak (which is defined as two or more residents with confirmed cases).

I am pleased to say that everyone at LTC is well and we have no suspected cases.   We continue to follow stringent infection control processes and have PPE.  All staff, and any critical visitors (eg. district nurses) have their temperature checked at the start of every shift.

In terms of the last four days, we have kept everyone busy.  The glorious sunshine helped no end and many residents enjoyed the garden.  We were all excited to report that we have blue tits nesting in the bird box at the end of the garden.

We have had Zoom calls with families - Name that Tune and an Easter Quiz (sadly the residents lost 23-21 to the families, but we will look forward to another competition soon)...

Many of you face-timed and sent video messages which of course the residents loved.  On Easter Sunday we had an easter treasure hunt.  Every resident had a personalised clue which took them to another location to the next clue.  It was lovely to see some of the residents reading out the clues to other residents and then helping each other search out a clue.

The final clue at 4pm read "Part 1 - Your Dad's Dad (Formal), Part 2 - I have a face but no eyes, and arms but no hands".  The stash of Easter eggs were discovered at 4pm.  The residents are still enjoying the chocolate....


Friday, April 10, 2020

Feeling like a duck


Today's blog is going to be a story of two halves.  I feel rather duck like at the moment.  For the residents we are having a lovely time, everyone is busy, the sun is shining and we have lots of plans for Easter.  Under the surface I am paddling away furiously, and will continue to do so.

S and I speak often throughout the day, regardless of whether we are actually at LTC.  In the last few weeks we probably speak or message each other 20/30 times a day.  This morning our messages started at 5.45am, planning Easter activities, discussing residents and planning PPE.   The responsibility of looking after 20 residents and 22 staff members literally keeps me awake at night, but I am following all the guidance we are provided with.  I know that thousands of care home owners and managers are doing exactly the same thing.

The last few days have been busy for the residents.  S&S have done an amazing job cutting and styling hair.  I have promised J I will colour her hair when we get hold of some hair dye.  On Tuesday some of the residents felt a little down in the dumps (we are encouraging all residents not to watch the news more than once a day) so we came up with a plan, a glass of champagne**, well, it was Tuesday, so that was as good an excuse as any.  R shouted out "Let's have a toast to LTC, the best place in the world".  Which brought a tear to my eye.  L had a birthday on Wednesday, J had baked a wonderful cake with her name on and all the carers sang Happy Birthday and made a real fuss of her.  I was not there, but getting the video and being able to forward it to family members was a privilege.  Another staff member sent me a video of the lambs in the field behind her house so that I can show the residents.  Like me, I know the staff have the residents continually on their mind.  Easter weekend is nearly upon us and we have planned Zoom activities with family members - exercise classes, Name that Tune and Easter Quiz. It will be wonderful to have family members with us on the screens as they can't be with us in person. We also have a treasure hunt planned with clues for every resident.  Yesterday we had chair based exercises, and almost all of the residents joined in, many also spent a few hours in the garden, enjoying milkshakes and cups of tea (we also thought that was an unusual combination, but they requested it...).

And below the surface, this is what is going on without the residents being aware.  We have had two staff meetings which all staff have attended (that is more tricky than it sounds with 24 hour shift patterns).  All PPE and infection control guidelines have been checked and donning and doffing PPE has been discussed in detail.  Staff have their temperatures checked at the start of every shift.  I have been on numerous calls with PHE and County advisory bodies and NHS staff.  I am regularly in contact with other care homes as this situation develops (and sadly many homes now have Covid 19 within their homes).  S and I have managed to source more items that are so hard to get hold of - thermometer probe covers was the challenge yesterday.  My daughter has even been helping me by tracking down 11R face masks.  If we need to move into the quarantine phase, S and I will speak to those residents who are able to understand the procedure if we do have more than one suspected case of Covid19.  All residents will be quarantined to their rooms for 14 days, all staff will wear PPE.  We will have these conversations calmly and try not to worry the residents, but I feel that they need to be prepared.  I worry about the impact on the mental wellbeing of residents seeing us with visors and facemarks, and of course this will be an issue for those residents who are unable to hear so well.

What worries me most - is that they won't be able to see us smile, they won't be able to feel our skin when we hold their hand or give them a hug.  But, I promise I will do everything I possibly can to keep everyone safe.

In the meantime, I will keep busy, keep smiling, keep all the residents smiling, and paddle like mad beneath the surface.


**. It wasn't actually champagne, but prosseco, I have promised we will have some of the real stuff when we get through this tricky time...




Monday, April 6, 2020

Guidance and Preparation

Saturday was a glorious day at LTC.  The sun shone all weekend and many of the residents made the most of the garden.

Our residents have been loving all the FaceTime and phone calls.

However, over the weekend new guidance in relation to Covid19 has been bombarding us, Public Health England, NHS, 111, Bucks Council, all were updating us.  Process changes have not always been communicated clearly but I am confident and I am up to date with ever changing guidance.

We also learnt that Covid 19 has hit many local care homes and with that news, new guidance came out regarding End of Life care.   Care at end of life is something which is not always talked about, but I can guarantee at all times the individual is treated with care, love, dignity and compassion.  They are never alone and have all the support they need.

We have to prepare for the worst even though we hope for the best and do everything in our power to keep our residents safe and well.  End of Life care plans are not something that can be done via email, ideally they are discussed in person, but the restrictions of every day life meant that these conversations with the new guidance had to take place via phone today.

I have spoken to almost all of our residents families, and to be honest after 12 of these conversations I am emotionally drained, as I am sure many of you are.  But I am happy that I have spoken to almost everyone (if I haven't called you rest assured I will tomorrow)

But, prepared we must be.  I hope that we will not need to use them but I felt I was not doing my job without having these conversations.

Tomorrow I am back at LTC, I promise an update about residents later this week, but rest assured behind the scenes we are doing everything we can to ensure that your loved ones are safe and well.


Friday, April 3, 2020

What I hope ....


When I tell people I own a care home, one of the first thing people often ask is "Is it difficult to find good staff?"

At this point I wax lyrical about the amazing team of carers and staff that work alongside me. I talk about my relationship with S and the rest of the staff, the fact that staff are often messaging me to ask about a particular resident, how they will send suggestions about things we can do with residents.  I am aware that in the last two years I have changed a lot and asked masses from the team (just ask them what the response was when I said we were going to move to online care notes...), if I am not there I am on the phone constantly and I notice when I say "I've had an idea" the staff raise their eyebrows, wondering what I am about suggest....

I tell people about the staff; how we are like a family (and often are infact family as there are quite a few mother and daughter combinations who work together) and how the team support each other and I know that they think about work constantly.  Once you are part of our family you never leave, infact we currently have a resident who was a podiatrist for the home decades ago and we had another resident who used to be a cook at LTC.

One of the senior team told me a story (pre lockdown!). She said that she was at the pub with friends, all of whom did different jobs in different industries.  She told them that she "reckoned" she could have "a good go" at any of their jobs.  She reckoned she may last a week, two weeks, three weeks or more, but that she would try their jobs.  She told them she didn't think any of them would last more than 5 minutes in her job... and I suspect that is true, I think very few people could actually do a care job.

Working in care is not a highly paid job, you are paid hourly (so the fact that staff members are contacting me when they are not working just proves how they love their job). Not all the jobs that a carer does are pleasant, it is physically, mentally and emotionally demanding, and at times it can be frustrating and feel thankless.  In recent years you hear lots of horror stories about what goes on in care homes, but the moments of magic (of which there are many) so infrequently get coverage.  
You are born a carer, and it takes a special type of person to work in care, particularly caring for those living with dementia.    

In the current climate, those working in care, like other healthcare workers, we are about to face our biggest challenge ever and yet they are keeping smiling, keeping on working, putting aside their own emotions for the sake of caring about others.

It is lovely to see the clapping which took place last night and the Thursday before, but what do I really hope?  When this is all over, I hope that social care reform really does take place.  I hope that the care industry can get the funding it so desperately needs and that carers can be properly rewarded for the incredible job that they do, day in, day out. 365 days a year, 24 hours a day.

To all the carers, thank you.  You are incredible.

Wednesday, April 1, 2020

Zoom... it worked!


This week has been all about “Zoom”.  In the last 48 hours I have had a crash course in how to use video conferencing.  After Mother’s Day I saw how much joy our residents got from seeing their family members on the big screen, and was determined to build on that.  Our residents may not be able to see their loved ones in person but I am committed to ensuring we find as many possible ways for our residents to see their family members - even if that is on a screen.

This week I decided to give “Zoom” a go.  With a handy cable which connects an Ipad to the TV I was able to project the iPad screen on the large TV.

Thank you to all of you, most of you I know were new to Zoom.  Yesterday the residents enjoyed a chair based exercise class which was joined by two family members.  

Today everyone enjoyed a nursery rhyme competition, a couple of jokes and a good old sing song, made so much more enjoyable by having nine different sets of people joining in, and all our residents being able to see their loved ones’ faces on the screens.

The sessions were such a success we will be doing them every week from now on.  More details will be sent separately.

As I left Lime Tree court today two huge bunches of flowers were delivered.  We have one resident in particular who LOVES arranging flowers, so tomorrow the home will look glorious, and that is in addition to the vegetable seeds that were being planted by L with some of the residents.

With love from everyone at Lime Tree Court.



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