Friday, May 29, 2020

Track and Trace, Testing and NHS. Support

Just a quick update.  BBC News is on, it is all about care homes.  Here is my perspective in relation to the three items on everyone’s lips, but in relation to our care home;

1.  Track and Trace  - this has HUGE impacts for us.  Currently, if a staff member becomes symptomatic they self isolate, and are tested.  With track and trace, ALL staff who have worked with that person would need to sel-isolate, and presumably residents would go into quarantine?  That is hugely problematic with a small workforce, and would essentially mean we would not have enough staff for the business.  Many other Care Homes are in the same position, we have been asking these questions for a few days, I keep getting the same answers “Oh, that is a good question”.  I presume that my risk assessments, because we wear PPE at all times, mean we would not all have to self isolate with no symptoms - remember all staff and residents have temperature checks daily.  This is yet another example of policy being put in place with no understanding of care homes.

2.  Testing - we have tests for staff and residents, but again, no thought about those with dementia.  To test the majority of our residents will be very difficult and very distressing and will require some form of restraint.  Of course, if we have a symptomatic resident they and all residents will be tested but testing only works at one point in time, to test with no symptomatic residents or staff, and have to put residents through a very distressing process is not clear cut - again, guidelines talk about a rolling programme of testing in care homes, with no understanding or thought about the impact of those living with dementia.

3. NHS / Medical support - the BBC have run a distressing news item about a care home that did not receive the medical support it required.  We have GP FaceTime calls, the district nursing team visit when required.  We have received paramedics visits and we have had two residents admitted to hospital during the Covid pandemic - not for Covid related issues.  Both were tested on admission (negative) and in theory were tested on discharge (although we were unable to get that in writing on both occasions).  Both residents were quarantined and strict infection control protocols were followed for 14 days.  Both residents are now out of quarantine and healthy and well.

Hope that may help - it’s from the horses mouth so to speak!

Tomorrow I am putting up new PPE dispensers on the walls - power drill is charged and screws purchased.  Wish me luck....

Wednesday, May 27, 2020

Our Garden...

The garden has always been a tranquil, calm oasis.  But this spring it has become even more important to our residents and staff.

Like all gardens in the UK, right now, it is at it's peak.  Nearly all the residents have been in the garden most days.  Some of the residents have helped the carers and our amazing T, who is in charge of the garden.   T is also S's Dad - you see our home really is a family affair!  One resident in particular waits for T to arrive and rushes outside to be his assistant (at 91 years old she is incredibly sprightly).  Another resident enjoys sitting with an iPad watching messages from his family.  We even had a visit of peking bantam chicks this week in the garden which all the residents loved - families you will see the pictures later this week.

We have chosen the plants, the bronze ducks on the lawn, the metal owl on the post.  T has put in place some incredible hanging baskets and the memorial bed with the rare Sorbus is surrounded by colour.  We even have a rare "Rockhampton Red" - Carpinus Betulus (which is a special tree for me as it was discovered over 20 years ago by my Father
).  We think we have Blue Tits nesting in the bird box too.

L has been plating seedlings and starting a veg patch with the residents, and earlier this week I built another set of tables and chairs, with the residents directing me and holding the tools.

Last July we had our summer party.  Families and friends filled the garden, we decorated pebbles, we sang around the piano when the son of one resident played for us, children rang amongst the residents and played with garden games.  It was a day filled with happiness and love.

This summer, I would dearly love for residents to be able to sit with their visitors in the garden.  Realistically the likelihood of family visitors within the home is low, but visits outside in the garden, socially distanced may be something we can consider later this summer.

It is not an easy decision to take.  I know that many families are desperate to see their loved ones, and what better place than in the garden.  But this is a decision that could impact all of our residents, and one that weighs heavily on me.

For the next three weeks I want to wait to see whether there is a second peak.  I need to consider the impact on every single resident individually.  Although family members are desperate to see their loved ones, the impact on the resident may actually be more unsettling.  Some residents may not be able to understand the rules of social distancing, and are likely to want to hold hands, to touch, to hug.

 PPE will need to be worn, temperatures need to be taken and any decision I take impacts all the residents and so I will consult with all the families, Public Health England, and our other advisors.

I can not write now what I will decide, I can not predict the future, but know that I speak for all the residents when I say we would love more than anything to have you with us enjoying the garden, but for now we will just dream of you and send you all our love.

Friday, May 15, 2020

A busy week

The last week has been a busy one,  for VE Day the home was decked with flags and bunting.  It was a day of reflection, singing, memories being shared, Zoom calls, and a very special afternoon tea.

The weekend was calm and relaxed.  In the last 48 hours we have all chosen our favourite songs for our "Desert Island Discs" playlist.  The residents have shared their memories with each other, and I will share these will our residents families.  

I continue to lead chair based exercises and I have been so impressed with the improvements in strength of many of the residents.   We used exercise bands yesterday and even did some quite energetic standing exercises.  The garden continues to bring so much joy.  Our residents have even expanded their knowledge of technology today, we created our first tiktok dance, I think I was the least co-ordinated.    A local farmer dropped of asparagus which had been picked a few hours earlier, we will be enjoying that tomorrow.  Today on "Zoom" our residents joined in my daughters singing lesson, thank you to the singing teacher for making it possible.

Whilst all this has been going on Care homes and the impact of Covid 19 has continued to make news headlines.   The headlines make distressing reading, for everyone working in social care, and all the residents who insist on watching the news and reading their newspapers (and oh how I wish I could ban the Daily Mail entirely....).  All I want to say is that much of the information contained in the news is incorrect, government briefings are misleading the public in terms of support that is available.

So far we have remained Covid free.  I believe that is because of a number of factors;  We "locked down" to all visitors earlier than advised.  We have a relatively small, local and stable workforce and we never use agency staff.  I sourced PPE early and have ensured that I have enough to cope with ongoing demands, we are on top of all infection control processes.  In addition to this, over six weeks ago I asked to admit new residents from hospital who would not have been tested, despite significant premiums in terms of rates this was something that I did not do as I had committed to residents. their families and staff that I would do everything in my power to ensure their safety.

I am very clear that the risk remains of Covid 19 infection and I continue to do everything in my power to avoid the possibility of it entering the home.

Thursday, May 7, 2020

A week is a long time

There is a lot of talk at the moment about resilience, and there is no better proof of this than how we have all adapted to life in PPE, and facemasks in particular.

I can not lie and say that it has not had a negative impact on some residents lives, but in a week residents (and staff) have got used to them.  The sad fact remains though that for some of our most vulnerable residents, by wearing facemasks our ability to communicate, calm and reassure has been reduced.  But, I remain committed to ensuring their safety and the safety of our staff.

Perhaps the weather improving has also helped, but in the last seven days smiles have returned on the faces of residents.  The garden is being loved by all, and earlier in the week two of our male residents had the most in-depth chat about how old they both were (they were both out by about 20 years) and how they used to like paddling in a stream.  Both of these residents don't normally have long conversations with each other, perhaps it was because we were wearing masks and one in particular struggles to hear through our masks, but it was a special moment to see new friendships being forged - resilience.  Two residents in particular are making massive improvements in their strength and we even did some ballet based bar moves a few days ago.

Tomorrow is VE Day and we have bunting ready and lots of fun activities planned, including a zoom call with families.

In the meantime to give you some behind the scenes challenges....  The nasal strips on the facemasks we use have been breaking down and the fibres go up our noses and in our mouths.  The facemasks have been purchased from the government recommended suppliers.  We received 300 from the National Supply Disruption Service and I purchased almost 2000 more.  At the weekend I noticed that every single box has a sticker over the best before date - now 2021, underneath it is 2016.  Over the weekend I made many calls, sent many emails.  A senior Doctor called me from the Bucks Protection Health team, he advised that as the masks were intended for short term single use (which PHE are telling all providers to use them for a full session as there is not enough stock in the system) this is why in part the masks are failing, but he encouraged me to raise this issue.  As an aside he advised that the county has just received 600,000 masks that all need to be returned as they are not fit for purpose.  

I then spoke to the National Supply Disruption Line they told me that they were just a supplier and I had to call CPC but they had no telephone number for them or email address and could not tell me how to contact CPC.  I then spoke to Countrywide Healthcare who provided the masks I purchased, they were helpful but told me the Department of Health and told me that they had re-certified the masks and I had to contact them.  I can not get hold of anyone from Department of Health, and the HSE I have emailed but have had no reply.

I contacted Deprivation of Liberty team and Safeguarding team about the long term implications of use of facemasks on residents mental health, but to stress, I remain committed to following PHE advice.  They both advise that in relation to facemasks PHE advice overrides any other legislation, t

In terms of future supply, I am continuing to try to source more APPROVED 11R masks which is proving challenging.  We probably get 30 emails a day trying to sell us PPE, most of the masks are not approved, the latest I received 10 minutes ago - one 11R mask is now £2.28 each, before the pandemic they were less than 20p.

If you have read to the end of this well done!  I am back to the home later this afternoon and evening.  I will be smiling (behind my mask).

Friday, May 1, 2020

Testing Times


The start of this week was glorious, in more ways than just the weather.  Residents and staff were used to a new normal, laughter and sunshine were abundant.  The weekend was relaxed yet busy.  One resident was busy gardening, some others were drawing (we love "Draw with Rob" on you tube), face times, and general quiet one on one chats between residents and staff.

Sadly behind the scenes things were about to change...  Guidance from PHE, NHS, Gov.co.uk, CQC is constant, if I take my eye off the ball for one day I have literally pages of guidance to read.   The guidance is being rewritten daily and there are no "version" numbers, and previous versions are deleted (read into that what you will).  Over the weekend I had a number of conversations with PHE about facemasks, PHE agreed the guidelines were inconsistent but advised in the near futures facemasks would need to be worn at all times to ensure the safety of our residents from Covid19 transmission from staff who may be asymptomatic.  On Monday, that guidance changed, previous versions of the guidance were deleted and PHE are now saying that the guidance has always been to wear facemasks.  

I want to make it very clear I understand that need for facemasks and keeping our residents safe is paramount, however when I questioned PHE about the impact for those living with dementia, they acknowledged that this has not been considered.

Our home is run like a family, the staff and residents feel like my family.  For someone living with dementia life in general is frightening, but we know the residents inside and out and we know how to reassure, and calm.  Many residents have significant sensory issues including lack of hearing.  On Tuesday afternoon their new normal changed again when we moved to wearing facemasks at all times.  I anticipated that this would unsettle residents, sadly I was right.  Wednesday was spent trying to reassure both staff and residents about how we would manage this new normal, with residents not being able to see our faces.  In addition to my concerns about resident wellbeing, that the rate we are going through masks mean we will have to ensure we can replenish supples...  It was a really tough day.  I cried on they way home.

Yesterday I was at my home.  I spent a long time on the phone to both Safeguarding and the DoLs (Deprivation of Liberty) teams raising concerns about how residents mental well-being has not been considered.  I am definitely not saying that we should stop wearing facemasks, but yet again this most vulnerable population are having their own wishes ignored and they are being dictated to.  We need to ensure that their whole health is considered, physical and mental.  I have also spoken to two companies who may be able to help with the production of clear facemaks (not visors, we already have them) where residents will be able to see our smiles, I have told them what we would love... you never know, I may have a future in product design.

Today is the first of the month, so it is day to run payroll.   I am back at the home tomorrow.  I have lots of ideas for activities that can be done despite facemasks, I will be back to smiling.  We are resilient, our residents are resilient we will get the laughter and sunshine back.

PS.
Forgot to talk about Testing......  This would have been the answer and could have avoided the need for facemasks if all staff and residents could be tested regularly.  
But great news was announced that all staff can get tested even if they are asymptomatic.  That is absolutely NOT the case, I also had calls with the testing teams finding out how we can arrange tests for staff and residents.  I was told "What the Government says and what is possible are not the same thing, the infrastructure is not available yet".    







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