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.
