- The restrictions in care homes are now more dangerous than the virus itself
- Life needs to now return to normal, and Covid should be treated as a disease along the same lines as flu.
- The government needs to listen to the care home community – how care homes interact with government officials needs to be streamlined to drive efficiency and not bureaucracy.
- People with and without dementia need to be treated differently and can’t be bucketed into one care home community,
I have now seen first hand the devastating impact on residents wellbeing from being isolated in their bedrooms. Testing, isolation, visiting restrictions, definitions of “outbreaks” within care homes. I spend hours and hours each week writing policies, guidelines, filling in forms for the Department of Health, answering questions from Local Authorities. All the time doing this I could spend with my residents, supporting staff, speaking to families. I don’t feel supported by the Government, I feel let down.
The vast majority of Care Home Owners and Managers want to support and encourage visiting, we want life to return to normal for our residents. In the last few weeks restrictions have lifted for the general population, but for care homes we are under inconsistent stringent rules;
1. Just two positive covid cases warrant an outbreak, and as such this means that we have to close to all but just one visitor per resident. Homes also have to isolate vulnerable residents to their rooms, and due to the risk of this homes are unable to take new admissions, including hospital discharges.
2. We know testing is far from infalible, but if it is required, then the costs of tests should not be paid by visitors.
3. NHS frontline staff (including A&E and district nurses) are required to test twice a week, all social care staff are required to test before every shift – why the inconsistencies? It has to be remembered that all social care staff from 11 November 2020 legally had to be double vaccinated. This was proposed for NHS staff but as we all know, this was then postponed in April due to concerns about loss of staff. All those who worked in Social Care shared the same concern, but our concerns were not listened to....until a sudden U- turn last week (too late, tens of thousands of care staff had already left).
4. The Department of Health / Health Protection Agency needs to consult with care home owners, and it needs to listen. There is a woeful lack of understanding about the needs of residents within care homes and the catastrophic impacts of the current guidelines that are in place.
My experience of an outbreak came a little over six weeks ago when Covid entered our home I have to admit that after two years of remaining outbreak free, I felt proud. I knew that we were doing all we possibly could to avoid the virus entering the home. I was aware of every piece of guidance, we were testing more that was actually required. Our visitors process was stringent.
We followed every rule, we were rigorous with testing, but Omicron found a way in. Two cases in a 14 day period, either staff or residents are defined as an outbreak as per Health Protection Agency rules. Two staff members tested positive three days after working, despite negative LFT’s at the start of their shift. A day after they tested positive, we tested all residents, three residents were positive. We have no way of knowing whether the residents gave it to the staff, or the staff gave it to the residents (those residents had been having visitors).
We felt prepared, we had outbreak plans in place. We knew what had to come next. Nothing could have actually prepared me for what happened next. Within a seven day period half of all staff and eleven out of eighteen residents tested positive. Staffing levels were stretched, but as a team we pulled together, the “Business Continuity Plan” was enacted. We maintained safe levels of care and I am proud of what we achieved. But, I have never known physical and emotional exhaustion like it and it is an experience I never ever want to repeat.
The brilliant news is that, thanks to triple vaccinations, all staff members who tested positive were either asymptomatic or had mild to moderate symptoms. All were back at work within 10 days. Of the 11 residents, all made a full recovery. Some were entirely asymptomatic (in the middle of the pandemic I was frequently told “there is nothing wrong with me, this is ridiculous” by one 99 year old resident who was desperate to come out of her room, she was entirely without symptoms despite testing positive). Some residents were poorly, but all apart from one has fully recovered, one is not back to her previous health, but this would have been no different to her getting a cold / stomach upset. However, I fear that the longer term impact due to the isolation for two weeks in their rooms on some of the residents will be more detrimental than Covid. For those who live with moderate to advanced dementia, being isolated in their bedrooms for even a couple of days has significantly negative impacts.
I have however had time to reflect and digest the experience. I am left, frustrated, angry and let down by the Government and Department of Health.
Every single day I need to complete something called a “Capacity Tracker”, this centrally reported database tracks resident occupancy, staffing levels, sickness, testing, sickness pay, how staff travel to work (!). Since having an outbreak as a home I am now under the spotlight. I don’t feel supported, I feel checked up on. What has become crystal clear is that that the Department of Health is woefully lacking with its understanding of care homes. Each week I am called by the Local Authority, I have to answer questions about numbers of staff testing and residents testing – I am told that this is to “check track and trace data”. I am then questioned about staffing levels, testing and infection control training.
In the midst of our outbreak I had many calls with the Health Protection Agency (previously Public Health Team but in the middle of a pandemic they decided to change their name). I asked questions and required support. Of course these calls and emails could only be answered on working days between 9am and 5pm... . I took a call from a Health Protection Agency member who was concerned about the infection level. This is how the call went;
HPA “Can I confirm you are following all PPE guidance and donning and doffing correctly and all staff have been trained ”
Me “Yes” (I did not have time to take the call I was caring at the time)
HPA “Can I confirm that this happens at ALL times”
Me”Well, can I give you an example – D (who has dementia, has tested positive and is mobile) comes out of her room frequently, her movement mat sounds to tell us she has left her room. I am with another resident. I leave the other residents and run to D. She is moving along the corridor going into another residents room. Should I spend 20 seconds putting on a different flimsy apron and new nitrile gloves and visor while she wanders into two or three other resident’s bedrooms, or should I go to her straight away, hold her hand, reassure her and take her back to her bedroom”
HPA …. Long pause….. “Hmm, yes that is a challenge, but you must keep PPE on and don and doff correctly. Can I ask, have you taught your residents hand hygiene and told them how to clean their hands and also told them to put on a mask”.
Aside from the fact that as a 90 year old woman, teaching someone how to wash their hands could be construed as entirely patronizing, the lady in question has advanced dementia, and would definitely not be able to follow instructions.
The list went on…. On another call I was told that I should move residents to different bedrooms to keep those with covid together in one area. Can you imagine moving residents with dementia to different rooms in the middle of an outbreak when staffing levels are stretched in the extreme fai.liming to consider the impact on the resident.
The Local Authority called me during the outbreak. They had no suggestions, other than “call an agency to get agency staff if you have staffing challenges” but they did have another form for me to fill in…. They will be visiting next week, undoubtedly to check my infection control processes.
But, the outbreak is over and I hope that immunity levels are now very high as a number of residents and staff have had Covid in addition to triple vaccinations. Several of us, despite being exposed to covid on numerous occasions during the outbreak have remained covid free. Lateral Flow Tests are not infallible – people were positive on PCR’s and negative on LFT’s and people. Some residents we know were infectious prior to LFT’s turning positive.
On February 9th our outbreak was declared officially over and visiting resumed – not just for essential visitors but for everyone. On February 23rd the Government released it’s “living with covid” guidelines, outside of care homes life returned to normal. Care Homes are still subjected to testing, visitor restrictions, PPE. Our most vulnerable is society are being “protected” from a virus that may possibly kill them, but so would a cold, stomach virus or other infection, but their mental wellbeing is not being considered. I want my residents to see their loved ones, to hold hands, to cuddle their grandchildren, to see my face. As a carer, I want to care, and I want to enjoy a cup of tea and a piece of cake with my residents…something I have not done in two years as I am now allowed to take my facemask off. A cup of tea, a cake, holding hands - Is that too much to ask?
The protective ring of steel around care homes now feels like an ever tightening noose.
What an excellent summary of the ridiculous and dangerous situation now faced by care homes.
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