It’s a year since I last updated this blog. I hope that this will be the last blog entry I ever write about Covid. I have just written this for the “Every Story Matters” website which aims to ensure everyone can provide their input into the Covid enquiry. I hope that this is read by those taking part in the enquiry, but I will continue to speak up for all who receive, and work in Adult Social Care.
EVERY STORY MATTERS…
As an owner and manager of a small family run care home I experienced first hand the impact of the Covid pandemic on Adult Social Care. Although I could tell my story about PPE shortages, I could speak about Local Authorities offering significantly increased weekly fees to take untested residents from hospitals, thus risking whole care homes to outbreaks when they were hugely lacking in the medical support required, I want to focus on the what I believe are the two key issues arising from the pandemic in relation to the support given to care homes and their residents;
1. The Government, Department of Health and Public Health England demonstrated a woeful lack of understanding about how to support care homes. Guidance was useless and demonstrated a total ignorance about the challenges faced by those working in, living in and supporting care homes.
2. The Government used the pandemic as a fact finding exercise demanding information which at many times was unnecessary, unworkable and impacted our ability to support those in need, this information gathering exercise was one sided from care homes to the Government.
My care home specialises in the care of those living with moderate to advanced dementia. We have up to 19 residents and a staff of 25. I took the decision to “lock down” earlier than the official advice. I was able (with enormous amounts of effort and cost) to secure adequate supplies of PPE. My focus as a (very hands on) owner of a care home was to keep our residents safe, ensure reassurance and communication to families, adhered to policies and to support the staff as they cared for our residents.
Throughout the pandemic what became clear for all care homes is that those making the decisions, those putting a “protective ring around care homes” were woefully lacking in understanding about what the sector really required in the most difficult of time in decades.
We were lucky in that we were outbreak free during 2020.
Our home being outbreak free changed in 2021, and this one example I believe sums up the lack of support but more importantly the enormous lack of understanding of the sector that Government agencies were supposed to be supporting.
In January 2021 one member of staff tested positive for Covid after working a night shift. In a matter of days the outbreak took hold.. numbers of residents and numbers of staff testing positive started increasing. Very quickly our staff numbers were depleted as staff began testing positive. During that time there were very clear guidelines about how long staff were to be off work, residents were to be “quarantined” to their rooms. We were bombarded with donning and doffing guidelines of PPE – including how to use a flimsy apron that covered one third of your mid section but not your arms because of course if someone sneezes of coughs droplets only land in the tiny areas covered by the flimsy aprons.
We followed the guidelines regarding how long staff were to be off work. About a week into the outbreak and half the staff were testing positive. Just over half of the residents. I had worked a night shift with a member of staff who had just returned from having Covid, ( truth be told she had probably returned to work too early). It was a tough night with many residents unwell (albeit with mild symptoms but unwell nevertheless). At 7am that Monday morning the phone started ringing, every single carer due in that morning was now testing positive. We were on our knees, but had no option than to keep doing what we were doing.
And then we started getting the “support”….. which was as much use as a chocolate teapot
The capacity tracker had been updated and I had done all the necessary reporting to the Local Authority and Public Health about the outbreak. Families were all advised. But over that week as the staff had begun calling in advising that they had tested positive the calls increased from the Local Authority “Resilience team” and Public Health England. In terms of support their suggestion was to get “Agency” staff. This is something we have always avoided and we are proud of our long standing dedicated team, agency staff are no golden bullet, it would take at least four days training to get a new member of staff fully inducted and safe to care for our residents. By the skin of our teeth we somehow managed, but it was the phone calls that highlight the lack of understanding, it felt that every single phone call during the outbreak from those that were supposed to be offering support were trying to point the finger about what we were doing wrong.
The ignorance of those providing support;
This phone call will be etched in my memory forever. That Monday morning after learning that the entire planned care shift was not able to come in Public Health called – the lead for our area as they wanted to understand why our Covid rates for staff and residents were “increasing so quickly”. I had called on Friday evening, but the Local Authority Resilience team and the Public Health team only worked weekdays because clearly Covid outbreaks only happen in the week (something which I was further exasperated.
PHE “Can I ask if you understand how you and your staff know how to wash your hands”
Me “Yes we do”
PHE “Have you taught your residents how to wash their hands”
Me “Well, we are a home specialising in the care of those living with dementia - a very large proportion of our residents are non verbal, some cared for in bed, most are disorientated to time and place and unable to tell you if they would like a cup of tea and those that have capacity to understand the question not would probably answer that of course they know how to wash their hands”
PHE “OK, well perhaps put a poster in each of the residents bedrooms about hand washing so that they have visual cues. What about donning and doffing – do all staff know the correct process”
Me “Yes we do, but can you answer when resident A who is covid positive comes out of their room to have a wander and goes into residents B room, what takes priority? – do I carefully Donn and Doff my PPE or do I stop A going into B”
PHE “Oh, but residents who have Covid are to be quarantined - that’s what you are doing wrong”.
Me “How do I quarantine a mobile resident with dementia who is totally disorientated to time and place”
PHE “Oh,…… well you must don and doff correctly. You should move all the rooms of the residents so that those with Covid are in one area of the building and the ones who are clear of covid are in another area”
Me “I beg your pardon – with two members of staff you want me to move residents rooms – personal effects, air flow mattresses, hoists etc etc in the middle of an outbreak – what about the residents, aside from the logistics of being able to do this, it is totally unfair and upsetting for the residents”
PHE “Well this is what the guidelines say, you must quarantine the residents, you must keep them together and you must ensure correct handwashing techniques. We will check in on you tomorrow”
After that call a resident pulled my mask off to “see my face”. Another resident who at the time was 98 (she is now 101 and still with us) appeared in the corridor from outside her room with her frame I said to her “X, please go back to your room you have a virus which we need to make sure other people don’t get it”
Her reply?
“Don’t talk rubbish, there is nothing wrong with me, I am going to the lounge. I’ve survived a war, I will survive this”
Survive she did, and I am delighted to say from that outbreak and the following two outbreaks we lost no residents to Covid. In part that was undoubtedly due to vaccinations, but the other reason was that all of us who work so tirelessly within our care home was that we cared for our residents the way we knew best.
Those who supposedly put a ring around care homes were clueless, they sat in their ivory towers working Monday – Friday trying to discharge Covid positive patients to care homes, not providing adequate PPE, and writing guidelines which were unworkable, unrealistic and of no use.
I would love to educate those in the Department of Health and willing to offer work experience within our care home whenever they would like, please get in touch.
