A look back over the last 15 months

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.

 

 

Vaccinated and Fake News!

I am delighted to report that all residents and all staff were vaccinated this week.  Other than the one staff member who tested positive for Covid19 and remains asymptomatic, we have remained Covid free.

We are testing regularly and all is well and calm.  Today every resident had a manicure and we have been enjoying singing along to the Sound of Music.  I was able to sit and chat with every single resident today one on one, they are happy, content and as safe as we can possibly keep them all.

As I type this the ITV news is on in the background in one of the lounge areas in our care home. There is a “ special program “ about the challenges experienced by those living with dementia in care homes.  The headlines talk about how the pandemic has had a detrimental impact on residents with dementia due to the lack of visits from family and friends.  

Apparently ITV did an exclusive survey of over 100 care homes to ask whether the physical and mental health of residents had been Impacted, nine of ten said yes.  We were called, by ITV but asked a different question.

The ITV program will cover claims that the use of anti-psychotic drugs for those living with dementia has increased due the lack of family visits during the pandemic.  From our point of view not one of our residents has been put on an antipsychotic drug during the pandemic.  A professor is quoted saying that  ...”“drugging” has become one of the few tools left to treat serious lockdown anxiety and that the best treatments for agitation are human contact, good nursing care - reassurance, a hug”.  The implication is that care homes up and down the country are drugging residents because they are so unhappy and lonely in the pandemic. The implication is that in care homes residents only receive human contact , care, reassurance and a hug from their family members.  The reality could not be further from the truth, carers treat residents as their loved ones, their Own family members.  The pandemic has brought carer and resident even closer.

The program has not yet been on, but I anticipate that it is going to portray a story of life in care homes during the pandemic in a very unfavorable light.  

Life during the pandemic has been tough for everyone, but I don’t believe these claims are true.  I believe it is scaremongering and for the vast majority of care home residents living with dementia the love, care and affection shown by the tens of thousands of carers who have worked tirelessly throughout the pandemic can not be underestimated.

To imply that residents have not had human contact, reassurance and a hug during lockdown is simply incorrect.  It has been really hard on everyone not seeing their loved ones, whether they live in a care home with dementia or not.  

What makes a carers job so much harder in the pandemic is this sort of reporting.  Carers themselves have struggled with not seeing their own families, having the enormous burden of knowing that they are caring for the most vulnerable in society.  Knowing that they will really be on the frontline if there is an outbreak in their care home.  

To every carer who works tirelessly, demonstrating, love, empathy, patience, hard work and ultimate dedication... hold you head up high and be proud.   You are doing a great job.  Ignore the fake news!

The result we didn't want....

On Monday morning a member of staff tested positive when they were tested with the daily Lateral Flow Test.  They were immediately sent home with a confirmatory PCR Test, that subsequently confirmed the positive result.  

It was what we had feared for the last 10 months; our first positive test.  The staff member is asymptomatic and took no risks, she did everything right.  She feels dreadful, when she has done nothing wrong, but being a carer by nature means that her thoughts are of the residents and other staff.

We had planned for this, the next steps have been ingrained for months.  We were ready.  Enhanced Infection Protection Control protocols were implemented, residents were quarantined, in their rooms or in the public areas for those who would not understand the restrictions.  We started testing daily.    All residents were tested.  Alongside that we reassured residents and staff and communicated with families.  Health Protection team were notified.

It is now Friday, all of the test results are back, all of the residents are negative, but we remain in a quarantine situation.  All staff results have been negative.  But we are clear the risk remains, but there were no PPE breaches, so we are hoping that the one positive result was an isolated case.  

All week I have heard of care home after care home suffering outbreaks.  The situation is bleak across the care home community.  

On Wednesday I received the call I had been waiting for - vaccines should be coming at the weekend for residents and staff.  I did not tell the staff, I knew they desperately wanted the news, but I could not risk them being disappointed.  I was right to be cautious, I was then phoned yesterday afternoon after spending all day trying to speak to someone who could confirm we would indeed be vaccinated, to be told that actually we would not be vaccinated this weekend, but hopefully at the end of next week.

In recent months we have been lead to believe by the Government that Care Homes would be the at the forefront of the vaccine program.

In the last month we have seen exponential growth in the virus spreading through the community and we are now constantly hearing of more and more cases in the Care Home community, infact I currently do not know of any local care home which does not have an outbreak.  

There seems to be no consistency in the roll out of the vaccines across care homes, some care homes received vaccinations in December, we are still waiting.

I applaud everyone who receives a vaccine in these terrible times, but was under the impression they would receive their vaccine after the Care Home community.   

As each day passes we are bombarded of images of individuals in the community receiving vaccinations, but the care home roll out of vaccinations has been inconsistent and communication has been too generic regarding timelines.   This situation is a ticking time bomb and yet again I fear that care homes will be let down.   Only last night Boris Johnson announced, proudly, that 40% of care homes have been vaccinated with 45% of over 80's.  I was surprised that this was not higher.

Earlier today I received a letter from our Council and NHS Trust requesting urgently placements for hospital discharges at hugely inflated rates (more than £300 per week than we currently charge a week).  It feels rather like March again, when covid positive discharges were made to care homes.  

This time we totally appreciate the immense pressure that the NHS are under and will do all we can to support the NHS, but it is clear we can not assist in anyway until we have clear direction on when vaccinations for all staff and residents will be in place as promised.    

Sadly I fear that some homes may not have the luxury of being able to turn down these placements, they have wages to pay, businesses to keep a float.    

I made a commitment to all staff, residents and their families I will do all I can to keep them safe.  This I will continue to do.    I do not know what the solution is to discharging people from hospital, but I do not believe that care homes should have pressure put on them to take unsafe discharges.

In the meantime, we will keep our residents safe, happy and loved.  A few days ago I was with a resident in her bedroom, I asked her if she was bored and struggling with being in her room "To be honest she replied, its rather nice to be not quite sooo busy, I'm perfectly content"

Testing, Testing and more testing

 Our residents had a wonderful Christmas.  We would have loved the home to be full of visitors but sadly that was not to be.

On 22nd December I received a call to put all staff on standby for vaccinations to take place on either 23rd or 24th December.  Sadly these did not transpire, but with the news about the Oxford vaccine I am hopeful that our residents and staff will be first in line from next week.

However, we did get a Christmas message from the Department of Health to advise that Lateral Flow Tests should be performed on all staff twice a week in addition to the weekly PCR tests.  This email was received late on 23rd December.  

This is an enormous logistical challenge, but of course we support anything that can be done to minimise the risk of an outbreak coming into the home.  Testing is key to this,  however, the administration that is required alongside this in terms of recording results has not been thought out.  To explain I have made this video.  

Yesterday the Department of Health announced that for two weeks care homes do not have to log in all results - only positive results, but in less than two weeks we are expected to log in all Lateral Flow Tests, for all staff (twice a week) and all visitors.

This video explains the challenges we face...

Lateral Flow Tests ....

What will Christmas be like in Care Homes?

I've talked to Times Radio a few times over the last six months.  This is an interview on December 18th.

From 1hr 41mins

Happy Christmas to everyone. x 

Times Radio Interview

So much to say....

 

It has been a while since I have updated this blog, I have been trying to work out what to write, where to start, what to share.  

Everyone is safe, we have remained Covid free.  Our home is full of laughter, fun, dancing, singing, and pets.  What has been a great success since September is our three times a week zoom calls with a handful of teenagers who are volunteering to speak with our residents and it shows how great it is for young and old to connect with each other.  Some lovely relationships have been built and the residents really look forward to the calls (and so do the teenagers too).  They have also sent some of the most beautiful letters and delicious cakes, which we have all enjoyed reading and eating.  On the quiz front, so far, our residents are winning in the general knowledge stakes, however, the teenagers seem to have the edge on the maths based questions.  Our home is full of Christmas cheers, with fairy lights twinkling everywhere.

Behind the scenes, the analogy of a duck could not be more apt.  On the surface I am definitely not serene like a swan, more busy like a duck, but beneath the surface I am paddling as if my life depends on it... and it really could be life and death for our residents.  But this time I have pond weed pulling me down.  I know that I speak for thousands of people like me working in a care home.

I have written in the past about communication and this continues to be imperative.  No decision that I take is black and white, there is no right or wrong answer, decisions have to be balanced, often taking into account the balance between physical health and mental health.  The balance between trying to avoid Covid-19 at all costs but ensuring our residents are happy and visits from loved ones are possible.

Almost a year ago to the day was our 2019 Christmas Party, then our home was full of visitors, all ages, the home was full of laughter, singing, and the corridors were bursting at the seams.  I long for that to happen again.

We have built a conservatory in the last few months so we now have a visiting pod to enable safe visits to take place.  We then had to put in floor to ceiling doors to segregate the areas.  Next week we being lateral flow testing, quick acting tests for all visitors.  Consent forms for the vaccinations are in place.  It all sounds so positive, and it really is, I have high hopes for 2021.

However, behind every good bit of news, every step forward, the pond weed continues to pulls us down.  Earlier in the summer staff testing was announced, aside from the initial massive delays in getting results, behind the scenes we have to enter every single staff members details every single time we test - name, dob, ethnicity, role, where they work, where they live, mobile number, address.  Every single time.  Upload functionality doesn't work.  We test staff on two different days each week.   This takes in excess of three hours every week, time not spent with the residents or staff.

The Government announced that "visiting is permitted" not explaining that every care home had been sent pages and pages and pages of guidelines to allow safe visiting, things like, one way systems in care homes, separate entrances for visitors, windows open at all times (in winter I know!) (!), again the paperwork is enormous, again it took hours to justify why certain things could not be done - windows open when someone is in their 90's is not possible.  One way systems in a care home for those living with dementia is not feasible etc etc.  

Lateral Flow Testing is being rolled out from next week, this is hailed as an additional defence against an outbreak, I have spent in excess of 12 hours working out the process.  The guidance notes are more than 60 pages long.  Tests have to be "logged online" by the visitor "using an iPhone" - clearly not everyone has an iPhone, and there is no mobile reception where our home is located.  This has not been considered in the guidance.  What is not announced is that the Lateral Flow Tests identify less than 50% of positive cases compared to the PCR tests (this is shared in the Department of Health webinars).  We will of course continue to do everything we can to ensure the safety of our residents but the administration around these tests is enormous.

Vaccinations are clearly going to be the game changer.  Care Home residents and staff are first in line.  We have not received any details about when.  I totally appreciate the massive issues in working out how the vaccinations will be delivered, but some honest communication would be appreciated, and also before the fanfare message is delivered to the general public, some of the underlying processes have been considered. 

I have written before about communication and I continue to be hugely grateful for the support I receive from our residents families.  I have been honest every step of the way, I have admitted I do not have the answers, I am trying my absolute best, I will continue to over communicate with our families and admit that processes are changing daily, sometimes hourly, based on changes to official guidelines.

Infection Control Fund payments have been made to support care homes to enable safe visiting / cohorting of residents, and whilst this is hugely appreciated, we need honesty and we need our opinions to be sought before announcements are made and before unworkable guidance is rolled out.

So the pond weed continues.  This week I am away from the home, S and I decided that I would use this week away to focus on our processes, our controls, filling in the mountain of paperwork that is now required.   I feel like my arm has been removed not being to be with the residents, but I know that the amazing staff are doing everything possible to keep all the residents happy, content and ready for Christmas.

So, apologies for the delay in writing this blog entry.  I will keep on paddling hard and getting through the pond weed..... and then I will go and finish wrapping 18 stockings with individual presents for our residents.

We are committed to ensuring that our residents will have the best Christmas possible.

Care Home Visitors

As anyone who works in a care home will testify, it has been a challenging seven months. As the pandemic developed care homes became at the forefront of news reports.

Within LTC the families of our residents have been wonderfully supportive.  I have tried to communicate honestly and regularly.  They understand the rationale for the decisions we take, and I am grateful for the support they have given us all.  We have tried to involve the families of our residents with life in the home.  They may not be physically with us, but we make sure that they are aware of everything that is going on, not just with phone calls and emails, but with weekly videos of all that has happened .  

Over the last few weeks however one of the most challenging things to deal with from a staff morale point of view has been the news reports about visiting restrictions in care homes.   Dementia charities and mental health campaigners have been pushing for loved ones of residents in care homes to allow more frequent access to care homes by treating them as care workers.  A pilot in England is being planned which would mean visitors would be tested weekly and given training in PPE.

The Alzheimers Society report that "People's loved ones with dementia have felt bewildered, abandoned, and in many tragic cases, faded away from the lack of personalised care, understanding and love that only family members can bring".  To read that as a carer feels like a kick in the teeth, as a carer our prime focus is care, and to read reports that our most vulnerable feel bewildered, abandoned and are fading away is hard to stomach.  Over the past year it seems that the media continues to focus on the negatives.

I can not speak for all care homes, but the quote above could not be further from the truth.  Personalised care is central to everything that carers do.  It is the bread and butter of what care is all about.  I can hand on heart say that I believe that none of our residents feel bewildered, or abandoned.  As a team we can never replace the closest family members, but the love, support, laughter and care shown to all our residents is a constant.

Personalised care is all about treating each resident as an individual.  In this respect how can there be a one sized fits all approach to visiting?  The residents must be central to that decision, and then the circumstances of the care home, staff and risk profile of the visitors have to be considered.

Any decision about visitors not only impacts one resident, but possibly all the residents.  The decision also impacts the staff and other family members who feel safer if no visitors are allowed.

The proposed "pilot" is to treat visitors in the same way as key workers.  That would include weekly testing and full PPE and training.  I wonder if that will also include the many personal sacrifices that carers made over the last eight months and continue to make, many carers are effectively self isolating apart from when working to ensure that they minimise any risk to our vulnerable residents.  Carers are not able to work in multiple locations, so does that mean that if visitors are treated as key workers will they also make those personal sacrifices?

I know I speak for everyone who works in social care when I say that the policy regarding visitors is far from clear, it is upsetting for us all.  We hate the fact that due to Covid19 we can no longer have a home full of our residents loved ones.  We do not want to stop family members seeing their loved ones, but equally we must do all we can to keep them safe.  

And with regard to the news reports about residents being "lonely" "fading away" "abandoned" "bored" nothing could be further from the truth.  In the last seven days our residents have enjoyed a pub afternoon with traditional pub food and games, twice a week zoom calls with quizzes with teenagers taking part in the Duke of Edinburgh award scheme, reading "100 steps" by Captain Tom, playing with the pets, gardening, flower arranging, planning the next months menus, loads of singing, loads of dancing, and lots and lots of laughter.

Our residents tell me they do not feel abandoned, they told me they feel loved, supported and safe.