Behind the Scenes

On Monday this week we had our fire alarm service, this had been delayed a few months, but I felt it was critical it took place.  It was planned with military precision, the engineer had a precise time he had to arrive, I was with him at all times cleaning behind him (he was in full PPE), the residents were shielded away from him.  The residents were moved into the garden for his arrival. When he had left I went into the garden, to find a calm oasis of smiling faces, which turned into an impromptu dancing event.  Clapping, cheering, laughing.  The birds were singing, the flowers were in bloom.    Later on we had a story telling game, all the residents adding bits to the story.  In the other lounge the residents were watching family videos of great grandchildren racing around and singing.    The residents are fine, happy and safely cocooned, we continue to keep smiling behind the masks and do everything in our power to keep everyone safe.

Last week I had a week away from LTC.    Anyone who knows me knows that switching off is not something I am very good at.  During the pandemic I have been encouraging all staff to take time off, there is a tendency to just keep on working.  All of our staff have cancelled holidays and would prefer to carry forward holiday, but not only would this cause issues later in the year or early next year with everyone wanting time off at the same time, but it is important for staff to have time away from the home and the residents.

For social care staff and healthcare workers we have not had the lockdown time to tidy cupboards / do Joe wicks workout / homeschool.  It has been been a stressful time, pressured, confusing, scary, but equally we have all had a purpose, a goal, and LTC has been our safe little bubble, keeping our residents and each other safe.

So actually switching off is hard for everyone.  I used the time to just hang out with my family and be there if my teenage children did need me.... rather than be at the care home, taking an urgent call from the home / families, PHE, Dept of Health etc etc.  But I used that time away from the care home to also speak to other care homes, chat about best practice and share ideas.

On Tuesday last week I had a very distressing call.  It was with a care home that had lost more than 30% of their residents to Covid 19.  It is not my story to tell but suffice to say it was a heartbreaking story.  The manager of the home was so open and keen to share her experience.  She had decades of nursing experience and it was very clear that this was an impressive nursing home, they had done everything right but very early on in the pandemic, Covid 19 entered the building.  She directed me to this programme which was aired on newsnight in June.  I urge everyone to watch it.

https://www.youtube.com/watch?v=bS-6_phuWFQ

I reflected on that conversation and it made it crystal clear to me that despite pushback that I may receive, minimising the risk of transmission of Covid 19 into the home must continue to be my main focus.  At times decisions I take may not be popular.  Anyone who has read my previous blog entries knows that I have expressed concerns about some of our residents wellbeing due to staff wearing facemasks all day long, for a few residents this negative impact continues, but the use of facemasks is a critical step to reduce the risk of asymptomatic transmission and ensuring our residents safety is paramount.  Guidelines changed yesterday to say that facemarks must be worn by all and this includes everyone in the care home at all times - whether cleaning or cooking, or just servicing a boiler.  

Guidelines also changed about visitors yesterday, recommending that visitors should be limited to a single constant visitor (socially distanced wearing PPE).  In recent weeks there has been much in the news and on social media about residents in care homes (particularly those with dementia) suffering without visitors.  Quotes are made about residents wellbeing being so negatively impacted without visitors.   I am certain that in the majority of care homes residents wellbeing is being focused on at all times, and residents are happy, loved and settled, even without visitors.   Whereas it is awful having to limit family visits, these visits continue to represent an additional real risk to our residents.  I have individual risk assessments in place for all residents to understand the risk of external visitors - because for every single resident their circumstances are different.   I am hugely grateful to the families or our residents who have been so supportive of my decisions regarding visiting their loved ones.

I will continue to hold firm and do everything that I believe is the right way to minimise the risk with the best interests of the residents and staff, even if those decisions are not always popular.

Regular Testing of staff and residents will begin shortly.  We did receive the test kits, but these were recalled earlier this week due to safety issues and we have been advised that there will be a few weeks delay until we received the new test kits.   Staff are tired, PPE is uncomfortable, guidelines change often weekly, sometimes more often.  But I know that together, as a team, we continue to do everything we possibly can to protect our residents and each other.  

What I am most proud of

It is Friday evening, and I am reflecting on what has been a challenging week.

Challenging in terms of guidance, PPE issues, testing.  But after a longish walk I have reflected on what is really important and what I am proud of about our home.

Anyone who has read my blog up until now will, I hope, understand my frustrations about inconsistent guidelines which have been produced for care homes with a lack of understanding of the challenges.  I will continue to try to educate and ensure that care home residents, staff, and their families have a voice.

But this entry is all about what I am proud of in our care home.

1.  I am obviously proud that we have kept our residents and staff safe and that we have remained Covid free.
2.  I am proud that every day I go to the home it is filled with smiles and laughter -both residents and staff.
3.  I am proud that our residents have been protected from every challenge that the "outside world" has experienced in the last three months - they have eaten like kings and queens, never wanted for anything and their life have continued unchanged (apart from visitors).
4.  Our activities have kept everyone busy and energised, from flower arranging to visits to the farm to see robotic feeders, from VE zoom to Tik-Tok routines, from horses to chicks visiting, from online singing lessons to zoom bingo.
5.  I am proud to be part of the most wonderful community who have shown masses of support and love, from parcels from Tesco staff to free visors, letters and messages from school children, fancy dress visits twice a week.
6.  I am proud of the wonderful team who smile, laugh and have kept going and adapting to the ever changing process.
7.  I am proud of our amazing 700 year old home and beautiful garden... even when bits keep falling off.
8.  I am proud of my DIY skills - particularly with a power drill due to a lack of maintenance visitors
9.  I am proud that I have a job that I love and that my family extends to 17 residents and 25 staff.

And finally, a picture tells a thousand words, so this is just a taster of what the last 13 weeks have looked like.

OUTRAGEOUS - Facemasks - Now recalled....

I have written a lot about facemasks and particularly the impact of them on those living with Dementia.

Today I have different concerns, I don't know my next steps in this regard.  But I need to write this down somewhere.

At the start of the pandemic everyone is aware that there were issues with  PPE supply chains.  The "National Supply Disruption Resolution team" which, I believe, came under the NHS dispatched 300 Type 11R fluid repellant facemasks.  We were encouraged to buy future supplies from Government approved suppliers.  I bought over 1800 additional masks from Countrywide Health - an approved supplier.

At the end of April we noticed that the nasal strip on the facemasks was failing and particles were getting up our nose and in our mouth.  On close inspection, ALL of the boxes had a sticker over the best before date extended the 2016 expiry date to 2021.

On 3rd May I called the CCG and NHS PPE team, expressing concern about the extended expiry dates and the masks failing. I also emailed them.  They called me back and said to keep using them as they were better than nothing.

PHE also referred me to the HSE following my email to them.

On 4th May I called the National Supply Disruption Resolution Team - they told me to call NHS England as they "didn't deal with issues of expiry dates"  They told me they "thought" they were re-evaluated.  I asked for the certification of this.  They told me to call the "CPC" but could not tell me who the CPC were or what the telephone number was.  I called Countrywide, they told me the Department of Health told them they were ok to sell and that the Department of Health had the certification relating to the extended expiry dates.

On 7th May I emailed the HSE with details about my concerns about the masks failing and the extended best before dates.

On 20th May HSE sent my email to MHRA - regulator of medical devices.  They asked for more details which I sent that day.

On 2 June MHRA replied and said that they were looking into this.

TODAY an email was sent from the Local Authority Resilience Team that reads as follows;

We understand that the following masks have been recalled from the NHS supply chain. We believe these have only been issued through the NHS supply chain and therefore it is unlikely that you will have any in your setting. However, as a precaution please review the attached document which provides further details and check that have not been supplied with any of these masks.

What does this mean?
1.  We have been using facemasks which have not been fit for purpose.
2.  It has taken eight weeks for my concerns to be dealt with - is this an acceptable timeframe, in relation to PPE?

I literally have my head in my hands.  I had to write this down to share this.  How on earth has this been allowed to happen?

Luckily I have some other facemasks which we are using (as of 30 minutes ago).

To Visit or not to Visit.... that is the question..

First things first, the virtual tour with our MP two weeks ago went well.  I am delighted to report that he was able to spend over 1.5 hours with me (via video call), meeting staff and residents and seeing around our home.   I think I can say with certainty that he understood more of the challenges after the meeting than he did before the meeting.  We discussed;

• The admission of untested residents from hospitals at the start of the pandemic (although we took in no admissions we were asked to do so).
• The challenges of PPE and social distancing and how "one size" does not fit all when it comes to guidelines for care homes.
• The challenges specific to those living with dementia through the pandemic.
• PPE issues - some PPE which is not fit for purpose.
• End of Life visits
• The future of small privately run care homes

Many of the issues we discussed do not have easy solutions, there is no magic wand but I really wanted to give him an understanding that a one size fits all approach can not work.

It was not all gloom and despondency.  He said at one point he was surprised just how "homely" our home was.  Music to my ears!  We told him about the activities, how we have communicated with families...  I even sent him a link to this blog.  I hope that going forward he will be able to fight the corner for the residents of care homes...

Over the past few weeks the subject of family visits has been one that plays on my mind.  As lockdown restrictions are lifted I know many family and residents themselves look forward to the time they can see their loved ones.

Today further lockdown restrictions were lifted.  Two hours after Boris made his announcement we were sent guidelines which state "Family and Friends should not visit care homes apart from next of kin in exceptional circumstances". But that ultimately it was for the care home to make the decision on whether it is safe to visit or not.

When we allow visits they will be in the garden (although I am hoping to build a visitor pod in the not too distant future), socially distanced and limited to one visitor.  Every single resident, every single family member has their own set of circumstances.  

Will the resident benefit from the visit?

Will the resident and family member be able to socially distance - imagine you visit your Mum, she dissolves in tears at the sight of you after 14 weeks, how hard will it be not to hug, not to hold hands.... even more so if your Mum has dementia?

Is the resident part of the very vulnerable shielding group?

Has the visitor been socially distancing / do they work in a higher risk environment?

Do I temperature check on arrival? what PPE to provide? How to we clean the seats between visitors?

And then the most serious of all..... if we make the wrong decision and a visitor is asymptomatic and passes Covid-19 to their loved one, who pass it on to the other residents...... and staff......It keeps me up at night.

At the moment I feel that garden visits will be right thing to do for some residents.  Those residents who we know will benefit from a visit.  I know how hard this is for families having to wait to see their loved ones in person. 

In the meantime I will ensure we keep our wonderful residents, safe, loved, busy and happy.  I will send images, I will send videos, I will over communicate to all our residents families.... and my dogs.... they will also keep watch on them.

How to communicate?

I have not updated this blog for a little over a week, it feels longer!

All our residents are fit, well, happy, loved and well cared for.  We remain in lock-down and our residents have not seen their family and loved ones for more than three months,

I know that I speak for all carers, all over the country and probably world, when I say that although bonds between residents and carers were strong before the Covid-19 pandemic, but since lockdown our bonds have become even stronger, we have been cocooned with our residents, seeing them rather than our own parents and other family members and our residents have become part of our family.  I think of them before I got to sleep, when I wake in the night, and first thing in the morning (whilst also thinking about my husband and children).

We continue to keep our residents busy with a variety of different activities.  I am honest with them all, telling them everything I am doing to keep them safe

and keeping them updated as guidelines continue to change.

Communication is critical, and with our facemasks being worn at all times, this is tricky, particularly for those living with dementia who are unable to verbally communicate (and read).  I have raised these concerns to every single regulatory body and advisory group.  The feedback remains that the risk of asymptomatic transmission trumps the need to communicate.

These "expert" advisory bodies recognise the challenges and suggests;
- Put a mask on the residents so they don't get scared and feel the same as you (this does not even warrant a response from me).
- Give them a teddy or doll with a mask on (our residents are not children).
- Use an iPad to wipe board to communicate (many of our residents are not able to read or communicate in anyway, and for those who can, imagine if every single conversation you had with your loved one was on a wipe board)
- Wear stickers with your face and name on your tabard so residents know who is behind the mask (I got these made up, with the help of a company in Dubai..... and then we were advised that PPE changes meant they are no longer able to be worn).

PPE guidelines change weekly - now we are allowed no lanyards, no bright badges, no "Hello my name is..." badges, hair has to be in a bun (not plaited), headbands must be worn at all times.

So our residents now see us in masks, plain uniforms, no name badges, no smiley pin on watches.  I continue to advise the staff of these changes, and every time my heart sinks as I know we are ever so slightly chipping away at our ability to communicate.

I have done my own risk assessments, with family members and staff and for one resident who cried everytime we were with her, some staff do remove their facemasks,  she instantly brightens and relaxes.  I believe the negative impact on their wellbeing can not be under-estimated.  When I am doing activities with our residents and can ensure I am a good distance from them I do remove my mask.  When we go outside I take my mask off and keep as far as possible from them.  As the picture shows, some of our residents find other ways to communicate safely with those they meet on a walk.

I am not saying we should not wear masks, but the whole issue needs to be understood and the impact on quality of life considered with consultation with residents, and their families.

Which brings me onto this....  Tomorrow I am meeting (virtually) our MP to give him a video tour of our home, introduce him to some residents and carers and talk to him about the reality of life in a care home.

Today I am planning how to structure the conversation....

What would you want your MP to know if you were me???

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....

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.