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.

 

Written by one of our carers....

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Real stories

Working in a care home during coronavirus: ‘We’re keeping our residents safe and busy’

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Ellie is a care home worker and has been providing crucial support for their residents, including people living with dementia. Ellie hopes that sharing her experience will reassure people who are unable to visit their loved ones in care while there are visiting restrictions in place.

17 September 2020

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Coronavirus has made some things difficult when working as a carer. However, it has also pulled us all together and has shown us, even more, that loving and caring for other people can also give yourself a sense of joy.

The carers I work with agree that the most enjoyable thing about working in a care home is seeing the smiles on the resident’s faces. 

‘To see happiness and laughter in those you care for is the most rewarding thing about being a carer.’ 

As carers, our main goal is to make the residents lives happy and keep them safe. Care home life can be not only pleasant, but a real joyous and cheerful place. We are like one happy family. 

Ellie enjoying activities with residents in the care home before the coronavirus pandemic

Contacting loved ones with video calls

Life in a care home during the pandemic is different than before, in a few ways.

The main difference being that for a long while we have had no visitors. This was not an easy decision for us to make, but keeping our residents safe was the most important thing. They have found the restrictions of visitors challenging.

Advice

Keeping in touch with a person with dementia in a care home through coronavirus

Staying in touch with someone in a care home is made much harder by the pandemic. Visits have been severely restricted. This advice for friends and family should help you stay connected.

Nonetheless, we have overcome this obstacle in creative ways, which means that our residents have still been in regular contact with their families and friends.  

The families of our residents have received weekly video montages including pictures and videos of what we have all been up to. These videos really show how happy and contented everyone is at our care home.

One evening I sat with a resident while she had a video call with her daughter. 

‘Although this lady is unable to speak due to her dementia, you could see the look of delight in her eyes as her daughter’s  smiling face appeared on the screen.’

Dementia has taken away her ability to communicate, and she is unaware of what is going on outside, so she remains perfectly happy, content and calm.

Another gentleman watched a video on the TV that had been sent by his family, he gets these every week. As his children, grandchildren and friends each left messages of love and affection, his face lit up with an endearing smile that brought tears to everyone watching.

Activities in the care home during coronavirus

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Activity ideas during coronavirus for people with dementia

Keeping active and purposeful when staying at home will help fight off boredom and frustration. Here are some activities you can try at home during the coronavirus pandemic.

As well as keeping the residents safe, we have been keeping them busy. They love nothing more than spending the afternoon doing chair-based exercises, playing games, and singing along to their favourite music.

One of their favourite pastimes is bingo, they even enjoyed an exciting game of it through video calls with their families - not just traditional bingo, but musical bingo too! 

‘The owner of our care home spent time with the residents making desert island discs.’ 

The residents really enjoyed taking a virtual trip back in time, spending the afternoon listening to wartime music. They chose their favourite songs, the staff compiled the track list and sent it to the families. 

One of the residents has found delight in tending to the garden. She quite happily potters around, watering the plants and weeding the flower beds. She really enjoys this, and as well as fresh air. It gives her a responsibility. 
 

Ellie enjoys working at the care home

Support from the local community

Activities have become even more important in part due to the lack of visitors – both family, and the normal community visits from the church and local school children.

The local village community have been incredibly kind and generous to our care home. 

‘We have received all kinds of messages of love and appreciation.’ 

We had a very special visit from a horse, and a carer brought in her chicks. We have also received lavish donations including hand creams for staff, lots of sweets and chocolate, and homemade laundry bags.

Difficulties as a care home worker during the pandemic

One of the difficult things being a carer during the pandemic is trying to work out how much the residents should know. We don’t want to lie to them, but also don’t want to frighten them and cause concern. The TV channel had been switched over when the news story talked of lots of residents dying in care homes, and this just was not helpful for them to hear. 

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One morning, the newspaper was delivered. On the front in large font it read ’EVERYONE IS GOING TO DIE IN CARE HOMES’ (or something like that). Initially, the owner thought it best to tell the residents that the paper hadn’t come, but then decided that she had to be honest. 

She handed it to them and said, ‘I am giving you the paper, but please don’t believe everything you read, and I give you my word, I will do everything in my power to keep you and the staff safe.’ 

The residents replied with a ‘Thank you for being honest, we know you will!’

How better government support could help our care home

As carers, to protect ourselves and the residents, we have to wear masks at all times. Although we know this is necessary, it has been somewhat unsettling for some of the residents. A few of the residents who have dementia rely on the carers’ facial expressions for their peace of mind, so we have been even more reassuring and compassionate. 

Other ways we have been keeping our care home coronavirus-free includes often and thorough hand-washing, taking our temperatures at the start of every shift and not wearing our uniforms to work or home. 

‘They may seem like small things, but they could be the reason we have no coronavirus symptoms in either staff nor residents, and that is no small thing.’

I had a chat with the owner and the manager of the care home, and they both agreed that they think there is more that the government could do to support care homes. 

They said that it would be helpful if the MPs asked owners and managers of care homes what support they need, instead of just telling them, without understanding what actually goes on in a care home. All care homes are not the same, there should be no ‘one size fits all’ approach. 

The government had suggested keeping a 2-metre distance between residents. If MPs visited care homes, they would see that it just wouldn’t work and could be detrimental to the resident’s wellbeing. 

Care homes could also benefit from visits from MPs so they can see firsthand the struggles, what extra support is needed, and what it takes to run a care home successfully. 

Communication is key

 It’s over six weeks since I updated this blog.  I have thought about what to write many times.... so much to say, but where to start.    

It has been an exceptionally busy week.  Our “visitors pod” in the form of a conservatory attached to the outside office has been built, just the floor to go down and then we can welcome visitors inside, just in time for the colder weather (despite a short heatwave being forecast for the next few days).  The last few days have been warm and calm, residents have been in the garden and it has been wonderful to see family visiting their loved ones - albeit socially distanced and wearing PPE.  

Activities in the home continue and a highlight of my week is sharing the special moments from the week before with our residents families.  It is always a job I look forward to.  I sit with a cup of tea, going through all the images and videos from the previous 7 days, putting them into a video and what’s app'ing all of our residents loved ones.  I relive those special moments once again.

I have been incredibly thankful of the support we have received from the families of our residents.  I have attempted to explain every decision we have taken, I ensure that they are regularly updated at all times, guidelines changed a lot, particularly in the early stage of the pandemic.  The entire team and the families of residents have been appreciative of the updates and supportive of all of our decisions.

A few hours ago I took the difficult decision to temporarily suspend all non essential visits.  With Covid-19 cases rising, I felt that it was the prudent thing to do.  Safety of all of our residents is paramount, and every additional visitor represents an additional risk.

We are doing everything in our power to keep our residents safe.  Over the last few months, like other care homes, we have put in place detailed new infection control processes.  Staff have been trained, risk assessments put in place.  We follow all infection control protocols.   Staff temperature checks, changing into uniform and out of uniform at the start and end of every shift.  PPE being worn at all time.  We have all made many personal sacrifices over the last few months to ensure that we are minimising our risk exposure.  We looked to the Government to fulfil their promise of weekly testing of all staff, so critical to ensure that we can control the risk of asymptomatic transmission.  Sadly the Government have yet again failed on this promise.

We all hear constantly that test and trace is critical to controlling infections.  Testing was rolled out to all care homes in July (the fact that the Randox kits all got recalled and then there was a four week delay to get the new kits is not mentioned).  Time and time again I hear about the “ring of steel” around care homes.  

Over the summer care homes planned for what may happen over the winter.  Testing of all staff and residents was rolled out, and yet as I sit here and type this blog I am waiting for test results....  Results from tests that were collected on Sunday - seven days ago.  We have had just three results (all negative).. we are supposed to get results within 72 hours.  Other care homes are experiencing the same delays.  

We expected a difficult winter, but I felt certain the mistakes that happened earlier in the year when our most vulnerable in society were so badly let down would not happen again... surely not...

And yet, the testing that we were promised clearly is not working.  

I feel I have support from our residents families, from the team of carers and from the residents.  I believe a lot of that is down to open and honest communication.   

I fear we have a difficult winter ahead.  I promise I will keep communicating, I will keep being honest.

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.