This Spring the coronavirus outbreak severely affected care homes and their residents in the UK. During the first wave of the pandemic many private care homes were unprepared and left unable to operate safely as the contagion swept through the country. Owners of establishments looking after the elderly and infirm were not able to easily buy the personal protection equipment they urgently needed. This is because most materials that were available, when the crisis hit hard by April of this year, were automatically allocated to the NHS.
“Between 2 March and 12 June this year 28,186 “excess deaths” were recorded in care homes in England, with over 18,500 care home residents confirmed to have died with COVID-19 during this period.” states Amnesty International this Autumn. (3)
Cases of the disease spread through the staff teams and vulnerable residents. This was following a situation where patients, who were discharged from hospital having contracted Covid-19 infections, were being reintroduced back into care homes. Care home nurses were unable to effectively identify and then quarantine people who had become unwell with the dangerous pathogen.
Amnesty Internation has called for a full public enquiry after reviewing the situation during the first national lockdown when: “on 17 March, four days after the World Health Organization (WHO) declared COVID-19 a global pandemic, the Government ordered the discharge of 25,000 patients from hospitals into care homes, including those infected or possibly infected with COVID-19.” (3)
A lot has been learned in nine months by officials about how to contain and prevent new Covid-19 cases. New government guidelines that came into force today enables relatives to more easily visit their family members who are living in a care home in England. In all tiers the closest people to a man or women who is currently staying in a care home, can arrange a convenient time to sit with their loved ones and enjoy each others company. The formal guidance summary emphasises how visiting is vital to maintain contact with family and friends and continue life-long relationships whilst contributing to residents support and care.
“Visits to care homes can take place with arrangements such as substantial screens, visiting pods, and window visits. Regular testing will be offered to up to 2 family members or friends per resident by Christmas, which when combined with other infection control measures like PPE – will support indoor visits with physical contact.” (1)
The new procedures outlined in detail yesterday give clear and detailed direction to all registered care home managers who are supported and inspected by the Care Quality Commission.
During the first lockdown testing was not easily accessible and this month care homes are being asked to open their doors to the public after doing a risk assessment, with the promise of more testing kits to become available by Christmas but that are not available yet.
This means normal visits are only advised in Tier 1 areas until the healthcare managers receive the new tests. “Lateral flow devices (LFD) are being provided for this purpose, where the results are available quickly so that the visitor will take the test on arrival, and the visit can only take place provided there is a negative test result.” (2)
A risk assessment of the meeting rooms coupled with monitoring social distancing within the home environment, hand hygiene measures, the wearing of PPE and advising visitors to limit physical contact even if they have had a negative test result is all part of the new guidelines for attending an appointment to see a family member or close friend in a residential care lodge.
Establishing a one-way system through the facility’s interior is recommended where possible. Opening windows and doors is also advised. However as the highest daily temperatures at this time of year are likely to be below 10 degrees this may not be practical at all for managing the space of many frail and elderly folk who need to keep warm at all times.
“Living room temperatures should ideally be kept at 70F (21C) and above whereas bedroom temperatures should be kept at a minimum of 64F (18C)” says Caroline Abrahams, Charity Director of Age UK who adds that ‘It’s vital for older people to keep warm, both inside and outside their homes in the winter months. Being cold, even for just a short amount of time can be very dangerous as it increases the risk of associated health problems and preventable deaths during the winter. (4)
In larger families with many loved ones, choosing two individuals to consistently visit a relative is a difficult situation. This rule will often mean excluding other family members from having any contact at all. This is hard for everyone involved and one of the many sacrifices we have all made this year.
Nevertheless it is clear that these new regulations are a big improvement. Previously the care homes policies meant nobody being able to visit their relatives, who may have degenerative illnesses such as dementia or be living with cancer or other long term and chronic conditions, that may negatively affect their longevity.
Special provision is made for residents who are judged by the care home managers to be in their final months, weeks and days of life. In this circumstance senior staff are encouraged to enable visits by a residents family as much as is practical to ensure the highest quality of care possible and to allow people to die with dignity.
These ‘end of life’ meetings are to be carried out with the most careful observance of social distancing, hygiene, temperature testing and PPE use possible. Currently in several establishments in Sussex visitors books are used to record who is visiting, their contact details and exactly when they visited. Plastic gloves and aprons and masks are worn by all visitors.
Healthcare assistants that are expert in elderly and vulnerable care are taking good care to help prevent infections spreading inadvertently. This includes keeping individual household bubbles separate at any one time on days that they welcome guests into their residents rooms.
There is good reason to be positive about the future. Private residential care is an important part of our communities. 800,000 doses of Pfizer’s approved vaccine which offers protection against Covid-19 are on their way to the UK this week according to the BBC this evening. “Elderly people in care homes and care home staff have been placed top of the priority list, followed by over-80s and health care staff” it was announced today in a press conference with health secretary Matt Hancock. If all goes to plan we can look forward to meeting together and hugging our seniors in relatively normal manor by the summer holidays.(6)
(1) ‘Local restriction tiers: what you need to know’ Gov.UK website official guidance, 2 December 2020 ‘Local restriction tiers: what you need to know’ Gov.UK
(2) ‘Visiting care homes during Covid-19’, Gov.UK website official guidance, 1 December 2020 ‘Visiting care homes during Covid-19’, Gov.UK
(3) ‘UK: Older people in care homes abandoned to die amid government failures during COVID-19 pandemic’ Amnesty International, 4 October 2020 ‘UK: Older people in care homes abandoned to die amid government failures during COVID-19 pandemic’ Amnesty International
(4) ‘Older people concerned about staying warm at home’ Age UK website, 28 October 2013 ‘Older people concerned about staying warm at home’ Age UK
(5) Image of interior by Illums Bolighus, Copenhagen, Denmark, 3 March 2017 https://www.illumsbolighus.com/
(6) ‘Covid-19: Pfizer/BioNTech vaccine judged safe for use in UK from next week.’ Michelle Roberts, Health Editor, BBC News Online, 2 December 2020 ‘Covid-19: Pfizer/BioNTech vaccine judged safe for use in UK from next week.’ Michelle Roberts, BBC News