Coronavirus: Neglect of Social Care

[Palerider]

An article from the British Medical Journal for those who might be interested. Your views would be valuable. Here's the link:

Covid-19: why we need a national health and social care service

Neglect of social care during the pandemic shames the UK Covid-19 outbreaks in care homes expose serious inadequacies in social care services across the UK. Data from across the world show that deaths from covid-19 mainly occur among older people, particularly those over 80.1 By 12 April 10 612...

www.bmj.com

 

[Louise7]

Well my thoughts are that the social care system has been broken for years due to under funding so it isn't going to be an easy fix! In relation to the Covid-19 situation specifically, it seems to me that the 'neglect' is in relation to treating the protection of vulnerable/elderly people as an 'afterthought'. It was clear from what had already happened in other countries that a high proportion of Covid-19 deaths had occurred in care homes, and that people were getting infected in hospitals and then being discharged back into care homes without being tested, placing staff and other residents at risk. All the focus was on 'protecting the NHS' rather than 'protecting those at high risk', and social care has only more recently been considered but only after the media highlighted what was happening in care homes. Testing was being provided to NHS staff and patients but not to care staff and care home residents, again giving the impression that social care was just an 'afterthought'. Things are starting to be put right but it is too little too late.

I'm not sure about this suggestion within the document: A plan to temporarily relocate care home residents to safe, infection-free accommodation allowing visitors; to provide covid-only facilities with extra staff support for those who do not need hospital admission;

If it is being suggested that care home residents could be located to infection-free accommodation to allow visiting then why can't visitors be allowed into care homes that are infection-free? I thought that the reasoning for stopping visits was because visitors could bring in the infection, not because visitors might catch it. Maybe moving care home residents with the virus to other accommodation might be a better option - it was suggested in the press that the empty beds in Nightingale hospitals could be used for this?

With regards to the plan to: "ensure adequate levels of trained staff in all facilities, with adequate protective equipment" how would this work, bearing in mind most care homes are privately owned? Is it being suggested that the government would fund the training of staff and provision of equipment to privately owned care homes, including those who are in a position to fund all this themselves? It's good that improvements to the social care system are now being considered but it shouldn't have taken a pandemic to make this happen.

 

[Palerider]

I'm not sure about this suggestion within the document: A plan to temporarily relocate care home residents to safe, infection-free accommodation allowing visitors; to provide covid-only facilities with extra staff support for those who do not need hospital admission;

If it is being suggested that care home residents could be located to infection-free accommodation to allow visiting then why can't visitors be allowed into care homes that are infection-free? I thought that the reasoning for stopping visits was because visitors could bring in the infection, not because visitors might catch it. Maybe moving care home residents with the virus to other accommodation might be a better option - it was suggested in the press that the empty beds in Nightingale hospitals could be used for this?

This has been raised about making safe areas for care home residents and was on Newsnight last week. It seems carehomes are built to maximise resident occupancy with no planning for anything else. I think the consensus is that a vast majority of care homes are not fit for purpose. This is something I personally have also raised, that residents with Covid-19 should be cohorted together in some way to protect other residents and permit decent care (more time and resources) to those with Covid-19, there aren't really any other options on the table-but this is now a lesson to take away as change is unlikely in the immediate future.

The reason of stopping visitors to those with Covid-19 is to prevent visitors from catching it and also prevent its spread to residents who are not infected. A Catch-22 is the current situation -without testing and cohorting into green and red areas or transferring non-infected residents to other safe areas or vice versa this will continue to be a problem as well as care staff being in short supply and under appreciated.

The article suggests change and I think bringing social care and healthcare together under one umbrella would certainly be of greater benefit having now seen first hand how badly social care has been neglected over the years.

 

[Pete1]

The article suggests change and I think bringing social care and healthcare together under one umbrella would certainly be of greater benefit having now seen first hand how badly social care has been neglected over the years.

Hi @Palerider, the care sector has been significantly underfunded for over a decade, this has been known and widely accepted. The system has been on a precipice for some time, with situations where single provider failure can lead to catastrophic breakdown in some localities. The Better Care Fund was supposed to start the integration of health and social care (NHS Trusts and Local Authorities) but in my opinion hasn't worked and failed to deliver anything of note (in terms of true integration) - as each have their own agendas to serve (neither want to release sovereignty).

It was very telling that the obvious traumatic issues that were happening in Care Homes were only brought to light a couple of weeks ago in the mainstream media, but had clearly been going on for weeks before that. Residential Care and Home Care are always in the forefront of our minds as it has been (or still is) a key part of our life and we understand the difficulties of navigating the systems, fighting to get the right care and support for our loved ones. We have experienced the traumas of home carers not turning up, or lack of staff in care homes. Now this is quite a difficult thing for me to write - for a lot of people social care isn't high on their agenda, which is demonstrated through the ballot boxes - if you haven't had personal experienced it you will be fairly oblivious to the current state of play (in the election it was highlighted there was an £11bn shortfall in funding).

In terms of the current situation what hasn't been particularly highlighted in the news is that many Care Homes have been locked down for over two months now - that is a challenge in itself, for residents. staff and of course the families.

It is a good article and helpful to highlight the difficulties of the situation.

 

[Sarasa]

My dream is that after all this we end up with a properly integrated health and social care service. I doubt that it will happen but I can hope that there are changes made.

 

[Louise7]

This article refers to how most care homes need 90% occupancy to be viable, and the impact the pandemic is having on the private care sector. I wonder how many homes will close as a result of the inability to fill empty rooms and resultant loss of revenue, and how would the social care sector cope with the potential extra burden? https://www.bbc.co.uk/news/uk-wales-52427033

In terms of the current situation what hasn't been particularly highlighted in the news is that many Care Homes have been locked down for over two months now - that is a challenge in itself, for residents. staff and of course the families.

Hopefully the impact of the lockdown on care homes, residents & families might become a consideration at some point, although judging by how things have gone so far I'm not sure that it will be high on the list. Interesting article here highlighting the "profound emotional & psychological harm" that the lockdown is having on care home residents, particularly those with dementia:

https://www.thenational.scot/news/18406029.residents-care-homes-showing-profound-signs-psychological-harm/

 

[Lawson58]

There has been a bit of a brawl going on here in Australia about the issues of care homes going into lockdown and not allowing visitors in and our Prime Minister saying that the mental health of patients is really important and that care homes need to rethink their policies.

The care homes are saying of course that they need to protect their residents who are mostly frail and unwell from Covid 19 and the only way they can do this is to keep everyone except staff out. However, there have been incidents of deaths at care homes where a member of staff has brought the virus into the facility..

The Prime Minister is adamant that by using PPE and restricting visits to a maximum of two a day and family only that residents would benefit immensely by the contact with loved ones.

Bit of a Mexican standoff at the moment.

 

[Bezzy1946]

I was very interested on reading all the comments. My husband has been in a care home since February and then we went into lockdown so not seen him for weeks. He has been admitted to hospital with a swollen elbow and tested for Covid19 which has come back positive !! The home now inform me that one of the carers was recovering from it and that two more residents were in hospital with it. I am really cross that the residents and staff were not tested for it or am I overreacting. My husband is 79 and has dementia he must be so confused bless him.

 

[Pete1]

I am really cross that the residents and staff were not tested for it or am I overreacting.

Hi @Bezzy1946, you are not overreacting at all, the response to residential care has been poor for both carers and residents. It must have been difficult for you to hear that. The revelation this morning by Edward Argar (Health Minister) that the Government took the decision to return residents diagnosed with Covid from hospital back to care homes without testing (up until 11 days ago) as they were a lower priority due to insufficient testing capacity was absolutely astonishing.

 

[Palerider]

I think the neglect of social care has become normalised @Bezzy1946 zy1946 -it seems to be OK to allow people to become third class citizens, many of whom have paid towards care through their taxes and again through their own capital. Testing and making the situation safer is not complicated but seemingly not very forthcoming.

 

[Palerider]

Anyway I watched Newsnight tonight and thought I'd post the link, rather than me repeat was said. I found it interesting what Andy Burnham, Mayor for Greater Manchester had to say, but he wasn't saying anything new. Its time the NHS and social care were integrated, here's the link:

BBC Two - Newsnight, 27/04/2020

A look at the crisis facing care providers, and what will change now the PM is back?

www.bbc.co.uk

 

[canary]

Im afraid that I am very cynical. I suspect that when this pandemic is over there will be a lot of words spouted about "lessons needed to be learned" and groups set up to look into the matter and suggest improvements, perhaps even government papers drafted. The reality (IMO) will be, though, that there will be a great number of vacancies in care homes, people will still need to move into them, waiting lists will vastly disappear, bed blocking will become less of an issue and in the light of the probable economic chaos, social care will have less priority and will be, again, swept under the carpet.

I hope Im wrong

 

[Louise7]

I'm with you @canary and don't see any real likelihood of social care becoming anymore of a priority after this pandemic. It is the one area that should be a priority now but isn't.

Testing and making the situation safer is not complicated but seemingly not very forthcoming.

I find it interesting that there is frequent reference to "following the science" yet the science shows that those in care homes are at very high risk. It isn't just the fact that they are at risk due to age/health reasons, it is also because of the way that the virus spreads within a care home environment. Decisions to prioritise testing/PPE provision to some people ahead of others is a conscious choice, not science led.

We are told that saving lives is a priority over saving the economy yet thousands of tests have now been made available to key workers - including supermarket workers, dustmen etc - to enable them to go back to work. There are no safeguards in place to ensure that those applying for these tests are actually key workers. In the meantime care homes are still not receiving the levels of testing that is needed. Research from other countries has identified that relatively high percentages of care home staff and residents who tested positive were asymptomatic - allowing the virus to spread undetected - so other countries have extended testing to all those in care homes, whether they have symptoms or not. During yesterday's daily government update it was announced that testing is to be extended to asymptomatic hospital staff but the same is not being offered to care homes. As @Palerider has said, it isn't complicated to protect those in care homes but there is no sense of any real desire to do so.

 

[Pete1]

Interesting @Palerider - especially that Vallance, one of the main Government 'Scientific' advisor predicted this effect on Care Homes back in January. Therefore one can only concluded the 'science' is followed when it suits - you are spot on @Louise7 it was a conscious decision, a choice made by the Government.

Sadly I agree with @canary, I doubt anything of note will happen. The only way integration will properly work isn't pooled funds i.e. Better Care Fund, but reassignment of responsibility to one sector - which I can't see happening, primarily as it will be deemed too costly.

 

[Louise7]

I see from the terrible figures released this morning that deaths in care homes are continuing to rise, whilst deaths in hospitals are continuing to drop. It will be interesting to see if this will make any difference at all to the prioritisation of testing & PPE or whether care homes will continue to remain a lower priority.

 

[Jaded'n'faded]

A few weeks back when covid tests and PPE were in desperately short supply, a decision was taken (I believe) to prioritise hospital staff first which left nothing for care homes. So we shouldn't be surprised at the numbers who have died. One infected carer who doesn't show symptoms can infect everyone in a care home in a few days. Wthout testing I don't see how that could be prevented.

Some of you may recall my mum died last October. Yesterday I bumped into a carer from the home she was in. She told me 21 staff have caught the virus and - so far - 19 residents have died. I imagine that won't be the final tally. It's a small place - probably only about 40 residents when full. The carer said it was heart-breaking to lose so many.

 

[Moggymad]

Some of you may recall my mum died last October. Yesterday I bumped into a carer from the home she was in. She told me 21 staff have caught the virus and - so far - 19 residents have died. I imagine that won't be the final tally. It's a small place - probably only about 40 residents when full. The carer said it was heart-breaking to lose so many.

Its shocking & I am seething that so many care home residents are dying.
My mum died last November after decline following pneumonia. In the 3 months following a further 12 residents either died ( chesty virus going round at the time) or were moved elsewhere but mostly died. This before the pandemic. I said at the time if the covid virus gets in the home it will wipe them out. However from what I been able to ascertain so far its all clear. I think it has helped that some time before it all got so bad the staff ( not sure how many) agreed to live in with residents. This was possible as most were young & without children to look after, plus a number of spare rooms were available.
I also think the reluctance to send people to hospital for treatment has contributed to losses not just from covid.

 

[northumbrian_k]

I am sorry to be cynical but the mantra about following the science (when it suits) is just a way of saying 'don't blame us' when things go wrong. It is like the phrase about 'underlying health problems' which seems like code for 'they would have died anyway'. There is a clear and to me unacceptable view that not all lives are worth the same. That is one reason why care home residents - and the people who look after them - are bottom of the pile.

 

[Palerider]

I liked the distinction between following the science and conscious choice @Louise7 -I think this shows the morality of the decision making, moreover it shows how badly this was all first thought out. I can't help feeling because these tests were in short supply at the start the good old British sense of rationing ethic came into play and now I see there is a backtrack based on yesterdays news -all care home residents to be tested. It won't come as surprise if the tests now show a high prevalence of coronavirus in care homes. I think the number of 19 deaths in one care home @Jaded'n'faded is truly shocking and a statement to how people in care homes are viewed from the higher echelons of public office. I think the reality is that while the NHS was given time and opportunity and resources to plan, the care home sector were ignored, no real thought in how to manage care homes if an outbreak occurred, but of course this is the private sector and they should have their own plans in place. The idea that pwd can be simply kept in their rooms as an isolation measure was never going to work and beyond belief coupled with lack of PPE and a large use of agency staff. The reality is that care homes as they are now cannot adequately provide proper isolation if an outbreak occurs. This last point has been raised a few times now, but it continues to fall on deaf ears.

Also agreed with the article you posted a link to in The National @Louise7, the blanket ban on visiting I think will have a huge impact on those with dementia and I can say categorically with what I am told about my own mum that my not visiting has increased her own anxiety and is asking constantly where I am and will I be coming back. Assumptions about this group of people are made without any real foundation and with nothing on the table to remedy the situation.

Some interesting points about 'following the science' as a get out clause @Pete1 and @northumbrian_k and others. I think agree, the logic of science is helpful as guide, but decision making doesn't just include 'the science' it also requires broader thinking and of course resources to carry out the decisions. I am sure no doubt that the lack of resources in a system already on its knees has encouraged the course of logic B being chosen over logic A.

I think we are right as a community to be cynical about change after this, but as the numbers of dementia grow, homes sold to fund care, inheritances lost and more and more younger generations not being able to buy their own homes the point will come where very few people will be in a position to fund their own care -this is the stark reality of the future. At some point the politicians are going to have to bite the bullet.

The sad reality is that it all comes down to money and who can shout loudest -life is worth more than this, and pwd are human beings who have put their faith and trust in the system only to be repeatedly let down. Sorry but it makes my blood boil, so I'll stop now.

 

[Louise7]

now I see there is a backtrack based on yesterdays news -all care home residents to be tested. It won't come as surprise if the tests now show a high prevalence of coronavirus in care homes. I think the number of 19 deaths in one care home @Jaded'n'faded is truly shocking and a statement to how people in care homes are viewed from the higher echelons of public office.

Yes @Palerider an interesting backtrack yesterday on testing all those in care homes regardless of whether they have symptoms or not. I'm afraid that the assertion that protecting those in care homes "was a priority from the start", seemingly based on a recollection of care homes being mentioned at a meeting in January, is not supported by what has actually happened. How did anyone think that discharging patients into care homes without testing them first, in order to free up beds and 'save the NHS', was helping to protect those in care homes?? I discovered at the weekend that more than 20 residents have died in Mum's care home and feel that she and the other residents are now 'sitting ducks' unless the promised testing materialises soon. It seems that the absence of figures showing numbers of deaths in care homes is somehow being used to explain the lack of action but there is no explanation as to why they only sought to obtain the figures in the last few weeks, following pressure from the media, despite knowing that over half of all deaths in Europe had occurred in care homes.

the blanket ban on visiting I think will have a huge impact on those with dementia and I can say categorically with what I am told about my own mum that my not visiting has increased her own anxiety and is asking constantly where I am and will I be coming back. Assumptions about this group of people are made without any real foundation and with nothing on the table to remedy the situation.

At the start of the lockdown Mum was her usual happy, smiley self but in recent photos sent by staff she looks worried and unhappy. The staff say that she is OK but when I tried a video call she was looking round for me and I'm concerned that she will think that something has happened to me or that I have abandoned her. The assertion that people's mental wellbeing is very important, and they can keep in touch with family via video or phone calls, shows a complete lack of understanding of dementia. My blood is boiling as much as yours is!