Time to allow visitors into care homes?

[Amelie5a]

Despite all the risks, for the welfare of people with dementia, is it time to think about how care homes might begin to allow visitors?

Two powerful thought pieces I've read this weekend:

https://scottishcare.org/finding-a-way-through-achieving-a-balance-between-risk-and-protection/

and this one

https://www.theguardian.com/comment...-care-homes-into-jails-of-enforced-loneliness

 

[canary]

Its a difficult one.
On one hand there is the mental well-being of the residents in the care home, on the other hand there is the physical well-being of these same residents who are in the "high risk" category.
The way that the virus can sweep through a care home because the residents cannot keep to social distancing has shown that anybody bringing in the virus can affect the whole home. If my mum were still in her care home now it wouldnt just be mum that I might risk by visiting, but other residents whose relatives might not want to take that risk.
I agree with allowing visits for end of life and I can see the problems with lack of visits - although I must say that if OH were in a care home he would have a much better social life with more people to talk to than he does now as there is only me and a carer once or twice a week here, and weve still got 5 weeks to go.

Im sorry, I have no answer.

 

[nitram]

Whilst agreeing with all the above the visitor should consider the possibility of them being the vector to bring C19 out of the care home into the community.

This is especially important if they live in a household with high risk or shielded people.

 

[Louise7]

There's been mention of some new guidance coming out soon around care homes but the focus seems to be on infection control. The only guidance given so far in relation to mental health & well being focuses on use of technical equipment such as phones & video so is not particularly 'dementia friendly'. At a government briefing this week it was mentioned that infection is getting in to the care homes via the flow of people in and out, and on the Andrew Marr show this morning Robert Jenrick referred to possible restrictions on staff and also 'shielding' care homes that have not yet had an infection. My mum needs social interaction and was always in the lounge in her chair but is now confined to her bed so the situation is far from ideal. The home has had a bad outbreak and is in total lockdown at the moment so residents can not even go out into the garden either, even though family could stay a good distance away.

The promised mass testing of staff and residents, whether they have symptoms or not, will help to show whether a home is covid-19 free but there won't be facilities to test visitors, and I think that managers will not necessarily want to provide PPE to visitors bearing in mind shortages/costs. I guess it's possible that individual care homes might be allowed to risk assess allowing visitors in but how many would want to let someone in, without knowing if they have covid-19 or not, placing the health of residents and staff at risk? As disappointing as it is, in the absence of a vaccination the recent comments from government make me think that there is unlikely to be any easing of care home visiting restrictions anytime soon

 

[Lynmax]

My mum went into a care home just two weeks ago following a stay in hospital. She has not yet experienced normal life in there, she was supposed to spend two weeks in her room but would not comply so they had to give up. I think she is even more unsettled than she might have been as on the one time we have spoken to her on the phone she cried because she didn't know where she was and she was angry that we were not visiting her.

But, even though there are currently no cases of Covid 19 in the home or among staff, I am in two minds about allowing visitors too soon. I'd love to pop in and see mum again but I would not want any residents to be exposed to the virus. I guess it's a waiting game.

We have not even been to the home to choose it, only dropped things off at the door, we have not met the staff, had a tour, gone through a care plan, sorted out contracts etc other than in limited phone calls. So I would be happy just to have a meeting with the manager to find out more about how the home is run.

 

[Baker17]

Despite all the risks, for the welfare of people with dementia, is it time to think about how care homes might begin to allow visitors?

Two powerful thought pieces I've read this weekend:

https://scottishcare.org/finding-a-way-through-achieving-a-balance-between-risk-and-protection/

and this one

https://www.theguardian.com/comment...-care-homes-into-jails-of-enforced-loneliness

These are interesting reads, especially the mention of signs of distress. This has manifested in the case of my OH with Alzheimer’s as they have become distressed showing anger. This in turn has lead to them refusing personal care becoming angry, swearing and threatening staff, luckily not actually using physical violence. There has been involvement from the Memory Matters team who are monitoring the situation, there will be no increased dosage of medication due to adverse reactions in the past which I am pleased about. I am currently visiting once a week and seeing them through the window and I’m pleased to say that they still recognise me, inviting me to come in, we get round that by saying I have a cold so can’t come in. I’m not sure they understand that but it’s best I can come up with.
I can’t wait for the day I can actually physically meet up with them. I have finally got a weekly phone call from staff with updates, but I don’t know how accurate the note taking is because when they called on Friday the member of staff said last Sunday my OH had personal care in the morning, I visited that day just before lunch and they definitely hadn’t had personal care, I pointed this out and the was a lot of blustering, when I visited today I noticed how keen they were to point out very detail of the personal care they had had since Friday and I must say they looked very presentable. Maybe I’m just a cynic, but going on past experiences of the social care system I tend to think it’s justified.
Sorry for the long post but it’s just how I feel and I think this situation is being ignored.
Take care x

 

[rhubarbtree]

I read the Guardian article this morning and found it rather upsetting. I think of my husband being in a caring community where he is safe and has the companionship he needs. At present he has more companionship than I do. I feel the best I can do is to support the lock down and not press for a resumption of visiting especially here in the North West where we are still at the peak of the pandemic. I would not want to be the person who took covid into the home or on a more selfish point contracted it myself (underlying health issues).

I suppose we should be grateful the care home situation is being discussed especially the unbelievably stupid decision to send untested patients out of hospital into care homes. I was flabbergasted when told this might happen. Who on earth thought this was a rational decision?

I cannot imagine what the 'new normal' will be for care homes but whatever it is someone will have to pay and I can guess who it will be.

 

[Lawson58]

Whilst agreeing with all the above the visitor should consider the possibility of them being the vector to bring C19 out of the care home into the community.

This is especially important if they live in a household with high risk or shielded people.

And I was somewhat startled to hear that starting in June, people arriving in UK will be required to be isolated for fourteen days. Is this really true?

Too late! Too late! Too late! That horse bolted weeks ago.

 

[marionq]

A strange decision @Lawson58 but he seems to be saying this is to prevent a second peak. My SIL had to go into a Care Home last week for her own safety but there are 5 cases of the virus in the home so what is safe? There are no easy answers to any of this so I’m leaving it to the professionals. When I tried to resolve all the issues I felt I was having a stroke so now I’m stepping back.

Roll on the vaccine.

 

[Lawson58]

A strange decision @Lawson58 but he seems to be saying this is to prevent a second peak. My SIL had to go into a Care Home last week for her own safety but there are 5 cases of the virus in the home so what is safe? There are no easy answers to any of this so I’m leaving it to the professionals. When I tried to resolve all the issues I felt I was having a stroke so now I’m stepping back.

Roll on the vaccine.

Its all very curious to me how different governments all claiming to be getting the best 'expert' medical advice do such different things. Many countries quarantined incoming people early by the thousands with stunning results. New Zealand, Israel, Taiwan, Austria and others undertook this process early and it worked.

A large percentage of cases here in Oz were people who came off cruise ships, and their contacts, Australian citizens and permanent residents who found themselves stranded abroad and having to be rescued, and patients in care homes. Thousands of people found themselves locked up in hotel rooms, stuck on an island resort off the coast of West. Aust., occupying disused army bases etc and spent the requirement to be isolated for 14 days,

To date, Australia has 6100+ cases and 97deaths and few cases of community transmissions. We are all wary of a second wave but I think they will move to locking down regional areas rather than a whole state or the country.

And today we found out that I can see my family on Wednesday for the first time in weeks which will be lovely.

 

[Louise7]

Having looked through the updated guidance which has been issued today it seems that the advice relating to care home visits remains the same: The Government expects all care homes to restrict all routine and non-essential healthcare visits and reduce staff movement between homes, in order to limit the risk of further infection.

I'm not sure whether the new guidance about being allowed to meet one person from outside your household as long as you stay outdoors and 2m apart (as infection risks are significantly lower outside) would apply to care home residents who are able to go outside and are not shielding?

 

[Shedrech]

the thing is that any visit from family/friends would most probably have to be monitored by a member of staff, whose responsibility is to the safety and health of every resident and other staff, and that takes that carer away from their main duties
the home my dad was in had around 60 residents, that's a lot of potential visits to deal with
maybe every visitor would fully follow any procedure set down by the care home .... however, I know visitors to dad's home did not always use the gel sanitiser at reception, some even when there was a norovirus oubreak ... it angered me that they were risking the health of their loved one, the staff and MY dad .... I stayed away to respect the need of the care home community

 

[Canadian Joanne]

From across the pond, Ontario will be extending the state of emergency till June 2. There has been some chattering about starting to reopen things gradually but I think it is too early, much as I would like to get out more.

In Canada, 20% of the COVID cases are in nursing homes, but 80% of the deaths are in nursing homes. To be fair, nursing homes have an extremely vulnerable population - even the common cold may be enough for some very ill individuals. But I am certain there will be a lot of revamping of the system, as it is obvious there isn't enough staff. It all comes down to funding, doesn't it?

As @Shedrech says, not every visitor followed the guidelines for hand-cleaning before, so I would think they would be just as careless now. Some people are, well, either not very bright, extremely inconsiderate or feel entitled.

As hard as it is when there is a quarantine, and my mother's home was locked down many times over the years, including the SARS outbreak, I think routine visits may have to go by the wayside for now.

 

[Palerider]

I think the closing paragraph from Nici Gerrards article in The Guardian sums things up at the end of well written viewpoint:

The virus has laid bare gross inequalities in the country. People living and dying with dementia – at home or in hospital or a care home – are among the most vulnerable in society, and they are also the easiest to ignore and forget.​

​

The closure of care homes to visiting cannot realistically continue from weeks to months and even beyond a year. The idea that a vaccine will resolve this isn't a given. Meanwhile as others in society will begin to enjoy the return of their freedoms, I can't help but feel this backtrack on care homes is another knee jerk reaction after 'the horse has bolted' on what was a weak response in supporting care homes from the outset.

The reality is that there is going have to be a real weighing of the benefits versus risks of re-establishing visiting in care homes as we are now moving into months and possibly a year plus. Infection control is only one aspect of care, not 'the' only aspect of care something which Nicci Gerrard articulates well in her write-up.

 

[canary]

The reality is that there is going have to be a real weighing of the benefits versus risks of re-establishing visiting in care homes as we are now moving into months and possibly a year plus. Infection control is only one aspect of care, not 'the' only aspect of care something which Nicci Gerrard articulates well in her write-up.

I agree, but there needs to be some sort of plan. Perhaps having dedicated visiting rooms that visitors can access from out side, so that they never set foot in the home, perhaps having perspec sheets up as homes in Holland and elsewhere are doing. There may be other solutions too, but I cant see that you can just open the homes up and resume visiting as before all the while the virus is circulating in the general population.

 

[Izzy]

@canary mentioned Holland and it reminded me that I had seen this article -

Dutch elderly home builds glass-sided cabin for safe coronavirus visits

A Dutch home for people with dementia has crafted a visiting cabin so that residents can safely meet with family or friends despite the coronavirus outbreak - separated only by a wall of glass.

www.reuters.com

 

[canary]

Thank you @Izzy - that is indeed what I was thinking of

 

[annielou]

That looks like a good idea.
In a simple form as some people are visiting loved ones through a window, maybe a seat could be put outside near a partially open window for visitor and one on the inside for residents. Visitors could have an appointment time they could turn up. The chairs could be antibac wiped between visitors. The chairs could be required distance apart and if wiped between visits it should stop any transferring of virus between people. It would take a staff member away from normal duties to wipe chairs and monitor resident but I imagine if doing skype or telephone calls a staff member has to spend time with a single resident then and maybe the benefit of actually seeing a loved one face to face would mean some residents were more relaxed, less anxious and calmer so wouldn't require as much attention from staff at other times. As the weathers nice at the moment too being outside wouldn't be too bad but in bad weather maybe there is an area thats covered such as a double entry door or maybe something like a smoking shelter like they had at bars could be used. I don't have a loved one in a home so have no experience and have no medical knowledge so apologies if my simplistic idea offends anyone.

 

[Palerider]

I agree, but there needs to be some sort of plan. Perhaps having dedicated visiting rooms that visitors can access from out side, so that they never set foot in the home, perhaps having perspec sheets up as homes in Holland and elsewhere are doing. There may be other solutions too, but I cant see that you can just open the homes up and resume visiting as before all the while the virus is circulating in the general population.

Yes there needs to be a 'plan' and solutions. I think there is a misunderstanding that lockdown and isolation will see the back of this virus, but unfortuantely it won't, even with a vaccine it is here to stay indefinately so there will always be a risk from now on, even if vaccines are produced on a yearly basis to allow for prevalence. As care home staff begin to enjoy the relaxing of lockdown in the future, they will again become a risk of being carriers into care homes, besides visitors. The problem doesn't just concern visiting in the short term, it requires a long term approach for all in the care home setting.

Testing is a key part of this process and continued testing will need to be a part of managing it, which so far has been a rather 'hit n miss' affair. I can see the short term use of screens in care homes being of some use, but in the long term?? The other significant contribution is that of PPE, which has now become a standing joke as countless reports reflect. PPE is going to be the main form of barrier protection for sometime and we need to get our act together as well as contact tracing and the potential of the new coronavirus contact app which may offer some help.

Finally in The Gaurdian yesterday an article by Robert Booth showed that finally common sense has prevailed after weeks of no one really having an idea what to do in care homes:

"...by the end of this week the NHS would also supply a named contact to help train care home staff – including in infection control – and that each home would be allocated a named clinician, a reflection of concern that care staff, who are not medically trained, have struggled to cope with the new virus... "​

 

[Louise7]

finally common sense has prevailed after weeks of no one really having an idea what to do in care homes

@Palerider you'll see from the link I posted in your other thread that there is now a 'plan' in place but it is only a short term one with no details of any longer term solutions, such as weekly testing of staff/residents which is happening in other countries.