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A lifelong friend and me

MartinWL

Registered User
Jun 12, 2020
223
It is a mess!. To clarify for anyone trying to follow, there are a number of laws that govern care home provision e.g Consumer law. In cases of negligence this reverts to case law in which a test has to be proved in order for negligence to have taken place. Negligence cases are unique in that each test or standard of measure is adapted to the particular matter in question. So any test of negligence by a care home would be proportionate to that which is accepted as an acceptable standard of care. On that basis the claim would not be on whether the care home was opened to visitors, but what foreseeable measures were taken to reduce the risk of harm to other residents who were not being visited at the time. (in a nutshell). I think there is too much emphasis on only one factor here rather than weighing all of the issues at stake and coming up with a balanced approach.
Everything you say here is correct but you have put your finger on the conflicting issue, which I have made bold in the quote. What is currently regarded as an acceptable standard of care may very probably be strict adherence to government guidelines. Of course, before you take me to task, that has not been tested in court, but it would be reasonable for a care home manager to make the assumption that falling below the standards set out in government guidance would expose him to a future risk of litigation, the claimant basing his case on that non-adherence. There could also be a prospect of criminal prosecution under health and safety legislation. Here I think the care home manager might be able to defend himself more easily as all risks, not just those of covid, need to be considered including the welfare of residents. However it would be a bold care home manager who defied popular coronaphobia and defied government guidance, and the local authority quite possibly, to take a balanced risk-based approach that took full account of the damage to residents' mental health and their welfare by denial of family visits, for example. Actually, now I think about it, there could be a case made that denial of family access constitutes a breach of S.4 of the Health and Safety at Work Act 1974 but I can't see any local authority having the guts to persue that in the current climate.
 

MartinWL

Registered User
Jun 12, 2020
223
It is a mess!. To clarify for anyone trying to follow, there are a number of laws that govern care home provision e.g Consumer law. In cases of negligence this reverts to case law in which a test has to be proved in order for negligence to have taken place. Negligence cases are unique in that each test or standard of measure is adapted to the particular matter in question. So any test of negligence by a care home would be proportionate to that which is accepted as an acceptable standard of care. On that basis the claim would not be on whether the care home was opened to visitors, but what foreseeable measures were taken to reduce the risk of harm to other residents who were not being visited at the time. (in a nutshell). I think there is too much emphasis on only one factor here rather than weighing all of the issues at stake and coming up with a balanced approach.
Everything you say here is correct but you have put your finger on the conflicting issue, which I have made bold in the quote. What is currently regarded as an acceptable standard of care may very probably be strict adherence to government guidelines. Of course, before you take me to task, that has not been tested in court, but it would be reasonable for a care home manager to make the assumption that falling below the standards set out in government guidance would expose him to a future risk of litigation, the claimant basing his case on that non-adherence. There could also be a prospect of criminal prosecution under health and safety legislation. Here I think the care home manager might be able to defend himself more easily as all risks, not just those of covid, need to be considered including the mental health of residents. However it would be a bold care home manager who defied popular coronaphobia and defied government guidance, and the local authority quite possibly, to take a balanced risk-based approach that took full account of the damage to residents' mental health and their welfare by denial of family visits, for example. Actually, now I think about it, there could be a case made that denial of family access constitutes a breach of S.4 of the Health and Safety at Work Act 1974 but I can't see any local authority having the guts to persue that in the current climate.
 

Palerider

Registered User
Aug 9, 2015
1,935
North West
watkin.observer
Everything you say here is correct but you have put your finger on the conflicting issue, which I have made bold in the quote. What is currently regarded as an acceptable standard of care may very probably be strict adherence to government guidelines. Of course, before you take me to task, that has not been tested in court, but it would be reasonable for a care home manager to make the assumption that falling below the standards set out in government guidance would expose him to a future risk of litigation, the claimant basing his case on that non-adherence. There could also be a prospect of criminal prosecution under health and safety legislation. Here I think the care home manager might be able to defend himself more easily as all risks, not just those of covid, need to be considered including the mental health of residents. However it would be a bold care home manager who defied popular coronaphobia and defied government guidance, and the local authority quite possibly, to take a balanced risk-based approach that took full account of the damage to residents' mental health and their welfare by denial of family visits, for example. Actually, now I think about it, there could be a case made that denial of family access constitutes a breach of S.4 of the Health and Safety at Work Act 1974 but I can't see any local authority having the guts to persue that in the current climate.
I think you've played a fair devils advocate, but we are in a situation where some care homes are allowing visiting and others are not. It seems that there is a consensus to allow visiting with management of risks by some organisations. It would be interesting to know nationally how many care homes are allowing visiting currently and what measures they have in place to judge the general adopted standard. After considerable pressure from families of residents, myself included my mums care home are allowing visiting this week after nearly 7 months of visitng being banned -or should I say lockdown.
Care homes have to start making decisions on visiting and eventually the Coronavirus Law will be reviewed and most likely relaxed, but that won't mean Covid-19 has gone away, care homes will still have to manage visiting -one way or another managers and care home organisations can't keep on dodging the bullet.
But another point has been missed in our banter, and one that has been raised a few times now. Many care homes are not fit for purpose from an infection control point of view. New care homes need more thoughtful design and build -less cost cutting more practicality
 

TNJJ

Registered User
May 7, 2019
1,727
cornwall
@Palerider it wasn't so much a row, it more me trying to get my point across and I got myself upset. When window visiting on most occasions bar two no one has said put a mask gloves and an apron on. It’s the same person would has said twice to do this, it was different person yesterday and she said put them on, bearing mind my husband doesn’t know who I am when I wear a mask. So I said why, she said it’s government guidelines funny I’ve not seen that bit. Anyway to cut a long story short she phoned an operations manager, another manager🙄 so I asked to speak to her and she said to me if the window is shut you don’t need a mask, fair enough. Ended the call and told her what the manager had said, she said are you telling me the truth!!!! Sorry but then I lost it. Anyway I got to see my husband without a mask Nd another more senior manager at C...... county council is ringing me on Monday supposedly and the saga continues..............
BTW have you seen the full page article in the Mail on Sunday, well worth a read
It is ridiculous that you have to wear PPE outside. No one wears it whilst shopping which going by the request to you from the care home to wear it outside an open window amounts to the same thing.
I wear a mask shopping but not an apron or gloves!
 

Bikerbeth

Registered User
Feb 11, 2019
1,556
Bedford
Out of total ignorance when you say many care homes are not fit for purpose from an infection control point of view and need a more thoughtful design can you give some examples as to what you mean. Thank you.
 

Palerider

Registered User
Aug 9, 2015
1,935
North West
watkin.observer
Out of total ignorance when you say many care homes are not fit for purpose from an infection control point of view and need a more thoughtful design can you give some examples as to what you mean. Thank you.
One of the issues around visiting has been how some care homes have no space to allow it, with residents literally on top of each other. My mums last care home was a good example, which was a modified house with add on rooms and lounge -51 residents all together with not even room to sit for all of them. This has been raised as one of the problems in allowing visiting, because care homes are saying they can't faciltitate due to lack of space. But more importantly care homes need thoughtful design not just for Covid but for any outbreak of infection. Its a balance between a sustainable income from running a care home and safety as well as residents comfort and assurity
My mums current unit is very spacious and there is an isolated room where visiting can take place seperate to all the residents but on the same floor which allows appropriate visiting -though it has taken weeks of arguing to get them to see the light.

I should say that there is a need for an isolation wing rather a room where residents are cohorted together until clear of any infection -but this means extra cost to the care home even though it is good infection control practice

Page 26 of this guidance is useful reading:
 
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Louise7

Registered User
Mar 25, 2016
2,375
I think you've played a fair devils advocate, but we are in a situation where some care homes are allowing visiting and others are not. It seems that there is a consensus to allow visiting with management of risks by some organisations. It would be interesting to know nationally how many care homes are allowing visiting currently and what measures they have in place to judge the general adopted standard.
The England guidance states that care homes need to ensure that dynamic risk assessments consider “a balance of the benefits to the residents, against the risk of visitors introducing infection into the care home, or spreading infection from the care home to the community”. Scotland & Wales have different guidance but yes, it would be really interesting to know the position across England with regards to what care homes are doing in relation to visiting restrictions to ascertain which restrictions are necessary for that particular care home and which restrictions have been put in place by care homes without a proportionate balancing of risk.

There's an on-line petition referring to the government restricting visits to only 30 mins in the garden, and not allowing indoor visits, but these are individual care home decisions, not ‘blanket’ restrictions that are included within government guidance. There are lots of different factors that need to be taken into account within the risk assessment, and I think that you’re right, the layout of the building is relevant in considering effective infection control measures.

Mum’s care home is probably 10/12 years old but seems to have been designed with a view to infection control. Access to the garden and two downstairs lounges can be made without entering inside the home, the reception area can be ‘sealed off’, there are two sets of lifts to the upper floors minimising visitor contact with staff/residents, and different units on the same floor are separated by security doors meaning that there is restricted access between groups of residents/visitors. We have been really fortunate in that both indoor and garden visits are currently being permitted for an hour at a time, subject to strict infection control measures. Staff are being tested weekly, residents are tested monthly, there are adequate supplies of PPE so that visitors can wear the same level of PPE as staff, and visitor’s temperatures are checked on arrival. Only one person at a time can visit a resident, maintaining social distancing, but there is no restriction in relation to this having to be the same person each time. The manager has said that he has considered both effective infection control measures and the residents wellbeing and is comfortable with the measures that are currently in place. It’s good that you have managed to challenge the restrictions in place at your mum’s home, taking into account the layout of the building, and that someone has (finally) listened.
 

Jaded'n'faded

Registered User
Jan 23, 2019
890
High Peak
Each winter my mum was in the care home there was a period of lockdown due to winter vomiting virus or something similar.

I can remember thinking it would make sense to have an isolation wing so residents could be moved there as necessary. It would be an area fit for purpose, easy to clean, etc etc.

But how many beds would you have in that wing? What if the number of residents with a virus exceeds that number? And in periods of no virus, it would mean the home had empty beds and they hate having empty beds for financial reasons.

It could be done but would be very difficult for small homes.
 

lemonbalm

Registered User
May 21, 2018
575
I agree, @Jaded'n'faded. It couldn't work for the smaller care homes. My mum's care-home is small with no areas which aren't constantly used, only one communal lounge/dining room. They have also had to close for days at a time due to other infections. We can't expect all care homes to have empty rooms just in case of infection. The fees would have to rocket to compensate!
 

Louise7

Registered User
Mar 25, 2016
2,375
We can't expect all care homes to have empty rooms just in case of infection. The fees would have to rocket to compensate!
Even the larger homes have difficulties managing with just one or two bedrooms empty, and the amounts needed to be spent on PPE are huge. Quite a few homes have had to close because of financial difficulties due to the covid situation, which has also increased reluctance to go into a care home. Mum's care home is quite large and has always had a fairly lengthy waiting list but currently has quite a few rooms unoccupied. Let's hope that another unwelcome consequence of the virus isn't a massive increase in fees next year :(
 

Palerider

Registered User
Aug 9, 2015
1,935
North West
watkin.observer
I agree, @Jaded'n'faded. It couldn't work for the smaller care homes. My mum's care-home is small with no areas which aren't constantly used, only one communal lounge/dining room. They have also had to close for days at a time due to other infections. We can't expect all care homes to have empty rooms just in case of infection. The fees would have to rocket to compensate!
I should clarify -the room I referred to was not a residents bedroom. Its used as a tea room, but never gets used that much. It sits outside of the unit next to it -which makes it ideal as a visiting room.
 

Jaded'n'faded

Registered User
Jan 23, 2019
890
High Peak
I think a fee increase is very likely and ....probably.... justified. PPE isn't cheap and they must get through an enormous amount.

(Having said that, I think care homes charge extortionate fees, particularly to the self-funded. Arrrgh! Don't get me started on that!)
 

Palerider

Registered User
Aug 9, 2015
1,935
North West
watkin.observer
The England guidance states that care homes need to ensure that dynamic risk assessments consider “a balance of the benefits to the residents, against the risk of visitors introducing infection into the care home, or spreading infection from the care home to the community”. Scotland & Wales have different guidance but yes, it would be really interesting to know the position across England with regards to what care homes are doing in relation to visiting restrictions to ascertain which restrictions are necessary for that particular care home and which restrictions have been put in place by care homes without a proportionate balancing of risk.

There's an on-line petition referring to the government restricting visits to only 30 mins in the garden, and not allowing indoor visits, but these are individual care home decisions, not ‘blanket’ restrictions that are included within government guidance. There are lots of different factors that need to be taken into account within the risk assessment, and I think that you’re right, the layout of the building is relevant in considering effective infection control measures.

Mum’s care home is probably 10/12 years old but seems to have been designed with a view to infection control. Access to the garden and two downstairs lounges can be made without entering inside the home, the reception area can be ‘sealed off’, there are two sets of lifts to the upper floors minimising visitor contact with staff/residents, and different units on the same floor are separated by security doors meaning that there is restricted access between groups of residents/visitors. We have been really fortunate in that both indoor and garden visits are currently being permitted for an hour at a time, subject to strict infection control measures. Staff are being tested weekly, residents are tested monthly, there are adequate supplies of PPE so that visitors can wear the same level of PPE as staff, and visitor’s temperatures are checked on arrival. Only one person at a time can visit a resident, maintaining social distancing, but there is no restriction in relation to this having to be the same person each time. The manager has said that he has considered both effective infection control measures and the residents wellbeing and is comfortable with the measures that are currently in place. It’s good that you have managed to challenge the restrictions in place at your mum’s home, taking into account the layout of the building, and that someone has (finally) listened.
Mums CH is similar on every floor and there are 104 residents, but it doesn't feel like that when you visit. Very spacious and areas that can be isolated. But the building is a more recent build than a converted house with add-ons. Like it or not I think coronavirus and Covid-19 have presented newer problems in care homes -certainly for those care homes with limited or no space and poor design. But this is now partly a private sector that has only one real concern -which means being a going concern. Hopefully lessons are learned from this year when new care homes are being planned and built.
 

Platinum

Registered User
Nov 7, 2017
75
South east
The guidance is just guidance and in theory can be disregarded by a care home as it is not legally binding. However the reality is that if a care home diverged from the government guidance to any significant degree they would be exposed to a lot of criticism at best and potentially civil litigation for negligence at worst when a resident dies. They might also have trouble with getting insurance. So unless the care home is run by a barrister who relishes a legal fight, it is understandable that they stick to the government guidance.
This Government directed the discharge of thousands of patients from NHS beds into care homes without testing at the beginning of the pandemic although they will say it was a medical decision which almost made it worse. How many of those in Care Homes who became infected and died are suing the Government? Some Care Homes have managed the risk better than others, for various reasons, including the configuration, size of home, etc, and have had a low infection/death rates. It is difficult to get correct information from Care Homes but the data is submitted regularly. Banned or restricted visits to residents is not in their best interests if the risk is managed properly, especially now testing is widespread. It is also inconsistent to allow end of life visits when the bedridden are denied any contact. It is not one size fits all and the Government knows this. Large Care Home groups operate government guidelines but their individual homes all present with different data. Residents are effectively imprisoned in Care Homes. How can this be in their best interests? It is painful enough for many of us that they are there in the first place. It will never be an easy decision to resort to a Care Home but frequent visits, every day in my case, pre-Covid, made me feel involved. Now we are left feeling anxious and adrift.
 

canary

Registered User
Feb 25, 2014
13,418
South coast
OHs care agency has recently increased the precautions taken by the carers when visiting homes. They now have to wear both masks and faceshields/goggles and I gather from talking to the carers that this, plus other restrictions in the movement of carers is as a result of government guidelines increasing the restrictions around care to people in care homes and receiving care at home.

My feeling (and I stress that this is only my opinion) is that this is a government decision resulting from a desire to keep the economy going in the face of increasing number of covid cases in the community. I suspect that they have accepted the rising cases as inevitable, although they are trying to keep them as low as possible using local lockdowns. As the vast majority of the deaths have been among the older people with other health problems (ie mostly among people having care at home, or in a care home), I suspect that they want to mitigate the rising covid cases by further restriction of contact among these people, thus effectively continuing to shield them. This keeps the covid cases mostly within the younger age group, who are much less likely to require hospitalisation, so that business can be kept open and the NHS not overwhelmed. This looks good in the statistics, but doesnt face the human and emotional health cost.

OK, Im probably cynical.
 

Palerider

Registered User
Aug 9, 2015
1,935
North West
watkin.observer
OHs care agency has recently increased the precautions taken by the carers when visiting homes. They now have to wear both masks and faceshields/goggles and I gather from talking to the carers that this, plus other restrictions in the movement of carers is as a result of government guidelines increasing the restrictions around care to people in care homes and receiving care at home.

My feeling (and I stress that this is only my opinion) is that this is a government decision resulting from a desire to keep the economy going in the face of increasing number of covid cases in the community. I suspect that they have accepted the rising cases as inevitable, although they are trying to keep them as low as possible using local lockdowns. As the vast majority of the deaths have been among the older people with other health problems (ie mostly among people having care at home, or in a care home), I suspect that they want to mitigate the rising covid cases by further restriction of contact among these people, thus effectively continuing to shield them. This keeps the covid cases mostly within the younger age group, who are much less likely to require hospitalisation, so that business can be kept open and the NHS not overwhelmed. This looks good in the statistics, but doesnt face the human and emotional health cost.

OK, Im probably cynical.
I think you are very close to home there @canary. A society needs a system of exchange to survive as a society, but the current system seems to be taking priority over everything that matters. I am not sure I understand some of the actions taken over the last several months, and probablly never will. In our world of today we had forgotten what nature can throw at us -as a species we are quite falible and never seem to learn.
 

Palerider

Registered User
Aug 9, 2015
1,935
North West
watkin.observer
This Government directed the discharge of thousands of patients from NHS beds into care homes without testing at the beginning of the pandemic although they will say it was a medical decision which almost made it worse. How many of those in Care Homes who became infected and died are suing the Government? Some Care Homes have managed the risk better than others, for various reasons, including the configuration, size of home, etc, and have had a low infection/death rates. It is difficult to get correct information from Care Homes but the data is submitted regularly. Banned or restricted visits to residents is not in their best interests if the risk is managed properly, especially now testing is widespread. It is also inconsistent to allow end of life visits when the bedridden are denied any contact. It is not one size fits all and the Government knows this. Large Care Home groups operate government guidelines but their individual homes all present with different data. Residents are effectively imprisoned in Care Homes. How can this be in their best interests? It is painful enough for many of us that they are there in the first place. It will never be an easy decision to resort to a Care Home but frequent visits, every day in my case, pre-Covid, made me feel involved. Now we are left feeling anxious and adrift.
You've hit on a few of my own feelings there @Platinum. Placing mum into a care home was not the first option, it was the last and now this situation -badly managed, fragmented and leaving many pwd in what is effectively imposed isolation with no family contact. No ones saying that lockdown wasn't required, but the situation now has got out of hand with no one in authority wanting to back track after the intial mistakes at the beginning. I just wish they'd GET IT RIGHT!
 

Palerider

Registered User
Aug 9, 2015
1,935
North West
watkin.observer
Moving on from CH visiting issues. I recieved an email form our solicitor with a proposed completion date of 11th September. I nearly choked on my coffee! I haven't found anywhere yet to live. The pressure is on to get moved pdq. I have a viewing tomorrow s am hoping I like it enough to yes this is it, but it won't be available until October :rolleyes:.

Getting ready to visit mum tomorrow as well. I'm a bit apprehensive but I guess thats to be expected
 

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