Coronavirus: Neglect of Social Care

[canary]

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.

Yes, I nearly choked over those words. All the focus has been on the NHS as, quite rightly, they didnt want the NHS to be overwhelmed. But in doing so, the care homes have been completely ignored. They have only looked at deaths in hospitals, they have only tested people in hospital, they have only considered PPE for hospital staff. All of these things are important and I wouldnt want any of it downgraded, but it shows that care homes are not a priority.

It reminds me a bit of Singapore who tested and eliminated the virus among the population, but forgot about the migrant workers where the virus has now become a hot-spot and they have woken up to their plight too late. It seemed to me that the migrants were not thought about - they were invisible "non-people" and I wonder whether our elderly people in care homes are also "non-people"

 

[Pete1]

Sorry but it makes my blood boil

Hi @Palerider, I think we all feel the same - I'm sure the vast majority who have used or are using care support, be it Home or Residential will feel extremely passionately about it. It is now crystal clear that what has happened was the result of deliberate actions (or lack of action) by the Government. It was obvious from the sad evidence provided by the good people on this forum for weeks before this came on the radar of mainstream media that an unseen catastrophe was unfurling.

@Louise7, I know it isn't the same but could you write Mum a daily letter for the care worker to read to her if she can't (and leave with her), perhaps with an occasional photo. It must be tortuous for you too not to be able to see Mum - and this has been going on for months.

 

[Palerider]

One thing is for certain @Pete1 @Louise7 -this now can't be ignored. On a more positive note, an optimistic article in the Health Service Journal (HSJ):

Will covid-19 close the integrated care gap or widen it?

It is time to rapidly shift our focus onto the primary, community and social care frontline to make our vision for integrated care a reality, writes Conor Burke

www.hsj.co.uk

 

[Louise7]

Yes, I nearly choked over those words.

I actually did, as I was drinking coffee at the time!

I know it isn't the same but could you write Mum a daily letter for the care worker to read to her if she can't (and leave with her), perhaps with an occasional photo. It must be tortuous for you too not to be able to see Mum - and this has been going on for months.

To be honest I don't think the staff have the time to read out a daily letter but I've dropped off a few cards and also a big photo of my face, but it didn't help to receive a photo of Mum staring at my photo and looking sad and worried I've asked if it would be possible for Mum to be brought downstairs so that she could at least see me through a window but this has been refused at the moment but will be kept under review. The manager said that they are currently submitting names so that all residents can be tested so that might make a difference to the movement of residents within the home, if they can establish who has or hasn't got the virus. It wouldn't be so tortuous if there was even a hint of light at the end of the tunnel in relation to when/if visitors will ever be allowed back into care homes but there isn't.

 

[Pete1]

It wouldn't be so tortuous if there was even a hint of light at the end of the tunnel in relation to when/if visitors will ever be allowed back into care homes but there isn't.

I can understand that Louise, it must be horrendous for you and Mum. My heart goes out to all you good people in the same position, whether it be residential care or loved ones having to isolate at home.

 

[northumbrian_k]

To be honest I don't think the staff have the time to read out a daily letter but I've dropped off a few cards and also a big photo of my face, but it didn't help to receive a photo of Mum staring at my photo and looking sad and worried I've asked if it would be possible for Mum to be brought downstairs so that she could at least see me through a window but this has been refused at the moment but will be kept under review.

There is a potential down side to just seeing one's loved one. My wife has a range of faces that never look good on a photo, or in person, but don't mean that she is feeling any better or worse than usual. It is easy to read lots into facial expressions and to interpret these to suit what we ourselves are feeling. I haven't asked to see her through a window as I think it might cause me more worry than not seeing her. I have been sending a weekly letter with pictures and the staff have been doing their best to engage her. I was really pleased to get a home made card from her. We also had a video conversation by Whatsapp and - notwithstanding what I said above - I was pleased to see that she did not seem to be any different from when I last visited. Being settled in and accepting that her care home is where she lives, together with the caring staff and her lack of perception about time have all helped.

 

[istherelight?]

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.

I so agree with all of this. The classification of those with certain long term conditions as, basically, not being ill was a convenient way to shove the long-term sick out of the NHS system and, therefore, its financing. If we cannot afford the mantra "from cradle to grave" then we need to be honest and face up to it. As you point out, house sales aren't going to be possible forever and then what? And for those who do receive funding help it is a tortuous process at the worst possible time. As for CHC (!) I am not going to even bother to claim for the last week of my mother's life as she fought the virus. She died last week and the care home have now lost 15 of their 60 residents. And still counting. And I want to shout loudly that their lives were all precious and they deserved better.

 

[Louise7]

There is a potential down side to just seeing one's loved one. My wife has a range of faces that never look good on a photo, or in person, but don't mean that she is feeling any better or worse than usual. It is easy to read lots into facial expressions and to interpret these to suit what we ourselves are feeling.

I get your point @northumbrian_k it is difficult sometimes to know how someone is actually feeling but Mum is always so happy and smiley that when she isn't it's an indication that something is wrong. She is settled in the home and is well looked after by the regular staff, and it was one of the carers who suggested that I ask if they could arrange for me to see Mum through a window,but it's not the end of the world if I can't.

She died last week and the care home have now lost 15 of their 60 residents. And still counting. And I want to shout loudly that their lives were all precious and they deserved better.

So sorry to hear about your mother @istherelight? You are absolutely right, every life matters.

 

[Palerider]

Well at last some recognition of deaths in care homes, anyone who hasn't heard the news.

The Guardian today:

UK minister admits main coronavirus focus was NHS rather than care homes

George Eustice denies care homes were overlooked but says there was ‘a real focus’ on NHS

www.theguardian.com

 

[grannydilly]

My husband caught Coronavirus either in hospital where he had an op for a fractured hip and arm,or in the rehab unit, he stayed for 5 days. They sent him to A&E with a high temperature and sweating the night before returning to us, with the advice that he had a chest infection through insisting on lying on his bed instead of sitting in the chair, no mention was made of possible covid.. 3 days later we had a call to say he had tested positive. No wonder he felt ill, weak and confused. this has impacted on us even more because we all had to self isolate for 3weeks it prevented us from having carers in the house or any of the agencies which could have helped, he is doubly incontinent and on strong painkillers, cannot stand without the lifting aid, and is oddly demented in that he has "bouts" of shouting, crying, demanding attention, and refusing advice, on the other hand he can be very chatty with the carer we have now employed for mornings P.S the rehab unit introduced masks gloves and aprons the day we went to learn the use of the aids. We will never know where he caught it for sure, but he has now recovered from it it is 10 weeks since he fell.

 

[Louise7]

Sorry to hear that your husband has had covid-19 @grannydilly but thanks for posting to say that he has now recovered as it gives a bit of hope.

 

[Palerider]

The New York Times published an article on companies enriching themselves and then asking for bailouts as coronavirus hits their margins (Wu and Serkez, 2020). I can’t help feeling that in the UK taxpayers will be bailing out decades of bad behaviour by some care home companies as they begin to ask for more taxpayer money.

In February this year the Financial Times published an article on the care home crisis and private equity in the UK (Plimmer, 2020). The article looked at how large care home companies have creamed profits while playing with borrowing. But it doesn’t stop there, the more you dig the more startling are the facts and questions really do begin to surface about whether social care should be outsourced at all. Its easier to blame the local authorities for not paying more, but this isn’t the true picture (Kotecha, 2019).

Its complex to unravel, and I can’t help feeling the big companies like it that way -no transparency. Anyone can track the accounts and business concerns online at Companies House (Gov.UK, 2020), but you won’t find very much in the way of the accounts as most information isn’t disclosed other than charge notices and insolvency notices being served and retracted under some company names, followed by the appointment of yet more new director replacements.

This is just the tip of the iceberg unfortunately I can’t highlight all of the points on a post in a forum, but I think the publics eyes need to be opened. The problems aren’t just about funding they also about how some larger care home companies cream off fees (state and self-funders) as profit which never goes back to care of residents. There is also the buy-back of shares to enhance CEO renumerations and off-shore accounts that can’t be traced outside of the UK as well as playing with large amounts of borrowing with no reserves for delivering care etc. Two reports (Burns et al., 2016, Kotecha, 2019) cover this in detail click the links below, and I invite you to read them. One thing is for certain, things have to change and the way how larger care home companies are allowed to operate begs some serious questions. I personally would rather see the integration of social care with the NHS and at least know taxpayers money is going to where it is needed and the unfair two tier system of self-funding and state funding are abolished. I sincerely hope these companies are not bailed out, having siphoned off millions of pounds away from care provision.



References

BURNS, D., COWIE, L., EARLE, J., FOLKMAN, P., FROUD, J., HYDE, P., JOHAL, S., RHEES-JONES, I., KILLETT, A. & WILLIAMS, K. 2016. WHERE DOES THE MONEY GO? Financialised chains and the crisis in residential care CRESC Public Interest Report [Online]. Available: http://hummedia.manchester.ac.uk/institutes/cresc/research/WDTMG FINAL -01-3-2016.pdf [Accessed 05/05/2020].

GOV.UK. 2020. Companies House [Online]. Cardiff, UK. Available: https://www.gov.uk/government/organisations/companies-house [Accessed 05/05/2020].

KOTECHA, V. 2019. Plugging the leaks in the UK care home industry: Strategies for resolving the financial crisis in the residential and nursing home sector [Online]. London, UK: Centre for Health and the Public Interest (CHPI). Available: https://chpi.org.uk/papers/reports/plugging-the-leaks-in-the-uk-care-home-industry/ [Accessed 04/05/2020].

PLIMMER, G. 2020. Private equity and Britain’s care home crisis [Online]. London: Financial Times. Available: https://www.ft.com/content/952317a6-36c1-11ea-a6d3-9a26f8c3cba4 [Accessed 05/05/2020].

WU, T. & SERKEZ, Y. 2020. These Companies Enriched Themselves. Now They’re Getting a Bailout. The New York Times [Online]. Available: https://www.nytimes.com/interactive/2020/03/27/opinion/coronavirus-bailout.html [Accessed 05/05/2020].

 

[kindred]

The New York Times published an article on companies enriching themselves and then asking for bailouts as coronavirus hits their margins (Wu and Serkez, 2020). I can’t help feeling that in the UK taxpayers will be bailing out decades of bad behaviour by some care home companies as they begin to ask for more taxpayer money.

In February this year the Financial Times published an article on the care home crisis and private equity in the UK (Plimmer, 2020). The article looked at how large care home companies have creamed profits while playing with borrowing. One care home company some of you may know, Four Seasons failing debt repayments of £26m and leaving thousands of residents of an uncertain future. But it doesn’t stop there, the more you dig the more startling are the facts and questions really do begin to surface about whether social care should be outsourced at all. Its easier to blame the local authorities for not paying more, but this isn’t the true picture (Kotecha, 2019).

Its complex to unravel, and I can’t help feeling the big companies like it that way -no transparency. Anyone can track the accounts and business concerns online at Companies House (Gov.UK, 2020), but you won’t find very much in the way of the accounts as most information isn’t disclosed other than charge notices and insolvency notices being served and retracted under some company names, followed by the appointment of yet more new director replacements. As Plimmer (2020) reports, tracing the finances of Four Seasons is all but impossible.

This is just the tip of the iceberg unfortunately I can’t highlight all of the points on a post in a forum, but I think the publics eyes need to be opened. The problems aren’t just about funding they also about how some larger care home companies cream off fees (state and self-funders) as profit which never goes back to care of residents. There is also the buy-back of shares to enhance CEO renumerations and off-shore accounts that can’t be traced outside of the UK as well as playing with large amounts of borrowing with no reserves for delivering care etc. Two reports (Burns et al., 2016, Kotecha, 2019) cover this in detail click the links below, and I invite you to read them. One thing is for certain, things have to change and the way how larger care home companies are allowed to operate begs some serious questions. I personally would rather see the integration of social care with the NHS and at least know taxpayers money is going to where it is needed and the unfair two tier system of self-funding and state funding are abolished. I sincerely hope these companies are not bailed out, having siphoned off millions of pounds away from care provision.



References

BURNS, D., COWIE, L., EARLE, J., FOLKMAN, P., FROUD, J., HYDE, P., JOHAL, S., RHEES-JONES, I., KILLETT, A. & WILLIAMS, K. 2016. WHERE DOES THE MONEY GO? Financialised chains and the crisis in residential care CRESC Public Interest Report [Online]. Available: http://hummedia.manchester.ac.uk/institutes/cresc/research/WDTMG FINAL -01-3-2016.pdf [Accessed 05/05/2020].

GOV.UK. 2020. Companies House [Online]. Cardiff, UK. Available: https://www.gov.uk/government/organisations/companies-house [Accessed 05/05/2020].

KOTECHA, V. 2019. Plugging the leaks in the UK care home industry: Strategies for resolving the financial crisis in the residential and nursing home sector [Online]. London, UK: Centre for Health and the Public Interest (CHPI). Available: https://chpi.org.uk/papers/reports/plugging-the-leaks-in-the-uk-care-home-industry/ [Accessed 04/05/2020].

PLIMMER, G. 2020. Private equity and Britain’s care home crisis [Online]. London: Financial Times. Available: https://www.ft.com/content/952317a6-36c1-11ea-a6d3-9a26f8c3cba4 [Accessed 05/05/2020].

WU, T. & SERKEZ, Y. 2020. These Companies Enriched Themselves. Now They’re Getting a Bailout. The New York Times [Online]. Available: https://www.nytimes.com/interactive/2020/03/27/opinion/coronavirus-bailout.html [Accessed 05/05/2020].

im not defending the iniquities of some of the care providers, but remember the history. Every city used to have huge psychiatric hospitals on their outskirts and they were not all bad, I did a lot of visiting.
Then Thatcher closed the lot and put folk out to care in the community. There was none of course, so private homes grew up to take up the slack.
Care home providers can be rapacious and unethical but basically we don’t have much else.
When my husband became violent and impossible and I mean that, and I was broken and planning suicide, I thank god for the local nursing home, private of course, not perfect but literally saved my life and my husband was so happy there.
Warmest, kindred

 

[Palerider]

im not defending the iniquities of some of the care providers, but remember the history. Every city used to have huge psychiatric hospitals on their outskirts and they were not all bad, I did a lot of visiting.
Then Thatcher closed the lot and put folk out to care in the community. There was none of course, so private homes grew up to take up the slack.
Care home providers can be rapacious and unethical but basically we don’t have much else.
When my husband became violent and impossible and I mean that, and I was broken and planning suicide, I thank god for the local nursing home, private of course, not perfect but literally saved my life and my husband was so happy there.
Warmest, kindred

Yes of course @kindred I think that when we are desperate we will do what we have to.

 

[Palerider]

Covid-19: GPs have a fortnight to start organising weekly care home reviews, says NHS

This should never have stopped in my view, but here we are! Here's the link to the full article:

Covid-19: GPs have a fortnight to start organising weekly care home reviews, says NHS

GPs will be required to give extra support to care homes, including a weekly review of patients, within a fortnight in the next phase of the covid-19 pandemic, NHS England has said. Every care home should get a weekly clinical review of priority patients, assistance with producing personalised...

www.bmj.com

 

[Palerider]

An interesting write up in Wired:

‘I’m furious’: Failing care homes are the real coronavirus scandal

Debt-ridden care homes were teetering on the edge of collapse before coronavirus. Now, they are at the front line of the crisis

www.wired.co.uk

Still no guidance on visiting in care homes or how the lockdown will be eased on visiting

 

[Agzy]

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

You echo my thoughts @canary as I too am cynical about this brand new dawn for the caring profession with better wages and conditions which just will not happen as the economy will struggle for a while and then party politics will take over and somehow we will al forget in the smoke and mirrors that so many politicians are masters of using. Ah well, too busy for a revolution anyway ?.

 

[May30]

Is there anything I can do at an individual level?

 

[Palerider]

Is there anything I can do at an individual level?

There are things you can do by supporting the Alzheimer's Society, here's the link:

Improve dementia diagnosis

There are tens of thousands of people living with dementia in England without a diagnosis. We want to help them access the care and services they deserve.

www.alzheimers.org.uk

 

[Pete1]

An interesting write up in Wired

A very good article. A significant concern for Local Authorities as a provider of last resort. The Home Care market is equally fragile, with Local Authority hourly rates driven by their reducing budgets rather than true delivery cost (which means of course the person receiving the service will lose out e.g. providers delivering 20 mins of care instead of an hour that was commissioned - with the Local Authority turning a blind eye as they know the hourly rate does not cover costs). A challenging situation for sure, but one that has gone on for at least the last ten years, the increased costs with the pandemic will certainly make the situation far worse.