DEMAND was rising this week for deaths from Covid-19 in care homes to be reported in the daily government press briefing, alongside the figure for deaths in hospital. The pressure increased after the Work and Pensions Secretary, Thérèse Coffey, said on Monday that she understood the number of deaths of care-home residents to be “about 1000”.
Ms Coffey also said that care homes were being provided with the right equipment to care properly for residents. “Care-home providers are able to access PPE [personal protection equipment] from wholesalers and others who are not discriminating between social care or local NHS care,” she told ITV on Monday. “But we will continue to make sure they are part of aspects of the delivery network.”
There are 11,300 care homes for older people in the UK. Figures earlier this week showed that 2099 had been hit by the coronavirus, prompting Age UK to suggest that the virus was “running wild” in them. Ninety-two homes were reported to have had outbreaks in a single day. The charity’s director, Caroline Abrahams, said that the current figures were “airbrushing older people out like they don’t matter”.
Her comment was echoed by many. The Bishop of Ripon, the Rt Revd Helen-Ann Hartley, said on Tuesday: “Over recent days I have become deeply concerned that the figures that are being reported of those who have died from Covid-19 do not include numbers from the care-home sector. Any Government must be held to account in how it cares and accounts for its most vulnerable citizens.
“Residents and staff in care homes are often forgotten about. It is right that organisations such as the Alzheimer’s Society and Care England are drawing our attention to the hidden plight of care homes, and I add my voice to theirs in support of a call for the fullest reporting possible.”
Age UK and other charities also responded swiftly last week to what it described as “shocking examples where blanket decisions seem to be being made about the care and treatment that will be available to older and vulnerable people, who have been pressurised into signing ‘Do Not Attempt’ CPR forms. Alongside this, many of the people affected have experienced fear and anxiety, and feel their lives and wishes do not matter. This is shameful and unacceptable.”
The Revd Dr Chris Swift is Director of Chaplaincy and Spirituality for the Methodist charity, MHA, which has 90 specialist care homes in its portfolio of residential and retirement living. Some, he said on Tuesday, had had multiple fatalities. The lack of testing meant that the majority of the people believed to have died with Covid-19 symptoms would not necessarily have been tested and probably would not have been tested post-mortem either. Any figure could thus only be “a good guesstimate”.
Homes had been urged not to have News 24 on all the time, as it was “not helpful to residents”, he said. “What they hear is that they are the group most likely to die. It’s important we don’t look at that almost as an excuse of acceptability. Yes, death in some cases may only have been hastened marginally, but we mustn’t lose sight of the circumstances in which they die. They cannot have family with them. They might have been part of a couple, the other isolating. These are complications which will lead to complicated grief.”
The churches, Dr Swift said, really needed to think about what they were going to do to respond to that grief and lack of closure, given that it could be a long time until large gatherings of people in close proximity, such as at a large memorial service, would be considered safe. There was “layer upon layer of complexity”.
Chaplains continue to go into care homes, as infection-control is part of their development and they have NHS standard PPE. Early on in the outbreak, MHA set up a pastoral support system, including phone and video links with families who cannot visit their loved ones. Those with dementia or impaired cognitive or communication skills, however, could be confused by some of these things, Dr Swift said. The intense, short periods of multiple deaths had resulted in what he called “real emotional attrition” for staff. “We are addressing it but nobody has experience of this.”
On end-of-life preferences, MHA had a good track-record of preparedness in having talked to people about their wishes, which were documented early on. “We will do everything we can to support someone’s wishes,” Dr Swift said. The sector was also beginning to think about the aftermath, he said, given that in any incremental relief of lockdown, care homes could be one of the last places to be relieved. “That is going to protract all these other things. It isn’t just about MHA but the whole sector,” he said. “We pay [care staff] a living wage, but many don’t. And we are paying this small amount of money to people who are facing fear and going into these places.”
A care worker and retired registered nurse who works in a home which locked down very early, said that, so far, no one has knowingly contracted the virus. Staff were working very hard with their “stoical residents” to keep everything as normal as possible, with activities every day, and video and phone calls for everyone who wanted them over Easter.
The news was not put on in the lounge, and staff were carefully monitoring what those with dementia were watching on their own TVs. “Headlines in the daily news can affect the mood of the whole day, and I think that some residents are picking up that care homes are the Cinderella of our health services, which of course worries them. They ask: ‘Will there be enough staff if you all get ill?’”
The staff there had very little PPE, she said, “just the usual plastic aprons that are so flimsy they break, and one box of surgical masks which are being held in reserve ‘in case we have a resident with the virus.’” There were no gowns. Care staff had bought their own goggles and made visors out of hairbands and plastic folders. The staff had had no training in how to wear PPE appropriate to the virus or how to take it off safely, she reported.
There are plans for the isolation of cases and to section off one part of the home if necessary. But this home also provides community care, in the mixture of community-based and home-based care recommended by the Care Quality Commission. Staff make community visits during a shift in the home. “All we have in the community are gloves and aprons, and I have one mask in my pocket ‘in case you come across someone who is infected’ — how would we know?”, she said. “It seems to be one of the biggest cross-infection risks we run, as we have no control over who goes into clients’ homes besides ourselves.
“As more and more homes report cases, it feels as though we are sitting on a time bomb. What comes across to me is the total unpreparedness of the whole sector for a pandemic of this nature. Managers have done their very best but there is an astonishing lack of equipment and a sense that it’s difficult to use what we have as we never know if we will get more.
“It’s also very difficult to find information about guidelines and resources. Online information is often out of date or completely inappropriate to the actual needs of elderly vulnerable people. There is a lack of medically or scientifically based advice for managers and staff about how to deal with this crisis. Many carers have no knowledge of basic non-touch techniques, and managers are floundering as to what procedures to put in place and what training to give. The official guidelines about safe practice cannot be met by a care-force dealing with close physical contacts and body fluids, 24/7, without PPE.
“Hospitals are attempting to discharge patients who may, or do have, the virus into our care. We have resisted the knowing introduction of the virus into the home. But there is a big question about how such patients will be cared for as the numbers grow.”
The Archbishop of Canterbury Tweeted on Wednesday evening: “Today I’m praying for those in care homes who are suffering with #coronavirus, and those who are working in such difficult conditions to look after them with extraordinary dedication.”
Selfless contribution. The Bishop of Carlisle, the Rt Revd James Newcome, lead bishop on health and social care, said:
AS WE continue to work together in countering the coronavirus pandemic, much emphasis has rightly been placed on the magnificent work of NHS healthcare professionals and staff. It is impossible to overstate how much we owe them; without them the challenge would have been immeasurably more daunting.
The contribution of care-home staff has been no less selfless and sacrificial. They, too, are our heroes. Day after day, and night after night, they care for our elder citizens, some of whom are among the most vulnerable in our society.
We owe both them and the people they care for a debt of gratitude.
Ensuring that elderly people in care homes are treated with dignity, shielded from harm, and given the best care possible is a priority for any civilised and humane society. These elder citizens have friends and families who love them, they have spent their lives helping to build the society that, until recently, we took for granted. Their past has built our present.
But they are not people of the past; they, too, are people of the present, and people of the future. Their presence and well-being are important for all of us; no person is of lesser or greater worth than any other. We all bear the same God-given dignity; we all share the same intrinsic value.
Sadly, some residents of care homes have become ill with Covid-19 and some have died.
It is essential, therefore, that at all levels of society, from government to individual citizens, we play our part in shielding care-home residents and in supporting the staff who care for them. From ensuring that PPE is available (while appreciating the logistical challenge), to following public-health advice to stay home and save lives, every step must be taken to protect those who are most vulnerable from this virus.
We cannot separate one part of our society from another; we cannot divide our communities into sectors and institutions, and we are glad of the attention the Government is now giving to this issue.
We continue to stand together.