What will it take for care homes to open their doors again?
When will we be allowed to get back into care homes to visit our loved ones?
While some homes are clearly working hard to find solutions to what is an incredibly difficult question, others are said to have pulled up the drawbridge and are implementing draconian measures to keep visitors out, and to isolate residents from each other.
It’s been a smouldering subject for months, and is finally being talked about in the national media. Alice Thomson in The Times talks about how we have incarcerated the vulnerable elderly in care homes, while Care Home Relatives Scotland talks to the Glasgow Times about ‘prison-style’ visiting.
Head of Policy at the Alzheimer’s Society, Gavin Terry, reports that some residents have got to the point where they’ve given up and have stopped eating and drinking. Where people living with Alzheimer’s would normally live well, the rules are making them go downhill rapidly.
Moving into a care home should be a positive choice, says the Chair of the Relatives & Resident Association, Judy Downey. The long-term result of the current situation is likely to be the closure of homes as they struggle to fill beds.
Why have care homes gone into their own lockdown?
What is making care homes quite so cautious when visiting seems to be possible in hospitals, and other areas of life have been opening up?
There’s a lot to do with fear. What happens if residents contract the virus and the link is traced back to a member of another family? It will be the home that shoulders the blame. And reflecting that, insurance is becoming harder to come by, and very expensive. Without insurance care homes can’t operate.
At the same time care homes need to achieve all sorts of balances. There’s the balance of protecting residents physically from the virus while also looking after their mental health – especially those living with dementia who don’t understand the changes happening around them. Care homes also have to balance the requests of families who don’t want to see homes opening their doors yet – and who are the majority according to Rachel Beckett, Chairman of the Wellburn care home group – with the pleas of the families who are desperate to spend time with their loved ones.
Then there’s been the confusion around guidance for care homes. The chief executive of Care England, Professor Martin Green, says that he and others were asked to comment on initial drafts of guidance, but that their feedback hasn’t been acted upon. The result is guidance that is vague, and isn’t even clear about whether it is mandatory or not. Unhelpfully, it pushes responsibility onto the care homes themselves, who have been taken completely by surprise.
Staffing is an issue too. At the beginning of the pandemic care homes were left very short of carers as staff became sick, self-isolated in case they were sick, or chose not to work for the sake of their own families. While staffing issues may have calmed down for now, the recent moves to get people back to education and the office could see more Coronavirus cases and more absentees for various reasons. Opening doors to visitors at this time, especially if the home feels obliged to provide carer support during visits, doesn’t seem to managers like a sensible thing to do.
Added to that is the attitude of local authorities. Leaked letters suggest that councils in England are requiring care homes to close their doors as the spread of the virus starts to rise again.
And finally, there’s the very major challenge of testing. Testing of residents, workers, visitors and those coming into the home from hospital is vital, but there have been endless delays in getting a working system up and running for care homes. The Department of Health has admitted breaking its promise of delivering test results with 72 hours, and we don’t know when this situation will be resolved.
What’s happening now?
For many there’s much anger and frustration that families have been kept apart for many months now.
There is no doubt that many care homes have tried to implement visiting arrangements, such as garden or car park visits, and the invention of pods. But as the weather closes in, no one knows how this is going to work over the winter. With Christmas on the horizon, this provides yet more concern for families and homes.
Those who do allow visiting are employing a variety of tools, including temperature checks, social distancing, masks, PPE and more. Contentiously, some are also assigning care workers to ‘support’ the visit, which means sitting in as a third person, though this means a lack of privacy and trust. And there are stories of visits being ended for those – especially residents living with dementia – who can’t understand about the no touching rule. It seems that for every potential solution there is at least one barrier.
There are families who are contemplating removing their relatives from their care homes, but that’s a difficult decision. It’s important to remember why they moved into the home in the first place, and whether care at home is feasible.
In direct action, John’s Campaign, which focuses particularly on those with dementia but is supporting families wanted visiting in all care homes, has instructed legal representatives to challenge the legality of the care home guidance. The campaigning group is arguing that the guidance goes against the Human Rights Act and the Equality Act.
It’s tempting for families to blame the care providers for the lack of visiting availability. But for the most part everyone does want to do their best for the care home residents, and therefore working together to get better guidance is the goal.
For those who worry about the care their loved ones are receiving without regular checks from family, the resumption of CQC inspections would be valuable. As would the recognition of the rights of residents to be represented, especially when family members have power of attorney.
Better testing is vital too, says Professor Martin Green, chief executive of Care England. But he points out that testing is expensive, and it’s not clear who will pay.
Those involved in care are pretty well united in the view that better direction needs to come from central government, and that is what they are demanding.
Update October 2020
In mid October the UK government announced a three-tier system in England for managing local conditions – medium, high, and very high risk. The advice on visiting care homes is set out in new guidance.
The guidance says that the first priority remains to prevent infections in care homes and protect staff and residents, although it does say that the goverment recognises the importance of allowing care home residents to safely meet their loved ones, especially those at end of life.
For medium risk areas, the goverment says that Directors of public health (DPHs) and care providers should follow this guidance to ensure policies for visiting arrangements and decisions are based on a dynamic risk assessment and minimise risk wherever possible. This requires consideration of:
- the circumstances of the individual care home (for example, its employee availability, resident demographics and outbreak status)
- its individual residents
- its local circumstances (local epidemiological risk, presence of outbreaks in the community)
All decisions should be taken in light of DPHs’ and care providers’ general legal obligations, such as those under the Equality Act 2010 and Human Rights Act 1998, as applicable.
In high-risk and very-high areas, the advice is different. The guidance here is that visiting should be limited to exceptional circumstances only such as end of life.
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Watch the debate hosted by Wellburn care homes