Shocked about death in care homes **MNHQ content warning**

[happyandsingle]

Just this.Cannot believe how care home residents and staff have been thrown to the wolves.
Everything focused on the NHS it's like the elderly didnt matter.
Feel ashamed how we treat our elderly and even if the government act now in my opinion it's to late as to many lives have been lost.
To think the goverment need to be held accountable for this.

It's obviously devastating when this many elderly people die in such a short a space of time, but the life expectancy of people in care homes is always short even under normal circumstances.

As a society we accept this and are normally willing for seasonal viruses to carry off a proportion of the elderly each year, as long as the virus only kills people over the average life expectancy.

Part of the reason the government has panicked and locked us all down this time is that this virus is killing younger people - 30, 40, 50, 60 year olds, in excess numbers. To me that is the real tragedy.

When the government says they don't want to overwhelm the nhs, they aren't taking about having capacity to treat all the care home residents. They won't be going anywhere near a hospital anyway. They're talking about otherwise healthy 35 year olds who could have lived another 40 or 50 healthy years.

Aren’t most cars homes privately owned?
How is the government responsible for them?

Some residents have such complex care needs and their care is funded by the NHS. Of course the government are responsible for them. The government has to ensure care home owners run their homes safely and effectively so are vulnerable are treated with the care and the attention they deserve.

'Are' should be 'our'

The problem is, as was highlighted in yesterday's briefing, we have been told repeatedly, that care homes have been left to cope alone, no tests, no PPE etc. And it is not true. The journalist who asked a very loaded couple of questions was told he was wrong, very wrong, in very clear terms.

Care homes come under PHE not the NHS and they have been active from the beginning. They have been testing, triaging etc, just with different procedures for the different circumstances.

As commercial enterprises it was always up to them to purchase PPE etc. Blame them for not doing so... they had a variety of guidelines to follow.

The truth is that care homes house those most vulnerable to COVID and are, the world over, experiencing high death rates with and without COVID, as predicted. That vulnerability is nobody's fault and is nigh on impossible to avoid without taking drastic measures that would inevitably cause fatalities too.

Of the 89 people who have died in the whole of Australia as of today, 19 of those deaths were in care homes, there have been 11 deaths in one Sydney Care home and they are expecting more. Absolutely tragic. This is a care home run by a respected charity, I think it just shows how vulnerable the very elderly are once the virus enters their environment 😐

As a carer we had hardly any protection in the beginning, and then it was restricted! Too little, too late

It unfortunately is the nature of the virus.

A friend is in a care home due to a spinal and brain injury, he’s 37. His home is individual rooms, so each time a member of staff enters a bedroom they need new PPE. He needs direct assistance with eating, drinking, toileting, dressing and bathing.

As a minimum he needs contact
-Get up/wash/dress/breakfast.
-Drink
-Lunch and toileting
-Drink
-Dinner and toileting
-Drink
-Toileting and bed

So for one person that is an absolute minimum of PPE being needed seven times. Seven gowns, seven sets of gloves, seven masks. He said they usually have around one member of care staff for each resident, so one member of staff is giving direct patient care around 35 times over a shift.

They ran out of the FFP3 masks weeks ago, as a non NHS company they have to speak to suppliers/wholesalers in person to determine if they have stock and if they are willing to supply to Non NHS. Companies are also now charging outrageous amounts for PPE.

They haven’t been able to secure testing for any staff or residents.

@WokeUpSmeltTheCoffee

Care homes - the clue is in the name but PHE decided in their advice to care homes that they didn't need to take any additional precautions, because to quote from the PHE website, they were all at low risk.

No hindsight is required, just basic infection control, no one with CV should have been put back into a care home and anyone being released from hospital should have been tested, as the rich and our politicians could get tests, there was obv no shortage of kits to do this, just as there is no shortage of PPE, D'Mail has just a plane load in from Asia

My opinion is that they did know, Prof. Chris Whitty told the govt this would happen and he was ignored... so the only conclusion is that they saw this as an ideal opportunity to reduce the numbers of the old and it could be done because most people would just accept the deaths of the elderly as collateral damage and they were right, the MSM has pretty much ignored it.

One day these people will be old and maybe then they will realise what they have done? but somehow i doubt it.

@CuriousaboutSamphire

Rubbish, PHE advice to care homes on their website, was that there was little chance of CV entering the care home system and no additional precautions to be taken, taken down 31/1.
My DD care agency cannot buy PPE from their normal suppliers and have been told to go to PHE/NHS and until recently, they wouldn't supply any.
Even now, staff told not use a mask unless client has CV symptoms.

The Telegraph reported that elderly patients were moved from hospital to care homes. The rationale for this? To create capacity in hospitals. There are serious questions to be answered about whether the measures taken to protect the NHS by creating capacity has actually caused deaths.

In two damning policy documents published on 19 March and 2 April, officials told NHS hospitals to transfer any patients who no longer required hospital level treatment, and set out a blueprint for care homes to accept patients with Covid-19 or who had not even been tested. Analysis by the Telegraph suggests that the rate of coronavirus deaths accelerated more than twice as fast in care homes than in hospitals in the week beginning 7 April - two and a half weeks after the first policy document was published. The number of Covid-19 deaths in care homes was estimated by Care England to have reached 7,500 a week ago, the Government is under pressure to start publishing a daily tally of coronavirus-related deaths in care homes. Under the government guidance, patients who tested positive for coronavirus were allowed to be sent from hospitals to care homes. The second document states that “Negative tests are not required prior to transfers / admissions into the care home

www.telegraph.co.uk/news/2020/04/24/care-homes-ordered-take-patients-suspected-coronavirus-nhs-hospitals/

Yes! The advice was taken down as it was by then out of date. The situation had changed and different measures were needed.

That's the PHEs explanation of the need for a changing care plan. The same as every country for every sector of society. The situation changes and hard pragmatic decisions have to be taken.

That's true of all epidemics, let alone pandemics!

In care homes with higher percentages of dementia patients, it has been virtually impossible to adhere to any sort of social distancing or isolation procedures amongst residents meaning that the virus has spread rapidly.

I do think there should be an investigation into employment practices in the care industry. There can be a reliance on bank staff who are on zero hours contracts and thus work in numerous locations increasing the risk of transmission. When I needed Carers for my son who needed 2 :1 care I had to insist on keeping the same agency team members. If someone new was offered I refused as the job was very skilled and I struggled on by myself. All staff had a contract with the agency for I think at the most 12 hours a week and there was competition for extra hours as staff could not earn enough in those 12 hours to pay their bills. In situations where you rely on an individual to give you extra hours it would be more difficult to raise minor issues as your hours would be at risk . This was not an issue for me because I was on duty also and could raise issues myself.
Most Carers were registered with bank agencies to pick up extra hours in other locations such as Care homes. . The local Tesco was often discussed as an alternative employer because the pay rate and job security was better.

The pay rate for the level of skill needed and the responsibility to keep someone with an unstable medical condition ? alive was a joke. Some of the Carers had years of experience but there did not seem to be any Career progression scheme for example a senior grade with more pay.

I am utterly appalled that no one has addressed the fact that the care home crisis will continue (& worsen) if we continue to discharge C19 positive patients into care homes from hospital. We've been watching this happen from the sidelines in horror for weeks and then watched the platitudes from the government about their concern for the crisis. I know there are arguments about the risk of hospital acquired infection if they remain in hospital, but I am not convinced that sending positive people into a care home is the answer.

That's been overdue for many years. I haven't had any work with care homes since about 2001 and we were shocked at the vast difference in standards between them then. That and the lip service paid to staff training etc.

That has to change...

But is quite separate from the claims that PHE did nothing to protect, monitor or measure death rates in care homes.

in the home my family member works in ALL the residents are confined to their rooms and the only contact they are having is with their key worker or other carer.

I think this is very sad though.
Keeping all the residents isolated - which will be upsetting for many - for what? So that their life can be 'saved' so they can likely die in the next year from something else?
Frail elderly care home residents will have a short life expectancy (different circumstance than younger people in care homes).
Isolating somebody in their room for a prolonged period will likely cause them to deteriorate physically, socially and mentally. What are they isolating for if they emerge after 3 months a shadow of their former self, then catch flu/ pneumonia/ have a stroke and die anyway?
Overall better to focus on quality rather than quantity of life when you are very elderly and frail.

Are you for fucking real. Dying alone gasping from breath no familiar faces, no one to hold your hand, a slow painful death alone.
Few ways to die are pleasant- many can involve 'gasping for breath'.
But being separated from loved ones for 3 months to avoid catching covid and dying without your loved one present doesn't make sense to me, in the context of somebody with a very short expected lifespan due to being very elderly and frail. Rather than spending 3 months separated from loved ones to avoid dying separated from your loved one, why not continue to have contact with your loved one in life for those 3 months?
Sadly covid will get into many nursing homes regardless as staff will unintentionally bring it in, even with PPE.

And plenty of people in care homes still have good quality of life both elderly people and disabled people. My gran had many happy years living in a care home.
Simply because you need some physical help that does not mean that you can't enjoy life

We had some frail elderly relatives in nursing homes die in the past few years, they were all enjoying life when they died but I didn't feel their death was untimely or should have tried to be delayed by heroic efforts, hospital admissions, restricting them from seeing others. Surely better to die when you are still enjoying life (but starting on a declining trajectory) rather than have life extended beyond that when dementia and other illnesses is taking its toll?

Not sure how the ? appeared in the last paragraph. It was definitely an unstable medical condition ( breathing difficulties, high risk of aspiration and fitting among numerous other issues)

I would have thought that it was pretty obvious to the Hospital Discharge Staff that discharging CV19 patients to Care Homes was problematic. Some of the empty non-CV19 Wards could have been adapted to Care for infectious CV19 Care Home patients until they were no longer infectious.

Maybe some NHS Hospitals/Trusts did consider this and do something similar - they can't have all just blindly followed Govt Policy without thinking about this surely?

From the Telegraph. The motivation behind this was to create capacity in hospitals. This has been achieved through myriad measures, including canceling surgeries, cancer treatments. NHS London instructed paramedics to apply a rigorous criteria which meant people struggling to breathe were denied hospital treatment. There is a lethal paradox at the centre of the drive to create capacity. What if the policies used to ensure hospitals are underwhelmed kill potential patients?

^a Whitehall official told the Telegraph that the policy to offload hospital patients was designed as a “stiff broom” to free up capacity in hospitals.
But care providers on Friday accused the Government of “reckless” behaviour which had “significantly” increased the number of coronavirus deaths in care homes.Dr Jamie Wilson, founder of Hometouch, which provides care to people in their own homes, said: “I’m astonished at the lack of foresight of these policies. To mandate that care homes should take back Covid-positive patients with such a high risk of cross infection and high mortality rate in vulnerable residents seems unfathomable^

Sorry to say but the care in carehomes is always awful and no one normally cares

Untrue and insulting to many staff who work in them and families who have families living in them.

Like everything some aren't great, some may be dreadful but there are some that are fantastic.

Guidance to care homes and the NHS has changed now

ALL patients being discharged to care homes from hospital ARE being tested now. We are not discharging until the test result is back.

There is also advice to isolate for 14 days if that is possible. It is possible for some eg bed bound patients or those without dementia and that is probably the safest measure to take.

How do I know? I work in care of the elderly.

Guess what though the tests are imperfect. Only 70% of negatives are really negative. Also whilst the patients are in hospital for a further 48hrs awaiting the test result they can be infected after being swabbed.

The testing is not a panacea.
A risk will always exist
It is not possible to save everyone in a care home. We should try our best but some deaths are, as I said, inevitable.

From The Times

Deaths from coronavirus in care homes could soon exceed those in hospitals as campaigners say that residents are being treated as second-class citizens. New figures showed that in the week up to April 17 mortality from all causes in care homes totalled 7,316, triple that recorded at the end of last month. Experts warned that deaths there may not yet have peaked. Sir David Spiegelhalter, a statistician from Cambridge University, said that even as cases fell nationally outbreaks were still a huge problem in care homes. “What we are seeing is a massive increase in deaths,” he said