To think care home bosses should take some responsibility for Covid infections in homes

[JustAsking1837]

This is just in response to criticism over Boris Johnson's comments. Sorry if this has already been done but I've not found any threads on this surprisingly. I am no fan of Boris or the Government but day in day out I have listened to the press savagely criticise the Government no matter what it does or doesn't do and is blamed for everything. However everyone is in uproar when Boris has suggested that many care homes may have not done everything they should have to prevent infections. I am not necessarily saying they are to blame, as I don't know, but think it should be fair game for discussion.

The NHS almost ran out of PPE at one point. The PPE recommendations were downgraded eg from gowns down to just plastic aprons for most areas not on any scientific evidence but because we couldn't get any gowns. Similarly the masks were down graded from the respirator ones to just paper even on Covid wards because there were not enough. The paper ones are known only to work for about 15 mins in terms of your own protection and then are just functioning as face coverings to protect others but it's still one mask per shift. We were having masks rationed on my NHS ward and you had to ask the manager every time you wanted one as we were down to the last box.

And that was on an NHS ward
What chance did care home staff have?

@TheId

Happiness is right

Even if you believe (and I don't) that care home bosses are evil capitalist pigs then even on a financial level it makes no sense for them to want residents to die. They do not want empty beds as this will jeopardise the margins apart from anything else.

Many of them are in big financial trouble now as there are so many empty beds and the fees will be driven down.

Financially they would want to do all they can to ensure residents are alive and paying fees. Saving the cost of a few pairs of gloves is not worth the loss of many thousands of pounds care fees. Saving money would not be the reason for lack of ppe it would be lack of availability.

Do you think it will be the case that homes struggle to fill the empty rooms? I thought they were very over subscribed to the point where people who really needed residential care couldn't move in. I don't live in England so maybe it's different here.

Having said that I absolutely agree that there's no way care home owners would have inexplicably risked the lives of their staff and residents by refusing to provide PPE.

In England (or where I am anyway) it was about status quo and there was not too long a wait as the market essentially self regulates (new homes open if demand is there) but some places have lost 20+ residents in a few weeks and we have already seen a bidding war to take some of our patients from hospital (unheard of! 3 offers of care for 1 chap) and prices much lower than they were asking pre Covid just to get beds filled again.
The LA are cheerfully bartering down prices and recouping some of the danger money they paid out to get hospital beds cleared in the early stages.
You can't be too fussy with 20 vacancies. Some providers might very well go under.

Having worked in a care home with massive outbreak, I agree care home managers should have refused admittance to patients not tested (this was back in March/April). I do understand that they were under enormous pressure from the NHS to take in patients from March onwards to empty beds in preparation but I do feel they (some care home managers) were more concerned about current contracts and, indeed, future ones with the NHS rather than the safety of the current residents.
Also, the care home I worked in did not implement infection control procedures immediately (back in March) (such as mask wearing, training) because they were busy conserving an enormous amount of PPE and just being poor managers (generally) will no clinical leadership experience.

To be honest I don’t think there is a black and white answer to this , and there will be different situations in each care home , but I will tell you this. My aunt and uncle were in a care home . The staff were brilliant . The care home manager was not . I tried to move them several times because of the lack of any stimulation of any type but because they loved the staff they refused to go . They both died of covid . The only time the manager contacted me at all during that time was to express his condolences when he sent the final bill . Disgusting attitude.

Here's a tweet showcasing the official government advice from April, when care homes were being put under extraordinary pressure to accept residents back despite not being tested or house new residents, who were also not tested, to free up space in the hospitals.

People did challenge this advice at the time, but the government kept it regardless.

Johnson and co have already tried to pin the consequences of their I'll thought out guidance on the hospitals in May, now that hasn't worked they're blaming the care homes themselves. We need to hold this government to account for the laissez-faire way they've handled COVID 19.

twitter.com/StefSimanowitz/status/1260665437790130177?s=19

Having worked in a care home with massive outbreak, I agree care home managers should have refused admittance to patients not tested

It's outrageous to blame care home managers, they were unsupported and given no choice.

I heard a care home manager on radio 4 saying when they refused to take a resident back without testing, the hospital sent them anyway and then threatened them with the police.

Susan McKinney of Wellburn Care, which runs fourteen care homes in the North-East and North Yorkshire, said staff had been "threatened" with police action if they did not accept an untested patient.

She said paramedics turned up to Eighton Lodge Care Home in Gateshead on April 10 and “refused” to leave until staff accepted a resident who had been discharged from hospital.

Family say Darlington care home 'didn't disclose' father's coronavirus symptoms before his death

Ms McKinney, who said there were around 40 other residents living at the home at the time, said staff were left with no other option but to readmit the patient despite having concerns.

Speaking to the BBC, she said: “We said we can’t accept this person back.

“We needed a negative test so that we know what we’re dealing with, because we wouldn’t know, whether we would have to isolate them or whether we didn’t.”

Ms McKinney said an ambulance team from Gateshead Healthcare NHS Foundation Trust “turned up” and refused to leave.

'There had been a stand-off'

She said: “There was a sort of stand-off at the home, family members turned up and paramedics had the poor resident on the stretcher at the door, and would not go away until we allowed them in.

“All we got was ‘you’re not following the guidelines’, which is a guideline, it’s not the law, we were threatened with police if we didn’t allow this person back in because it was their home.”

Ms McKinney said both the hospital, and ambulance service - belonging to the same trust - had been “adamant” they weren’t turning back despite staff concerns that the virus could be brought into the home

www.thenorthernecho.co.uk/news/18462966.coronavirus-care-home-police-threat-refusal-accept-untested-patient/

@eleventy3isthemagicnumber

This is absolutely true. I mentioned up thread of the ambulance service just turning up in the middle of the night trying to dump patients in care homes in my hometown and then threatening the home upon refusal to re-admit, involving CQC, the LA and raising Safeguards against local care homes.

Thank you for sharing that story. People need to know what was really happening in care homes. We are nowhere near Yorkshire so it sounds like these practices were countrywide.

I’ll add that most of the care home owners and workers I know feel that the government deliberately made sure Covid got into care homes. There are a hell of a lot of fees not needing paid now that so many poor residents are no longer with us. The priority and the push that was happening in care settings at Lockdown was not for PPE but for DNARs. Even in care settings for young adults with high functioning autism. LAs were insisting DNARs were put in place without consent of individuals or their families. One woman I know was distraught that her 40 year old physically healthy Autistic husband and father of their small children had a DNAR put in place without their consultation or consent in March.

Am I suggesting that the government was exploiting the Covid situation to cut future social care spending? Absolutely.

The reason people were sent home to care homes or discharged to care homes without re testing is because the evidence was suggesting that after a week of Covid19 you were no longer infectious even if you still tested positive. We had a patient who tested positive for over 3 months. If everyone with Covid was kept in hospital until they swabbed negative, the hospitals would have been overwhelmed very quickly. Hospital workers who tested positive were expected back at work 7 days later if they felt well enough. That was the guidance. I think about 60% of care homes remained Covid free but I also think it would have been almost impossible to guarantee no spread in a care home. My daughter lives with us and works in a care home. I work in a hospital. Our youngest was attending school. Fortunately daughters care home remains Covid free but there are lots of ways that staff could be picking up Covid and spreading it. I suspect not much of the spread was from hospital discharges but easy to blame that.

Just to add, there may have been cases very early on, when it was not known how widely spread Covid was, where residents were in hospital for some other reason and were discharged to a care home to free up hospital beds for the predicted surge of Covid patients and then ended up spreading it. I can see how that might have happened as we were expected to just empty the hospitals in a matter of days and many went to care home beds.At that time there was barely any known Covid in hospitals and the testing was not working efficiently as had to be sent to Southampton and was taking long time to get results!

I think its the emptying out phase that was to blame. I certainly know of cases where patients caught Covid in hospital after going for another reason and were discharged back to care homes unwittingly only to infect many others. Covid can present with atypical symptoms in older people. We had a man in his 90s test positive and the only symptoms were a one off low grade temperature and going off his food.
We are a non acute hospital ward and certainly experienced huge pressure to take patients from the acute hospital in advance of test results because 'you should be following the guidance'. Calls to the chief exec and the CCG all over one person in their bed for one day longer vs them possibly seeding infection into our whole ward.

That’s the point though. Cleared the beds of elderly patients when the nhs had no idea if they had Covid or not. Saved the nhs but not the patients. Covid in 40% of care homes is a disgrace.

So Boris blamed them for not following guidelines which he admitted were at best not clear, while hospitals dumped untested patients on them and having very little to no PPE. Yeah you’re right OP, they should take responsibility for the failings of the state abandoning them and their heroic staff.

Op you might want to clarify where you think they went wrong?

It's outrageous to blame care home managers, they were unsupported and given no choice

Bullshit! Ultimately, care home managers have a veto who can and cannot be admitted, however, as I said upthread they, indeed, were immensely pressurised (and, possibly, felt forced) into taking these patients in fear of creating a bad relationship with the NHS and by their own senior management.
Don't get me wrong---I, ultimately, blame the government for their policy, the ever-changing information, mis-information, lack of PPE, and for severe lack of testing.
But from my experience of where I worked (and I don't speak for all care homes), it was extremely poorly managed internally.

*Do you think it will be the case that homes struggle to fill the empty rooms? I thought they were very over subscribed to the point where people who really needed residential care couldn't move in. I don't live in England so maybe it's different here.

@DressingGownofDoom
*
Care homes in the company I worked for which had homes in the south coast always have some empty rooms, occupancy is normally at about 80%. There's different levels of care though and I believe the dementia wards are often full.

They didn't "struggle" to fill rooms, but 100% occupancy was very rare. With the covid situation in care homes I expect many relatives of elderly people will put off moving them into a home until there is absolutely no other option, so that, plus the care home deaths is going to cause financial problems for the next year.

@NameChange84

Am I suggesting that the government was exploiting the Covid situation to cut future social care spending? Absolutely

That's a very serious allegation, manslaughter or even murder?

However, Johnson said he would get "Social care Done!" so i agree with you.

The only other explanation is pure incompetence but even that should attract criminal charges.

Blair sent troops to Afghanistan to patrol in flimsy Landrovers and he got away with it!

Definitely one rule for them and one for the rest.

Blair wasn’t responsible for buying the equipment. The army/MOD was. So maybe the army/MOD should have got its equipment sorted out earlier? Ditto the procurement of PPE.

@My0My

Blair wasn’t responsible for buying the equipment. The army/MOD was. So maybe the army/MOD should have got its equipment sorted out earlier? Ditto the procurement of PPE.

Actually the government took control of the PPE pipeline and were directly responsible. Many care homes couldn’t but PPE and none was supplied.

The government also changed legislation to mean managers did not have ultimate control of who was admitted.
They certainly had no control of who would be accepted into hospitals.

If I believed in the death penalty, I would be happy to see Mr Johnson go to the gallows. His lack of action in February or March has resulted in thousands more deaths than would have happened under any other Prime Minister, more deaths than Harold Shipman ever caused. I am certain a government under Michael Gove or Jeremy Hunt would have acted quicker.

No attendance at several COBRA meetings, allowing people from Europe's second highest Covid 19 hotspot at the time (Madrid) to come to Liverpool in their thousands, not engaging all labs to provide Covid 19 tests immediately, falsifying figures on tests, and other lies on an industrial scale. Refusal to sack Robert Jenrick and Dominic Cummings.

Blaming anyone else is unacceptable. He set up government and the structure that has failed.

@Lifeisabeach09

It's outrageous to blame care home managers, they were unsupported and given no choice

Bullshit! Ultimately, care home managers have a veto who can and cannot be admitted, however, as I said upthread they, indeed, were immensely pressurised (and, possibly, felt forced) into taking these patients in fear of creating a bad relationship with the NHS and by their own senior management.
Don't get me wrong---I, ultimately, blame the government for their policy, the ever-changing information, mis-information, lack of PPE, and for severe lack of testing.
But from my experience of where I worked (and I don't speak for all care homes), it was extremely poorly managed internally.

@Lifeisabeach09

Unfortunately, this is not correct. The changes in the laws and regulations meant care home managers were given no choice. That is categorically wrong and we did a huge disservice to vulnerable residents.

My work has taken me to care homes all over England and I consider myself to have a good knowledge and understanding. Some homes are very poorly managed. This situation isn’t comparable though.

Well yes. I know the government took control and failed to get PPE. I just don’t think comparing that to going to war is quite the same. The army has years to evaluate equipment and inform the MOD of procurement needs. The army evaluated what is required. They didn’t evaluate well enough. The nhs didn’t have time. At least they knew what they needed but couldn’t get it.

Given that 85% of care homes are privately owned, and chose to ignore the guidelines when they first came out, I completely agree with you.

My SIL works in a care home, and although they had PPE they were told not to wear it because it would frighten the residents. They also had a free flow of visitors in and out because management didn't want to stop them, and the staff were moved freely between nursing homes, again against recommendations.

She complained bitterly along with the rest of the staff, and was told if she didn't like it she could leave.

I really can't see how it's Boris's fault that the commercial sector were stupid and short sighted.

@Stifledlife

Given that 85% of care homes are privately owned, and chose to ignore the guidelines when they first came out, I completely agree with you.

My SIL works in a care home, and although they had PPE they were told not to wear it because it would frighten the residents. They also had a free flow of visitors in and out because management didn't want to stop them, and the staff were moved freely between nursing homes, again against recommendations.

She complained bitterly along with the rest of the staff, and was told if she didn't like it she could leave.

I really can't see how it's Boris's fault that the commercial sector were stupid and short sighted.

Well I wonder why so many services like this are privatised? Of course having a service running for profit means than money comes before people!

I thought the guidance at the beginning was that staff didn’t have to wear PPE ? I heard many examples of where care homes chose to Ignore the guidance because they wanted to do MORE than was being suggested (locked out visitors before they were told to, had staff sleeping on site etc).

There will always be varying quality within the care section especially since people working get just terrible pay. However I don’t think the widespread issue as a result of Covid was specifically about how care homes responded (although obviously there will be some that fell below standards).