to suggest care home residents should be allowed to risk seeing family?

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On listening to today’s R4 ‘Any Answers?’ there were many callers saying they hadn’t seen elderly parents for 7 months. Some had been able to see them from a 6 foot distance with a mask on, in the garden, once a week only. Many of the residents are suffering from dementia and do not understand or believe what’s going on. Many have sadly already died in the midst of all this (mostly not from covid). It was heart-breaking.

I was thinking, could a possible solution be to segregate each care home into two halves, with no crossover of staff - a ‘safe zone’ and a ‘relative-friendly zone’...

Bear with me. The ‘safe zone’ could be a bubble for residents who are happy enough not to see family, or well enough to interact via video and the limited outdoor visits available, and /or expect to live several more years. They (and the staff) don’t want to take the risk of covid.

The ‘relative-friendly’ zone could be for those residents who are in their last months anyway, and would rather be able to see family daily in a normal way, rather than spend their last months trapped in this sterile contactless environment. Even if it means taking the risk of dying in 3 months rather than in 12 months.

In the ‘relative-friendly zone’ visitation rights would be relaxed significantly.

There could be mandatory testing for the relatives - I heard there is already a campaign for this (to treat relatives as key workers, which to me makes sense).

Also maybe visors rather than face masks so that there could be lip-reading and familiarity, especially for those who are losing recognition of family due to dementia.

The big question would be about how to keep staff safe in this ‘relative-friendly’ environment. Is PPE enough to prevent young carers dying? Is there enough knowledge about how to avoid high viral load, for this risk to be acceptably negligible? Would this risk be more than a school teacher?

It just seems so illogical to be trying to prolong the life of a 99 year old with heart failure, by keeping him separate from his spouse of 70-odd years, for 7 months, per one of the calls on this radio programme today.

Interested in any thoughts, feel free to shoot this idea down if I’ve not thought it through properly!

Visors don't work to stop the spread. Most care homes are unlikely to be able to split. And what if resident A visitor gave them covid that then killed residents B and C? Could the care home be liable for not taking action to safeguard even if those residents chose to have visitors?

I think that part of deciding to go into the relative-friendly part of the home would be accepting that you might catch Covid from one of your fellow residents or their family.

I think the main issue I see is that at the moment, there are hardly enough tests for staff, never mind relatives. The other thing is, how do you decide on behalf of someone with Alzheimer's that this is a risk they would want to take? My dad and my grandma both died of Alzheimer's and from what I knew of them before they got sick, they would have chosen to take the risk and have visits, no question. But how do you make that decision for someone else?

It's a lovely idea but not workable. You would need to potentially increase staff levels, find ones willing to risk catching covid (and being able to self isolate with family... Implications for school children/partners jobs/their extended family or accomadate them for 14 days) have relatives sign agreements that their relatives are able/willing to take the risk and there would need to be no way to sue the home. Also visitors would need to be aware of the risk they would be taking away with them after each visit, it would be a track and trace nightmare potentially...

The problem here is it’s not just about the resident’s own wishes and needs. The visitor could easily be asymptomatic and bring COVID into the nursing home when it hadn’t been there before.

PPE isn’t a guarantee, sadly, either. That’s why a lot of homes had their staff members live in in order to keep COVID out.

Yes I know visors are not very effective and it would be expected covid will run through some of these ‘relative-friendly’ settings. This would be where all involved are willing to take more risk for the sake of quality of life. There would have to be a legal waiver signed. I am not sure how staff and visitors could be kept safe which would be my main concern.

It would be really hard to set up for many homes at a time when they are pretty much on their knees funding-wise. It would definitely need increased staffing.

Additionally, dementia residents are generally in a specialist unit within a care home - you can’t just duplicate that environment within the existing walls.

As someone who works in a care home in management, this is completely not do-able. It would add so much more to already stretched staffing levels.

Something certainly needs to be done and I speak as a daughter of someone who died in a care home in August having not seen us since March. My dad had dementia and felt totally abandoned. Utterly heartbreaking .

The care home my FIL is in has started allowing visits inside this week. It's still just once a week and DH had to wear a mask, apron and gloves but he said it was nicer being able to see him in his room rather than outside in a makeshift area in the car park.

I think ethically your plan sounds good, but I think practically it is unlikely to work. The only thing is to consider, if someone looks like they are in their last days, could they have a ‘fast-track’ to relatives’ home as they do from hospital? But it would put a strain on resources and some people wouldn’t have the space at home.

@TheRuleofStix that’s terrible, I’m so sorry.

The longer this goes on the more people will sadly have died isolated from family like this.

can I just remind people that not all people in care homes are old.
my dc is disabled and lives in one. they are in their 20's, the age range is 20 upwards.
We are lucky that the home has had no cases. it does mean we can only visit outside, masks(for visitors) and sd in place.

I wish I knew what the answer was, but I do think this issue needs to be addressed. My mother is 96 and in a care home. Before she went in she was really depressed and angry and regularly saying she just wanted to die. Partly due to being prescribed anti-depressants things had improved, and a factor in that was that people in the home were lovely and there was quite a lot going on in terms of activities, outings, etc. She had dementia but her memory was OKish in terms of recognising me and my siblings, knowing who our families were etc, and she really enjoyed our visits and when we took her out.

All of that suddenly stopped in March. The home did organise Zoom and Facebook calls, but she couldn't really hear or see us properly and didn't understand what was going on. When we were eventually allowed to visit, she was back to shouting how much she hated it all and wanted to be dead. She didn't recognise us immediately, maybe because we couldn't sit close to her and were wearing masks. She said she was bored, and as her hearing and vision seemed to have deteriorated I can believe it as she can't read, watch TV or listen to the radio. She couldn't understand why we couldn't sit close to her or take her out, and if anything the whole thing was making her more distressed. Now they're back in complete lockdown having had a couple of cases so we can't visit anyway.

I can see it must be living hell for her. In effect, she's in prison. And the likelihood is that this will go on for several months at best and we may never see her again in fact. It's so hard to say this, but you have to wonder whether focussing on keeping her and people like her alive at the cost of having any quality of life whatsoever is necessarily doing her any favours.

I also listened to that R4 programme. I cannot see that the trade off between staying alive and deteriorating through lack of contact is worth it.

Another thing to consider is not everyone in a care home setting is in their 80s and 90s with a year or months to live.

Also if someone is already at the point they are almost dying from whatever ails them. Is it really fair to add on the horrendousness of suffering with the extremely severe covid symptoms they would get and have to endure?

If I was already dying from say heart problems or malnutrition, I can't fathom adding on to that fever, rigor (severe shaking from fever that causes pain) all over body aches, headache, coughing, chest pain with pneumonia and drowning in mucus and pus. This is not just like a flu, but even if it was, that is still a horrible thing to suffer at the same time as dying from something else. Think about how bad you have felt if you have ever had a bad flu alone when you are healthy and strong.

Also bear in mind that there are many younger adults in care homes, as young as 30s/40s/50s with certain conditions that could have up to a decade or more life ahead of them. The risk is too much, and not fair on them or their families.

It is absolutely heartbreaking for ALL individuals and their loved ones. It is so sad and unfair that they're kept apart from family. I would love nothing more than a solution that could make it possible and safe for everyone to be together at the worst times of their lives. Especially the end.

I'm wishing a vaccine can come along asap

This thread is heartbreaking.

There were 10,000 excess dementia deaths (unrelated to covid) in April this year. I don’t know how you keep covid out of care homes while allowing for some visitors but I hope someone is trying to find a way.

What a truly awful situation. There are no good answers here, it’s horrific.

It is incredibly sad but vital to keep people away from care homes.
Zoom calls, phone calls etc aren't ideal but they are better than putting the most vulnerable at risk.

I'd like to hear from care home owners about how they are going to invest their massive wealth in the further training of care home staff, the provision of more rooms to allow effective infection prevention and control measures and of course to pay their staff more which would stop the high turnover of care home staff. They charge a fortune yet pay carers peanuts.

This whole tragedy could have been reduced if anyone discharged from hospital had been effectively barrier nursed for 2 weeks, with or without a test. We just seem to accept it is the hospital's fault/the governments fault without looking at the failure of care home owners to provide a safe place for vulnerable people. Effective isolation of discharged patients works to stop the spread of infection.

I work for a large chain of care homes and we are permitting visits in a covid secure way, bookable time slows, checks in place etc. We are all Covid tested weekly, staff and residents. If there were any cases we would lock down again.

Not workable. Nursing homes need to have as many bed filled to be cost effective. Turnover of people is unsurprisingly high.

What happens when a person who doesn't have visitors passes away? Will the home need to turn down people who have visitors but the bubble can't be extended?

Most places will have the strict minimum of staff at night and will usually not be enough to have one working in one area and another in the other. They often need to staff to move a resident.

It's just not feasible.

Not all care home providers have 'massive amounts of wealth', in fact I'd say over 90% have to account for every penny and don't just have millions to throw at stuff. This is one of the biggest misconceptions in our sector. Over 70% of our income is spent on wages where I work and this has increased year on year, then there's the huge increases in utility bills, food costs, ongoing home improvements and repairs, making sure we meet new regulations, registration fees, residents well being, residents entertainment... the list goes on and on.

There's so much more to funding, lack of funding, where the money is spent or where it can be spent than most people realise. This mindset is very frustrating. We literally put the residents wellbeing then staff education above everything. I'm well aware that I can easily get 20k plus more for my job role if I went private but I believe in what I do.

And barrier nursing is a good idea in principle. Except care homes are not nursing homes, we don't have nurses or the staff power to do so. People didn't want to work or volunteer in care at the height, who could blame them, and while we had enough to cover the residents, we just didn't have spare staff to be stopping numerous people with dementia, who didn't understand what was going on and why they couldn't live their lives as before, leaving their rooms straight away. And then what would you have us do? Lock their doors and only let them out to go to the toilet? We literally got told, X person is coming to you, they weren't tested because that wasn't standard practise at first but there's nothing you can do about it because you have a duty of care and the NHS is on it's knees.

The entire situation is heartbreakingly sad, I really do get peoples frustrations because we are too. I can't tell you the amount of times I've burst into tears over it all. But it's just not that simple, I really wish it was.

It is a horrific situation, but the difficulty seems to lie in keeping staff safe, and in the staffing and equipment level that would be required to set up, essentially, two separate care homes with no cross-overs. Two of everything: a patient in the safe-home can't use the hoist used to put a patient in the non-safe-home on the toilet etc etc.

And in preventing the home from becoming a vehicle for transferring infection to the wider community. Care home patients are not always in a position to observe careful behaviour around transmitting germs. How do you get a dementia patient to remember that they can't just cough straight into the room or understand why they mustn't touch anyone?

Even the basics such as kitchen transporting food, new intake of resident etc would cause so much extra work which is sadly too much for most.

No, it’s too risky in terms of cross contam8 action, and potentially shortening the lives of residents not yet at the end of life.

However, blanket rules are lifted when someone is in the last stages of life. A family member died of Alzheimer’s in a care home three weeks ago, and her family were able to visit as much as they wanted once she was clearly not going to be with us for long, and she died surrounded by her immediate family. They were very grateful that the care home hadn’t allowed regular visiting and that she hadn’t been taken by Covid when she might have had longer to live, and instead her illness was able to take its natural course.