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

[MoreToExplore]

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!

*cross contamination

I don’t know what the answer is but I feel totally robbed of the last 7 months of my mam’s life. If something were to happen to her now, I haven’t seen her properly for 7 months. I haven’t hugged her or even held her hand.
I can’t complain about her home. They’ve been fantastic. There’s been no COVID in her home and they’re doing great. But this isn’t sustainable. How long can this go on?! My mam has Alzheimer’s and just doesn’t understand. Not being able to see her is heartbreaking.

I agree that the care home visiting situation needs a review.

Unfortunately your lovely idea would only work on a home-by-home basis - it's simply not possible for most homes to split themselves completely in half.

However, care home managers do have some leeway over their visiting policies, and it's clear that some are more focussed on enabling visits while others are more focussed on virus defence. It would be good if there could be some actual science or firm guidance on this for care homes as the situation is absolutely hideous.

@PinkiOcelot; I am so sorry for your situation. I'd be interested to know - would you prefer to take a bit more risk so you could visit her, or do you think the current measures are best?

It’s not workable. Back at the end of April a local care home admitted some relatives who swore blind that they didn’t have COVID symptoms to say goodbye to their father/grandfather who was on end of life care. They were given PPE for their visit and over the course of the day 5 of them visited, in just that room. The man died 3 days later. The staff caught COVID having kept the home COVID free by living in and whilst asymptomatic spread in to the residents. There was an out break of around 36 linked to it with several deaths and some staff still suffering from Long Covid. The son of the man who died later admitted that he knew he was ill, he’d had coughing fits whilst in the room for 3 hours or so and had taken paracetamol to lower his temperature prior to the visit. All of his immediate family also had it.

And that was with intense cleaning and PPE.

I managed a care home during a COVID outbreak. I am finding the whole situation utterly heartbreaking and my heart goes out to families desperate to see their loved ones and vice versa.

I do think we are going to have to rethink the national strategy on visiting-but it has to be supported by government as well. Care homes are being instructed to restrict visiting. If they do not do this and something goes wrong, there will be serious repercussions for them. Zoom calls are not the same. Garden visits are not the same. Wearing full PPE at a 2 metre distance is not the same.

But the alternative at the moment is fairly bleak. It is extremely difficult to limit the spread once it is in the home. We had to have a completely separate staff team to care for the residents with COVID, the staff level went through the roof, staff were off so agency use went up (huge financial implications for an already poorly funded sector), Zone the home, the PPE used was enormous, you have to think about logisitics of home layout for donning and doffing, waste management, linen management. The only way we controlled it was military precision and it was not OK. I am still scarred from the pressure of it. I slept for about 2 hours a night for 5 months.
Bearing in mind in Jan, the gov guidance was to isolate preferably in a negative pressure room to limit the spread (care homes simply do not have).

If visiting is allowed (and believe me, I am desperate to see this!) COVID will almost certainly be taken into the home. We all know what that can mean. I wish I had an answer :(

@Purplewithred I honestly don’t know. Sometimes I think what is the point in all of this, yes she’s safe but at what end?
When we were able to visit, I did dread the visits because she was getting more and more agitated each visit. Now they’re suspended again.
Then on the other hand, I’m thinking she’s safe and that’s the main thing.
The whole thing gets me so down tbh.

How do you split a care home?

Maybe possible for large ones, but you need completely separate facilities, staffing etc., which need to be properly separated. Maybe if there are, say, 2 or more separate buildings.

What about night staff? You couldn't have, say, one qualified nurse covering both halves. You'd need two, even if usually only one is required. What about GPs, hairdressers, etc - are they going to be happy to go into a potentially covid infested area?? Are the "don't care about covid residents" happy not to receive NHS treatment if they become ill - obviously it will increase the numbers catching covid, so that means more strain on local hospitals etc.

I think an effort needs to be made to do something because it's completely unfair and emotionally damaging to vulnerable people. This has gone on long enough and the end is not in sight.

Maybe an appointment system to visit?

There be a set maximum number of people visiting at any one time throughout the home.

The appointments could be set by the home only at times they can accommodate.

Under no circumstances do visitors come within 2 meters of any staff and residents.

A designated room/area for visiting that can be cleaned easily. Unless residents are bed bound in which case chairs could be placed a good distance away and not to be moved.

I don't believe it isn't possible for visiting I just think homes need to find a safe, practical way to do it and visitors need to stick to the rules to ensure it works.

I can't imagine how traumatic it must be for families to be torn apart at a time someone needs people around them the most.

@Needbettername

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?

^^This.

YANBU. The whole thing is utterly inhumane.

I know it’s not a popular view on here but all these measures and restrictions to ‘ protect the elderly ‘ ..... from what ? Miserable existence isolated in a care home ? That’s not living... I’ve seen grandparents of friends literally wither and die over the last 6 months completely alone having not seen family members and loved ones fir ages. Totally unacceptable
Yes I agree Measures should be in place- Ppe, testing, Etc it’s criminal to stop people seeing family
My own parents , in their 80s still come to see grandchildren etc / they simply want to enjoy whatever time they have and not be locked away

Your heart is in the right place OP and it's a lovely idea in theory. However people on this thread have done an amazing job at outlining all the issues that make it impossible.

What a desperately sad situation for everyone involved - residents, staff and families

This has turned into a hopeless and depressing thread, sorry about that! No easy answers.

Thinking about community care though, where the carers visit homes a few times a day- the carers will be mixing with loads of different patients and their families as well, is that really very different from a care home situation in terms of the spreading? I guess there’s perhaps not the same shared equipment.

So unfair to expect the elderly to live out one of their last years (and it will at least have been one year but possibly longer) in this inhumane manner.

My Mil went into a nursing home the day before lockdown for respite. She was only supposed to be in there for 3 weeks.
We were told the next day 'sorry no visits, she is not leaving until covid is over'. Her health has deteriorated and so
she now is there permanently. One of the team got her on zoom so we could see her.
It's only the last month that we have been allowed on to the grounds to stand at a window.
They have the top opening light open but she has started to go deaf so can't hear what we say.
We cannot complain about her care as they are doing their best. But when we do speak she just wants to die as she doesn't
want to be in there. (She couldn't look after herself).
I don't know what the solution is for our vunerable family members of society.

I know it’s not a popular view on here but all these measures and restrictions to ‘ protect the elderly ‘ ..... from what ? Miserable existence isolated in a care home ? That’s not living... I’ve seen grandparents of friends literally wither and die over the last 6 months completely alone having not seen family members and loved ones fir ages. Totally unacceptable.

As a few other posters have pointed out, it's not just about "protecting the elderly." There are young disabled people who live in care homes too, who have many years ahead of them. But as always they're forgotten about in conversations like this. And the staff deserve protection too, they're putting themselves at risk (for very low pay), why should they have to face even more risk?
As for protect the elderly from what. Well from needlessly dying an awful and premature death from catching Covid?

[quote Purplewithred]@PinkiOcelot; I am so sorry for your situation. I'd be interested to know - would you prefer to take a bit more risk so you could visit her, or do you think the current measures are best?[/quote]
Having a similar situation to PinkiOcelot's, I'd prefer the risk if it were just me and my mother affected. But of course I recognise that it's not.

We weren't allowed to visit MIL once lockdown happened.
She caught Covid and died.
We weren't allowed to visit even at 'end of life.'
Not sure if rules are different now. I suspect not.

The way I see it you cannot cut off people from the outside world indefinatly, and certainly not for 7 months.

People in care homes typically are in ill health, rrue, but they are also typically near end of life. A large % die every year - in the home near me, they have a 30% yearly turnover of residents. If the restrictions go on for a whole year, that would mean about 30% of the people in that place will have died being isolated for a year.

If I were elderly living in a care home I would be seriously pissed off, I'd be inclined to make some kind of legal challenge though goodness knows most of the people in those places don't have the stamina needed to do anything like that. If my parents were in such a place I would take them out if I possibly could make it work, even if it wasn't ideal.

lex345 thank you for all that you did for your team and residents. My DM’s care home manager and lead nurse both resigned this month after doing pretty much the same as you. It must have been frightening and draining and incredibly stressful.

I know it’s not a popular view on here but all these measures and restrictions to ‘ protect the elderly ‘ ..... from what ? Miserable existence isolated in a care home - Surely you know it's not as simple as that though? A care home resident is less likely to survive Covid than the infected (asymptomatic?) visitor that gave it to them. The numerous staff that would then be needed to care for the infected resident through to end of life are now expected to put themselves and everyone they come into contact with at risk while the visitor heads off home.

@JennyMcLenny

I know it’s not a popular view on here but all these measures and restrictions to ‘ protect the elderly ‘ ..... from what ? Miserable existence isolated in a care home - Surely you know it's not as simple as that though? A care home resident is less likely to survive Covid than the infected (asymptomatic?) visitor that gave it to them. The numerous staff that would then be needed to care for the infected resident through to end of life are now expected to put themselves and everyone they come into contact with at risk while the visitor heads off home.

So how long are you willing to keep them isolated? It's already been to the end of life for many.

Visors don't work.
Do patients with dementia who don't understand have the capacity to decide if they see their family ? Do the family have the right to decide on their behalf? Does anybody have that right ?
What about the rights of the care home staff ?

How are you going to explain to someone with dementia that they have to leave the room they have lived in for 10 years because it is now in the 'Covid zone'.

Also most care homes only have one kitchen and one laundry.

I'm not unsympathetic OP I've not been able to see my dad for months and he isn't in a home but it just would not be workable.