About 70-80% of care home residents have dementia but many are independently mobile not just lying in their beds. People with dementia do not understand or abide by barrier nursing restrictions. They wander about, they will not wear masks, they invade personal space and they do not wash their hands. They get aggressive if you try to force them. It is basically impossible to barrier nurse them without 1:1 staffing which care homes are not resourced for.
On the inpatient dementia ward at our hospital we quickly realised that the patients would not be effectively barrier nursed and we made a Red Zone corridor for new admissions, suspected cases and general hospital returners where at least they had some space to wander about. Most care homes would not have the space or the staffing resources to do that.
This worked out well for quite a few months until the delta variant came along and then as soon as we had one +ve case within days 100% of the staff and patients were infected and over half of the patients died. Yes they were old and had dementia and their life expectancy and quality of life wasn't great in any case. In a hard nosed pragmatic way you could say that locking down the country was not worth it to save them. You might be right. But they were (nearly) all loved by someone and it was hugely traumatic for us staff to try to look after so many people dying in a horrible way all at once whilst either sick yourself or impossibly short staffed. It was a horrible experience far far worse than anything else in my medical career. Obviously I am used to people dying, palliative care, breaking bad news but not in the volume and the circumstances that happened in the pandemic and it really hurts for people to suggest that my real lived experience is not true or exaggerated.
Even suggesting it was actually possible to prevent infections coming into care homes with the level of virus circulating in the community is pie in the sky. Care homes need staff who have to work closely with residents and the staff were getting infected by their kids at school when those were open and by their spouses working in acute hospitals or wherever. There is no PPE that's 100% effective especially as we had only paper masks not FFP3. At the time we were blamed and scapegoated by angry families for 'letting the virus in' but no-one was successful in keeping it out because it was impossible.
The only way to save care home residents was to bring down infection rates in the whole community by lock downs and later by vaccination. It can certainly be debated whether it was worth the undoubted societal harm from lockdowns but to not do that would have meant accepting even more people in care homes would die. You cannot have your cake and eat it which politicians appeared to be trying to do.