Lewis Goodall @lewis_goodall
What's going on in social care? (thread)
I spent the day in Hove, talking to social care providers and relatives of those in care.
Everyone knew that this was a sector in crisis before. It's still in crisis but now with a lot of fear thrown in. #COVID19
First, the relatives.
Virtually all care homes are on lockdown. Family visitation isn't permitted. None of the elderly residents can see their families.
This is bad but not nearly as bad as what happens if someone in the care home has Covid.
If someone in a care home has Covid 19, then managers I've spoken to say they're unlikely to be taken to hospital.
I spoke to a care home provider today who has been told that by those responsible for local health administration.
If they die from the disease, they will do so at the home, without family.
This happened to Guisseppe, who died last Monday.
His daughter, Gisella, told me she and her family hadn't seen him for 2.5 weeks-that to be robbed of those final days and hours "a chance to hold his hand was heartbreaking."
They now have to have a socially distant funeral in a few days.
How is Covid 19 getting into care homes? Through staff.
This is where lack of testing is a real problem.
With so many staff self isolating, agency staff are becoming more and more common. Those staff could be working in multiple care homes. Spreading covid.
More testing would help ameliorate that problem- by testing those agency staff frequently and by testing their permanent staff who are unsure whether they have the disease.
However, with NHS staff not getting tested, social care is even further down the pecking order.
Social care is also suffering from a PPE shortage. It's got slightly better in the last couple of weeks but it remains a big problem. One care home I visited today has just received a delivery but it'll last two weeks, with no idea when they can get more.
Residents who have dementia are finding the experience of being more or less confined to their rooms especially problematic- they're not really capable of understanding what is going on.
Residents who have dementia are finding the experience of being more or less confined to their rooms especially problematic- they're not really capable of understanding what is going on.
Staff I've spoken to say that every day "feels like a ticking time bomb right now". They know that if the disease hits, it'll spread like wild fire (one home in Hove has 16 of 20 residents infected). And if it is they're the ones who will likely have to treat them.
Care homes have therefore being tasked with two enormous challenges 1) treating the very sick for #covid19 for which staff (often on minimum wage) have no medical training 2) to in effect manage end of life and become hospices. Again, this is not what they're designed for.
Care homes have therefore being tasked with two enormous challenges 1) treating the very sick for #covid19 for which staff (often on minimum wage) have no medical training 2) to in effect manage end of life and become hospices. Again, this is not what they're designed for.
DNR forms are filled out in social care regularly but as @peterkyle says this now seems to be being done, in Hove anyway, "en masse". The suspicion of Kyle and the manager, is that this is authorities managing the disease and easing care/hospital resources at end of life.
The care managers say that these forms are reaching families, precisely at a time when they're emotionally vulnerable and that that is a problem.
Care managers also worry that by asking older people about whether they would like to be resuscitated, in this context, that some are opting to do so because they don't wish to be a burden.
What’s clear, is that social care is in effect being asked to become part of the NHS, to provide things the state would normally provide but without the the resources and the scale that the state brings. It's a unique challenge for a sector which was already in a perilous state.
If you want to learn more, tune into Newsnight now, my piece will be on shortly.
END THREAD
In case you missed it, my report from Newsnight on the #covid19 social care crisis can be viewed here:
t.co/IhZCphKDmu
Peter Foster @pmdfoster
This is a powerful thread about how social care world is becoming an (even closer) adjunct to the NHS during #Coronavirus #COVID2019 epidemic. It raises some important and difficult questions. 1/
The first is about frankness with the public.
NHS doctors on Covid frontlines are clear that these patients would almost certainly not get ventilated in hospital.
Even now, before the peak, am told prioritisation is already strong. Those with best shot get to ITU /2
This is not a random process - there are guidelines and score charts and ethical committees making evidence-based decisions.
But, per doc, estimate mortality of vented patients is around 50% - and the over 70s have much worse chances. See this on deaths by age from Times.