Shocked by the news coming from care homes

[YogaFaker]

It seems that really vulnerable old people and those adults with conditions that need round-the-clock care are the sacrificial lambs in this government's inept non policies for dealing with COVID-19.

I find this shocking, really shocking. People are of value whatever their age. Yet the policy seems to have been to let them die, if they contract C-19.

There was a thread here or on aIBU which made claims for the preferential treatment of elderly people in this pandemic. I don't think so. The vulnerable elderly have been totally let down.

Shame on us.

Yes, and it sounds such an unpleasant way to die. It must be just awful for tbe residents and their carers to be getting so little medical support. I heard Baroness Altmann speaking about this on the radio a couple of days ago and she said, which I agree with, you can judge a society on how it treats its most vulnerable. Apparently some NHS trusts are trying to get care homes to take patients from hospital who have/had Covid-19 to free up beds which is just putting all the other residents at risk. Once it gets into a care home, so many of the residents are likely to die.

Surely they should go to a Nightingale hospital, not a care home?

Apparently some NHS trusts are trying to get care homes to take patients from hospital who have/had Covid-19 to free up beds which is just putting all the other residents at risk.

There was a report about this on the Channel 4 News. If you wanted to actively come up with a policy to kill off as many people in care homes as possible, this would be it.

I think they need proper hospice/ palliative care. I get that intubation is not helpful to many care home residents. If the care home can give palliative care in a manner that’s safe for all residents & staff, then going ‘home’ may be a kindness.
But it’s not something the care home are able to do, then they need to be able to refuse the residents return.

Dh works in a care home. We are not supposed to tell anyone, but despite their meticulous checking of staff temperatures each day before they start their shifts, and their policy which bans staff from even driving to work with their car windows open, they have failed to apply these procedures to the elderly people they are admitting from hospital.

We are now in a position where dh is off work for 14 days, having to self-isolate at statutory sick pay rates (about £94 a week) because he helped this old person to the loo on the night they were admitted, but before the home had checked whether he had coronavirus. The resident, you'll be glad to know, has recovered. We, however, have yet to find out if it's been brought back to our house.

People are saying how the elderly are 'lambs to the slaughter' but what about the staff?

The average age of people in care homes is 85, over 2/3 have dementia and the average life expectancy is 2.5 years.

What is the point of aggressively treating these people?

The sad thing, to me, is that so many of our elderly end up in these places in the first place. I would far rather die of Covid in good time to not be in a ‘care’ home (where the care is often shocking).

And, those who tell about it being a bad way to die, how many end stage cancer patients have you seen? I have seen a couple, including a close relative. It was not a nice death and far more drawn out than COVID. There are few ‘nice’ ways to die. My guess would be that a minority achieve a peaceful death.

Covid has, maybe for the better, caused us to see and confront some unpleasant truths about life, death and our society.

A really moving interview on R4 this morning (Dorothy about 97? Or 94)

Asked to sign forms not to go to hospital if ill. At least enable palliative care somehow.

Disgusted maybe. But shocked, not at all. There will be loads dead that never make it onto the numbers as they are old and don't matter.

I think it all the time, I really hope we can choose to be put down by the time I am old. Awful how they have to live.

*The average age of people in care homes is 85, over 2/3 have dementia and the average life expectancy is 2.5 years.

What is the point of aggressively treating these people*

This. Do you realise that a person like that wouldnt survive ventilation? All it would do would be cause them agony and pain and suffering and then it would be unsuccessful. If by some miracle it was "successful" and they survived, they likely have damaged and scarred lungs making breathing even harder than it was before. Not to mention increased pain.
CPR would likely cause them to break every rib due to osteoporosis and that would be agony too.

Of COURSE people's lives are valuable at every age, including those who are older but these are people who are in nursing homes because they require round the clock nursing care. They are already very old, frail and unwell. Why would keeping them alive for another 6 months be better when they are then in increased pain, confusion and discomfort.
I'm sorry but I dont get this obsession in this country with quantity over quality of life. Its like we are obsessed with getting everyone to live to 100 no matter how horrific or how much suffering they are going through.
There is a reason pneumonia used to be called "the old persons friend" because the people who usually passed from it were right at the end of their lives and had really had enough by that point. It would be cruel to ventilate someone of 90 with dementia and other complications like dysphagia. And before you say it, yes, I have been through it with my dad. There were times when he was in so much pain and confusion and suffering that I prayed for him to pass. If someone had tried to ventilate him I would have punched them. Sometimes the kindest thing is to let people go.

My F in L died yesterday of probable Covid at his care home - they ensured he was peaceful at the end. They have been locked down 5 weeks but the virus has swept through, the nurse with him at the end had lost her own Mum only a couple of days earlier. Matt Hancock's announcement came about an hour too late for us and now I have to support M in L and DH and DC through this awful arms length grief without any of the normal rituals or extended family physical support. Hopefully we can have a proper memorial at a later date also because my F in L was the nicest man with no edge to him at all and deserves so much better.
Care work staff are heroes and its an absolute scandal what has been allowed to happen in them.

People are saying how the elderly are 'lambs to the slaughter' but what about the staff?

The staff aren’t likely to be dreadfully unwell with it though so the protective measures are for the elderly residents.

I don’t know why there isn’t better care via the nurses in care homes to manage symptoms well and keep residents comfortable. But I can see why not moving them is promoted as that’s actually very stressful and difficult to argue is in the residents best interests if they are not suitable for active and aggressive treatment due to their age and life stage. To be in a care home they’re not going to be fit and active people sadly and the end of your life has to come at some point- often illness is a way for an older person to die as it’s their time.

Yes I think they have behaved appallingly. I am not against DNARs and end of life plans but I am against not throwing resources at this problem so that care homes aren’t decimated.

Two weeks ago I saw an interview with a care home manager getting no help. Hospitals trying to discharge patients to him without testing them and not being able to get people tested in the home.

Even now they have carefully said they will test ‘symptomatic’ people in care homes and you can bet that will only be high temperature or cough. They are completely ignoring asymptomatic spreaders or other symptoms ( in the NHS too - I know people who have lost there sense of smell but no cough or temp who have been told to work and not eligible for testing).

This all stems from having to carefully ration testing. This is the governments biggest mistake.

I

It's not that their lives aren't valuable, it's that the prospect of recovery is tiny. Taking up acute hospital beds won't make a jot of difference for the overwhelming majority.

A really moving interview on R4 this morning (Dorothy about 97? Or 94)

Asked to sign forms not to go to hospital if ill. At least enable palliative care somehow

Yes, that was what prompted me to start this thread. And the contrast with the celebration of Captn Tom Cooper's amazing fund-raising (a right celebration, of course!).

And I remembered a thread (maybe in AIBU) which claimed that if COVID-19 affected young people as it does older people, the response would have been very different, claiming that young people were being sacrificed to keep old people alive - and views were expressed on that thread which weren't far away from "They're going to die anyway" kind of thinking.

And that a child's life was worth more than an elderly woman's life.

I think we're seeing just how little policy-makers think of old people (two-thirds of whom are women).

I find this way of thinking to be quite shocking. Yes, I know that many people in care homes are at the end of their lives, and yes, I know that many of them have dementia. From the outside, their lives may seem worth less than those of our children.

But every life is worth something to the person herself! And we should be judged by how we treat those at the end of their lives. (And I'm not religious: I 'm a humanist)

I don't mean "heroic" medical procedures which have few chances of success. But surely, leaving residents of care homes and their staff simply to die from lack of prevention of a preventable infection is unacceptable and shameful.

And that a child's life was worth more than an elderly woman's life

If I had a choice to save a 5 year old child or a lady of 97 I'd save the child, yes.

I would have thought that would be a pretty obvious choice. It doesnt mean the child is more "valuable" what it means is that the child hasn't had a chance at life. The person of 97 has lived their life and is at the end of it.

The irony of this is that many care home residents given a choice would have chosen to end their own lives at a time of their choosing and with dignity had the state not insisted otherwise.

Ideally, care home staff would be living on site to stop the spread. Saw a home in Sheffield on the news that has decided to do just this. Far from practical for a lot of care home staff, granted.

Re: funerals, they are for the living, not the dead. Emotionally difficult for the living yes, but you can celebrate the person’s life anytime anyplace. The difficult bit is not having the opportunity of a family member being at the bedside whether that be a care home on hospital. If some of the surviving relatives are younger & fitter the most robust candidates (grandchildren?) should definitely be given that choice to say goodbye on behalf of the family.

I accept that "aggressively treating" very elderly people is often not the best course of action.

But as many measures as possible should be taken to prevent them from contracting it.

Discharging patients from a hospital back to a care home without checking if they are carrying CV or not could be a death sentence for many in the home.
Not providing carers with appropriate amounts of adequate ppe is also appalling.

And what of the carers? CV could be very nasty for many of them too. Some young, fit people have severe cases of CV and many carers are middle aged, working busy hours in a stressful job, and many are also from ethnic minorities - all risk factors.
Many carers also live with others who may be more likely to have a severe case of CV.

To not even try to protect the residents and staff of care homes is truly appalling and it makes me deeply ashamed of my country.

If you get the chance, hunt down and watch a programme called Critical Care. We watched 3 episodes last night. It shows exactly why elderly people do not survive ventilation or CPR. It is incredibly moving and I suspect would be an eye opener for a lot of posters on MN. Programmes about hospitals show gentle CPR that would do fuck all and don't show what can happen. Doctors are clear with the relatives of elderly patients about the futility of resuscitation.

I agree that care homes can be horrific, but sometimes it is not possible to have elderly relatives stay with you. I have no intentions of leaving my DC (well, only one would bother) to deal with care home visits or dementia and plan to toddle off to Dignitas. Pity that I have to go to Switzerland to get that service.

There are a coupled of things I don't understand.

I get that care homes should have more help in terms of medical staff going into the homes to help treat patients with CV. However, aren't care homes private companies who make profits? If so, why didn't they have their own PPE, masks etc. anyway. Why didn't they do something in the weeks and months leading up to this? There are lots of care home owners making lots of money out of housing the elderly and frail whilst paying carers a pittance. Why haven't they used some of this to buy their own PPE? Why is the NHS being held solely responsible for private care homes lack of PPE?

Doctors make decisions on whether someone is likely to benefit from treatment or not, all the time. And it’s not based on simple chronological age, it’s based on the patient’s general fitness and whether they can withstand the rigours of that treatment with any meaningful prospect of quality of life afterwards.
When I was in my local hospital’s Covid isolation unit, struggling myself (merely in my 60’s), the patient in the next cubicle was in her 90’s. She was treated and survived to be discharged. Because she was previously fit, and nobody discriminated against her for her age. But to put a frail, demented patient with severe heart disease through anything other than sedation and palliative care would be cruel and unconscionable.

Isadora when you say The staff aren’t likely to be dreadfully unwell with it though so the protective measures are for the elderly residents, you are forgetting that those staff often live with extended family.

But hey, who cares about a bunch of low-paid careworkers, many of whom are 'just' foreigners, and their families, eh? Just cannon fodder. one careworker dies, another one comes off the jobseeker's list. No problem.

From an infection control point of view, vulnerable residents of care homes should be moved to nightingale hospitals and wards. If the virus is established in a care home, then it can spread like wildfire and have detestation effects.

However, most residents in care homes have complex needs, which may include dementia. It is unlikely that the nightingale hospitals are equipped to deal with dementia patients who may become aggressive or anxious. Whilst it’s unlikely they will have the strength to leave the hospital because it’s unlikely to be as secure as a dementia care home, they may cause harm to the NHS staff and volunteers particularly if the volunteers have never dealt with dementia before. We also know that patients can’t have visitors whilst in hospital. If a resident can be safely cared for at a care home, they still won’t have relatives but they will have carers they know and trust. I know nurses aren’t letting covid patients die alone but I think I’d rather have a known carer at my side than an unknown nurse. As others have said, these patients are unlikely to survive ventilation and if they are dying anyway, dying at the care home is probably the best way they can go under the circumstances. It would be brutally hard for the staff, who aren’t trained to deal with this situation.

*I accept that "aggressively treating" very elderly people is often not the best course of action.

But as many measures as possible should be taken to prevent them from contracting it*

Totally agree with this. The lack of PPE is appalling and we should be ashamed about that. Thats what we should be doing - protecting them from getting it in the first place BECAUSE aggressive treatment isnt appropriate for care home residents.