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.

No OP, you were very clear in what you were saying. That the lives of already frail and ill elderly people in care homes were considered less worthy than children and had been ' left to die' as 'lambs to the slaughter'.

You hopefully know by now that isn't the case at all.

So.. do you still think that? Or do you have more of an understanding of why these decisions have been been made which has nothing to do with elderly care home residents being 'less worthy' or 'just left to die' and everything to do with the extremely tiny risk of them recovering from COVID even if admitted to ITU and the trauma that would cause to them which is likely to lead in death a few weeks or months later anyway.

That even IF they survive, that outweighs the very clear risk that ITU beds would quickly fill up with elderly care home patients waiting to die and those beds being unavailable to people with a much greater chance of survival.

You've latterly claimed you didn't mean they should go to hospital so what did you mean?

Genuinely. If you don't think they should be 'left to die in care homes' where do you think they'd go other than hospital?.

I agree with you. Hospitals don’t test on discharge though. That’s bad enough. However we were told a test takes three days to come back - so technically a patient could be tested and wait in hospital for it to be revealed, meanwhile they contract covid from the hospital they are waiting in. Or they are sent to a home, only to retrospectively discover they were positive all along.
In our case the patient being sent had tested positive whilst in the hospital. Yet our management still wanted to accept them into a negative home, when there were other options. That’s negligent in my view.

Your only real line of defence is to not bring covid into the home in the first place. Certainly not knowingly do so.

Exactly @Bargebill19, keeping the virus out is the only way, but it's so very infectious, and has a long lag period between infection and symptoms showing up. It's impossible to hermetically seal care homes, carers have families and responsibilities, few would be able to reside at work for the duration. Even then, food and care supplies need delivering, primary care staff need to visit etc.

We're trying to do as much over the phone/ by video as possible because we recognise that medical and nursing staff are at high risk of exposure to Coronavirus, and also could spread it for days before getting symptoms, if we do at all! PPE helps reduce but does not eliminate spread. So again, all of this 'GPs are refusing to visit homes' in the press, we're not refusing, but we're minimising visits because we're aware that we could very easily be the vector! This, however, doesn't help the carers to feel supported, and I don't know what we do about that.

They go to a home which is already dealing with infections of the virus. Not to one where no one is showing symptoms.

@fluffysocksgoodbookwine
Thank you for your explanation.

We had managed a month to not allow covid into the home. Who knows how much longer we could have gone? It’s about managing the risk and lowering it as much as possible.
Not allowing it to march straight in through the front door. It was a home and company management decision.
I’ve not said anything about GPs etc.

I know you haven't @Bargebill19, but it's been in the press.

I can't understand the thought process that led to discharging a known COVID positive patient into a care home. I can't imagine the point at which someone thought 'that'll be fine!'. Especially a manager who knew the home and the impossibility of barrier nursing in that context.

I'm very sorry that you and your residents are having to deal with the fallout of that.

@Statistician999

That's what's fucking sick! It's 2020, how is it that human's still aren't allowed the choice of a peaceful and dignified death?!

@fluffy. Thank you.

I second everything said by @fluffysocksgoodbookwine - the set up sounds similar in our area.

Comments by PP such as -

Disgusting that they can’t even get a GP visit - what are these people paid to do exactly?

They cannot even get a GP visit so presumably are being denied any kind of end of life comfort in the form of pain relief, O2 or sedative.

None of the above is true so people can stop with their 'presumptions' and appreciate that everyone involved at the frontline is doing their best. Unless you are involved, your opinions and comments are based on assumptions.

And we are paid to provide care to our whole practice lists, including care home residents, which now includes remote working where possible. Visits are done where needed and we have dedicated Care Home Teams to provide another layer of care. But why let this get in the way of a good frothing, eh?

Well said Dr Fox.

These threads are really highlighting the fact that armchair warriors really do not know what is actually going on in the front-line and have no clue what its like to actually work in healthcare. Same with ventilation and other medical procedures and the cry of "a 90 year old with dementia deserves a ventilator just as much as anyone else!"- yet theyre completely ignorant of the fact that ventilating someone of that age and ill health will cause them untold pain and suffering.

I wish people would check their "facts" before they jump to hysterical conclusions

That the lives of already frail and ill elderly people in care homes were considered less worthy than children and had been ' left to die' as 'lambs to the slaughter'

You hopefully know by now that isn't the case at all

Care homes were not considered at all or not by anyone who knew anything about infection control.
Read the PHE website, where it stated in feb and march that staff pose a tiny risk to patients, whom themselves are highly unlikely to catch CV, no barrier precautions need to taken.

No one expects a 85 yo who is close to end of life to be rushed into an ICU bed but they do expect not to catch Cv19 because the care staff do not have access to PPE and/or tests.

So in that regard they were forgotten and even now, they wont be tested unless symptomatic and only then when capacity allows, this is hardly ideal and not what happens in hospital.

We cannot look at other countries and say their doing better or worse(except trump 😁) because every country start off from different circumstances

Nonsense, we didn't do what Germany did in January, equally Trump didn't even do what we did in late March.
That is fundamentally why we are seeing such huge differences in outcomes.

Every country started from not have any CV, some countries had more ICU beds but that doesn't seem to affect outcomes..... France/Italy had far more than UK....Germany took CV serious, other countries did not and allowed CV to become endemic.
My Italian friends pleaded with me to tell everyone in the UK to lockdown two weeks before we did.

That’s bad enough. However we were told a test takes three days to come back But Gove's daughter got hers in 24 hrs according to what is reported. I think they said Boris got his even fast. Mind you I suppose that all depends on if they are telling the truth.

What care would they get in hospital that they can't get at home?? There is no treatment for covid, apart from ventilation, which v few old frail people will survive. There's little point in testing people without symptoms as the false negatives are so high.

we didn't do what Germany did in January

What did Germany do in January?

Lockdown started on 20 March.

I recommend a good book "In the Midst of Life" by Jennifer Worth (Call the Midwife was based on her early life. It is a very informative look into what constitutes good and bad deaths. It is very well written, compassionate, a bit religious, as she was a very religious person, but all the more gentle for it.

But they ARE old and it's a care home. It's a perfectly rational and moral decision, not "scary", to allocate resources first to where there is the highest chance of survival medically and the next criteria, by use to society (a child/younger person vs an 85 year old.. or a druggie).

Also, are we talking private sector profit-making care home businesses? Dont people/their kids pay to be there? I dont see why the govt should intervene other than at NHS level where more testing/ppe/equipment etc is sorely needed

Exactly what policy do you want implemented?

Right to end life seems an irrelevant point here

Baaahhhh - I have read that. It is a very moving but very informative read. It totally helped me understand that it’s often better to die than to have life at any cost.

I have also seen a real life attempt at CPR by paramedics. It was totally brutal and the elderly man died anyway. I do under why they had to try in that case, but it was horrible and so so different to CPR on tv.

What did Germany do differently? I'm genuinely interested.

I saw an interesting BBC article saying that some people who died from coronavirus would have died anyway. The majority of the deaths are in people over 80 and with other conditions. Dementia and heart problems had the worst outcomes.

Oh, and don't assume that testing etc is the same across the UK. We've been testing care home staff in Scotland for weeks now

What did Germany do differently? I'm genuinely interested

Lock down started on 20/3 so same as UK. Never as rigid as in UK. Now being partially gradually lifted.

Germany has a much better resourced health system. But this comes at a price. People pay around 18% of gross income in addition to tax and NI so the tax burden is much higher than UK (around the 50% mark)

Many German health economists were saying that there was too much capacity in the system pre Covid 19 and urging the closure of smaller less efficient hospitals. But that may not now happen.

What they have been able to do is to test far more people than the UK. But they already had an established industry that they were able to scale up. Uk is starting from scratch.

Germany does not have a mega city like London so non of the problems associated with tranmission on the tube. Also perhaps fewer deprived people who are more susceptible.

The spread is still not really contained in Bavaria, Baden Wurttemberg and Saarland. Death rates have been slowly increasing over the last few days - latest figures put it at 2.6%. Still much lower than UK though.

I work in a nursing home I do not want to stay in the home looking after residents for two weeks on two off I have a family that need me

My German family say it is because of testing. And as far as my family tell me - they went into lockdown about a week before we did. Gyms, theatres, pubs were closed at least a week before ours were - my German family couldn't believe that it was still live as normal here before 23rd March. Even before Germany went into lockdown, they'd closed everything but food shops - well, at least in the Land in which members of my family live (one of the most industrialised & populous)

They were horrified (and concerned for my safety) when I told them that the UK government policy was "herd immunity"

German lockdown was less draconian, but it started much earlier than in the UK.

And they test.

Here's a really interesting article about the lack of leadership and the fallacy of "herd immunity" as a national policy.

bylinetimes.com/2020/03/18/herd-immunity-timeline-to-a-climb-down/