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.

My F in L had dementia and was in a care home. He almost certainly would have lived another year or so had the virus not taken hold in his home. They locked down at the start of March. We knew there was a chance the virus would come in via an asymptomatic staff member but were horrified to learn it could have been from
an emergency admission/hospital discharge. Here is a link to the Gov guidance, page 4, a negative test is not required: www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-homes

He was not taken to hospital and was given palliative care only. The carers who looked after him did an incredible job in an unbearable situation. The nurse at the home had lost her own mum to the virus only the day before. Once it had taken hold there was nothing that could be done other than to ensure he was as peaceful as possible. However he certainly would not have died anyway for several months.

Honestly, I'm really shaken by this, it just seems like a huge disregard for human life Why is it happening?

Whoever is signing off on this knows what is going to happen when they send sick people into these nursing homes?

I work in an NHS community team were providing PPEto care homes and domiciliary carers if they can't source it.

We're also providing palliative support and advice to manage patients, and administering medications to manage symptoms for end of life care, including in care homes. Some of the suspected covid residents have been admitted for treatment, those who haven't was due to their/best interests decisions.

I'm concerned about the care sector, it was under funded and resourced before this. The care homes we cover aren't dementia specialists but the vast majority of residents have moderate to advanced dementia and the homes are not funded for the level of staffing/equipment required.

I have patients living at home who desperately need care at home but care agencies aren't taking on new clients. Families are not able to support as they would have previously. Gps, social workers, specialist services aren't doing home visits. The already over stretched ambulance service are even busier.

I'm so worried that some of my most vulnerable patients will die and it won't be due to Covid, it will be due to other conditions, and in situations you wouldn't leave an animal in.

*Well quite a few medical academics I know (colleagues) were critical of government policies in late Feb/early March. Not hindsight, watching as it happened

Scientists & academics didn’t need hindsight to know that herd immunity wouldn’t be feasible with this disease. So they crunched the numbers, showed the government and the government changed it’s plan.

Quite a few of the international scientists that I know - I am one myself (I’m in Geneva) -acknowledge that the UK government listened to the experts and changed strategy accordingly.

Unlike you however, they don’t cherry-pick the data and they continue to be critical of Sweden’s use of the same strategy.

I'm not shocked at all. My mum works in a care home and she's been saying all this for weeks. They aren't even allowed to wear a face mask in case it scares the dementia residents. Our carers are being out at extremely high risk for the bare minimum of money and the residents have been forgotten about.

It's an absolute disgrace.

I get that measures to save an elderly persons life might not be appropriate but putting an infected person in a home with a lot of other people coupled with the no ppe as it scares them etc is a recipe for disaster

I can only comment for what is happening locally but I can reassure the poster who asked what are GPS / anps / District nurses doing is plenty.
We have sourced alternative palliative care drugs, we are visiting care home, we are advising on infection control measures.
Many nursing home residentsn( long before covid) received excellent palliative care in their care homes. Carers are like family to many of these residents who would rather be where they are than moved to other locations - many had pre existing anticipatory care plans regarding their wishes in illness or terminal care. We are as much as possible adhere to these.

In our home it was the manager and area manager who signed off accepting hospital patients.
I stood up to say it was wrong and lost my job as a result.

Thing is, when people are OK to leave hospital, and the hospital desperately needs the beds, where else can patients be discharged to?

What about the horrors of having Care home residents moved to palliative care rather than oxygen? Am not suggesting ventilation, but oxygen via a mask. That could be all they need. But instead too many care homes appear to be thinking CV symptoms = move to palliative care. Yet some residents would be more likely to survive than someone much younger with more cardiovascular health issues and (eg) diabetes.

Nobody has ever said to me before that Dad going to hospital for an infection to be treated is “too traumatic”, even where he’s been in the corridor on a stretcher for hours and hours waiting to be seen, no fluids, and returned home at 4am. But having no visitors for a few months even though the home is (knowingly) importing CV from new residents and will be kept to his room and given end-of-life drugs if he develops a temperature and cough.

Rest of population told plenty fluids with CV, Care Home residents given respiratory suppressant drugs (a side effect of many calming and pain relieving drugs), and “mouth care” rather than fluids.

Of course it is realistic to say that some residents would like to die sooner rather than later due to low quality of life. A lot would die of CV anyway, and it would be kinder to allow them to do that at home (particularly if family could be there). But there are residents who are not in that position. What happened to “individualised Care”?

DM's care home group shut out visitors really early on, before lockdown, refused to accept hospital discharges, even though they had room, and have bought their own PPE, it is a small private care home, not NHS. They, so far, are fully staffed and free of Covid.

Baaaaahhh that’s lovely and heart warming to hear. Restores my faith in that some care homes do just that - Care. Thank you.

I'm finding the personal experiences of people at the sharp end (as care home employees, relatives, medicos) really interesting. Particularly when put side by side with Matt Hancock's words ...

I really recommend people listen to Dr Rachel Clarke on Any Questions (it's on the iPlayer), particularly her answer to the first question from a viewer. She's impressive.

Baaah- Dad is in small private care home who shut to visitors over a week before lockdown.
Out of 24 residents, in the last week 4 have passed away from CV (3 were tested though they didn’t meet the criteria to have the test done). They have accepted new residents into the home AFTER they have had confirmed CV cases.

saz12 That is really sad and makes no sense. Why block visitors and then allow CV cases in. Bonkers.

Who is responsible for rolling out this idea?

Department of Health and Social Care, Public Health England, CQC.

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878099/Admission_and_Care_of_Residents_during_COVID-19_Incident_in_a_Care_Home.pdf

I also work in nursing home with covid-positive residents (who I have to add have access to GP care, oxygen and palliative care drugs currently but so far most haven't needed these as covid can present atypically in the elderly.)
We are continuing to admit from the hospitals. These aren't returnees and they aren't being tested.
We have two units were I work-nursing floor and dementia care. It is possible to barrier nurse/isolate on the nursing floor. It is impossible to barrier nurse/isolate residents on the dementia floor.
Staff have been told they aren't to wear masks except around suspected/confirmed covid cases.
Some new admissions are planned for the dementia unit. I am very concerned based on the reasons outlined above.

Where else can patients be discharged to?

Some can be managed at home with visitation from community DNs, carers and where possible family members. Some should stay in hospital. I have heard of a care home that only takes covid-19 cases but not sure how true this is. If it is, I hope it is well-provisioned and staff get hazard pay.
There really is no ideal solution but sending covid-positives to care homes with the exact demographic covid loves, increasing mortality and its spread really is not the answer.

My MIL is in a care home which has beenlocked down for 5 weeks now. The home is brilliant and it was the best decision for her after trying to manage her care at home for 3 yrs which resulted in many many falls and repeated hospital admissions. I am happy that she stays there rather than another hospital admission but and its a big but - it is a huge ask of the staff who are mostly on minimum wage, They are struggling to get PPE - PPE is only supplied in large numbers as would be needed by a hospital She is in a small privately run home who need PPE but not thousands of aprons, gloves, etc. I have let them have a box of gloves I have here and my DH had a box of masks they they use for fibreglass repairs.

What has the government done to reward/thank these carers - oh they can have a badge so they can access supermarkets at NHS time. But wait they have to pay for these (£9) out of their already small wages.

It is a disgrace. I spoke to the owner of the home today and I will pay for the staff there - it's something I can afford and I'm happy to do it but I really shouldn't have to

It’s incredibly sinister as is the springing up of DNAR’s without discussion. And calculated by those in government

Well, apparently, according to some PP, we're all making political points in "poor taste" which show our "venom and contempt for the UK."

Rather than just being compassionate human beings somewhat unnerved by what we are hearing - my main source of news is BBCR4 Today programme, and this topic has been covered several times over the last week, with expert commentators, and those affected by the policies eg the attempt at getting some care home residents to sign DNRs tending to confirm that this has been something of a hole in policy.

There is nothing wrong with getting care home residents to sign DNRs. Most people wouldn't survive resuscitation let alone elderly people. Resuscitation is traumatic and even without a signed DNR the decision to resuscitate is medical. Doctors and paramedics don't have to attempt resuscitation.

sorry harsh but it's a head v hear
of course treat and care for elderly but the harsh practical fact is ventilation is brutal and you are putting people through a process they have little chance of surviving and if they do poor poor quality of life .
Each is a case by case decision. There are some people in there 80's and 90's being treat but that would be a medical decision .

I don’t have any problem with DNAR if used correctly. Everything I have read and heard in the last few days suggests they are being used inappropriately, without proper consultation or assessment

I think that health care & social care professionals at all levels are doing what they can in a very difficult situation. My shock (and the prompt to start this thread) has been about national & governmental policies.

I've found this a most educative, interesting, and moving thread. Thanks to everyone (even the people who saw fit to attack me personally because they disagreed with me).

FWIW, I've always thought the Liverpool protocol/pathway is important. My grandmother died at 90 on something like that protocol. But even on the day before she died, when she was barely conscious (morphine to stop the pain of multiple failing organs) I saw her fight for the oxygen mask when we had to remove it briefly to give her morphine orally: she wanted to stay alive. I found it quietly magnificent - although I know there are many people who wouldn't have seen it that way. But that's my experience - pre C-19, at any rate.