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.

Untill this virus happened , and now some people think it's doesn't matter if it kills " elderly an those who are dying anyways " What's shocked me , an especially on Mumsnet , are the comments about how the vulnerable an elderly , do not seem to matter

Thank you for all you do @Lifeisshortandbitterswet and for standing up for the lives of the people you care for I'm glad I'm not the only one shocked by some of the attitudes. I know that when I need support & care, I hope I will be cared for by someone like you, rather than some of the ideas I read here.

Being 85 and wanting life saving treatment to be given to you so a child dies instead IS being a selfish prick.

This.

The Nightingale Hospital in London is NOT empty, though by no means full.
However, it is to be used only for those on ventilators, and the patients would be heavily sedated.
Ventilators are often not suitable for elderly people. It is higly invasive. I understand the decisions taken are based on medical need.

Actually @Somebodysringingabell not one person on this thread has explained factually why care home residents should be routinely refused hospital admission, or why it would be good practice to send COVID patients back into a care setting.

We have become so engrossed in prolonging life that we sometimes cannot see the wood for the trees. DH is in a care home having lived in complete squalor in a large house that he had literally pilled up with rubbish, junk etc. Trashed a room and then moved onto the next one. He had little quality of life and now he is towards the end of it he is in a good care home which he is funding out of the sale of his old house.

Would he want a DNR. Absolutely not. I have instructions when the time comes but people can be incredibly selfish and you also have their family to consider. If there is a decision to make and no conversations have been had before the poor family will indeed try and save their elderly relative as they don't even know who the other side is. No one will say 'do you want to save your Dad or a unknown 10 year old child'.

I think we honestly having lived and breathed this with both DM and DF review why we are prolonging lives of people who have no real quality of life.

Being 85 and wanting life saving treatment to be given to you so a child dies

And where have I - or anyone who is actually caring for elderly people in care homes and witnessing the lack of a proper policy - actually said that?

You're making it up, in order to - well, I don't know what you're trying to prove.

I will assume we all know why it bad practice to put a positive patient into a covid free home.

The reason it would be done is simple - money. A room is paid for. Councils are offering a 10% increase in their payment until May. (Matter of public record).
Also some council contracts are for block booking of rooms- the home has to accept who is sent to them. Despite having a duty of care to existing residents and staff. It harder to move on a resident than people think. Assessments need to be done.

@Dowser good luck to your son, DH's place has had staff coming through who are doing the same (getting experience for further education/career) and it has really benefitted them.

@yogafaker You did imply that

"But I hope that when I'm an 85 year old, and need medical intervention, I don't get treated by the people who think that my life is worth less than a child's. My life is worth everything to me"

So when you wake up after your spell in ICU and you find out you got that bed instead of a child, who has since died you won't be pleased?

When you grow up and get to 85 I'm sure you'll feel different

@YogaFaker

I can well believe that some people would make that choice. I do know it’s what my mother in law would say and HAS done. However - she has severe dementia now and whilst she is still insisting on treatment at all costs, it’s like a default setting. She is in a care home and totally believes she goes out everyday for a walk with her husband. He’s been dead ten years and she hasn’t walked outside since December. I hope that the choice of whether she was given treatment that would then be denied to a child. it wouldn’t be even considered.

@joydivisionovengloves71 what a stupid post. If the OP were to get a ICU bed in place of a child it wont be her decision, it will be the doctors, who will make it on the basis of who is most likely to benefit (clue: its rarely the 85 year old).

It doesnt seem like children are at any risk of people thinking their lives are not valuable. There do seem to be an awful lot of people around who think the lives of the elderly are of no value though.

you find out you got that bed instead of a child

And where did I say that?

This is getting silly: you're projecting.

@Porcupineinwaiting You need to read the thread again then. The dozens of reasons including the sheer numbers involved have been explained over and over again.

It isn't a case of an 85 year old getting an ICU bed instead of a child, it is about admitting someone who potentially has this disease into a home and endangering 10, 20 30 or more elderly people and their carers.

A woman who was over 100 has been discharged from hospital, elderly people living at home get treatment why shouldn't people in a care home get the same. Matt Hancock keeps telling us there are spare beds so people are arguing about a scenario that doesn't exist.

My mum is 75 and in a care home with dementia. She's not mobile and has next to zero quality of life.

We, as a family, were asked to give instructions on whether or not to resuscitate in the event of a heart attack. When it was fully explained to us we agreed it would be best to allow DNR, though it was still very sad for us to realise that this was effectively "it".

I was visiting her once a few months ago and we were in the main lounge when one of the other residents died sitting in his chair. No fuss. 5 minutes earlier he'd said what he wanted for his tea. I couldn't help but think that he'd escaped from the living hell that is being in that environment (the staff at this HC-One care home are all absolutely brilliant) and for that he was lucky.

Fast forward to today, and for the same reason as we wouldn't want my mum to have invasive resuscitation applied to her in the event of a heart attack, we wouldn't I think want to see her ventilated (not that she'll get the option). I know it's highly likely she'll die if she gets it, and now one of the residents in her 24 resident unit has died from it, and another has tested positive. It might only be a matter of time. I'm sure that others in her unit have it but haven't shown symptoms yet.

It will be appalling that she may die without us by her side, though that might change in view of the comments of Matt Hancock the other evening. It will be appalling if she has to die gasping for breath, terrified that she doesn't understand what's going on. It will likely be horrible as fuck.

Yes, the government has let her down. Let her down by failing to ramp up testing, so that the workers have not routinely been tested at the start of each shift. Let down at the abject failure to get PPE in to the care homes. Let down by all those who shout down any criticism of this government as inappropriate, when the government seems only to have responded to public criticism.

But sh'e not let down by there being no ambulance to rush her off to hospital as she nears death. Death will be a blessing. I just wish we could make it free of distress.

@Somebodysringingabell most hospitals are not at capacity at the moment. And the sheer numbers would be a hell of a lot smaller if we weren't busily seeding care homes w coronavirus.

This whole thing is a shit show. The language the government has been using itself needs more scrutiny. A vulnerable person (a 90 year old in a wheelchair, a 60 year old with dementia, a toddler, someone recovering from a major operation) is someone in general who can't self-isolate because they require the care of others to continue living. Not all vulnerable people (eg babies and toddlers) are vulnerable to this virus, but many are.

I'm ashamed that I didn't think more or know more about care homes (including how many people are in them) before this pandemic began, but I'm also angry that the government had so little to say about them when lockdown was announced. They're now very keen to justify the benefits of the lockdown and by making it seem as if the hospital death tolls (appalling but still far far lower than the original Imperial estimations) imply many lives saved. In fact, if there are 250,000 people in care homes, and they are exceptionally vulnerable to this virus, and their deaths are happening without testing or proper counting, maybe lockdown hasn't saved as many lives after all? We have certainly done a fucking poor job of shielding those people.

If we could get working antibody tests we could get workers into care homes who are immune and (almost certainly) can't pass on the virus other than by touching surfaces, at least for a few months. PPE also very important though I imagine there are social and psychological problems about having frightened old people with dementia looked after only by scary figures in gowns and masks. What about a national drive for this? I'm pretty sure I've had it and have recovered -- I would gladly suspend my normal job for a bit to help like this: instead I'm sitting at home all day doing relatively pointless online work, feeding my children crap by the end of each week as as fresh supplies run out, and letting them watch TV instead of home educating because I have so much work to do... There is just no joined up thinking on risk or protection in any of the government's responses.

@Porcupineinwaiting. What are you still not understanding?

They are free beds at the moment. There WON'T be if you start admitting elderly people from care homes to die there instead of in the homes.

Care home deaths are running into the thousands already and will continue to grow.

We do NOT have thousands of beds available in hospitals

You seem very sure of your numbers, show me the maths.

You also seem very sure that care home + covid = certain death, despite that not being in line with available evidence.

And also very keen on care home = disposable

I feel so sorry for carehome staff. They are the frontline of this pandemic. They are expected to turn care homes into hospices providing pallative care overnight - and this idea of putting covid patients into care homes to get them out of hospital to spread it to the other residents is negligent. I cant help think of all the carers who were at my grans care home. They were so young on the whole with minimal training. Doctors came in to do the pallative stage, or the qualified nurses. The staff didnt expect to be a hospice, understaffed just with a doctor on the phone, with no PPE and at risk themselves.

@Porcupineinwaiting

Care homes who have accepted covid positive patients have experience deaths soon after. Our sister home has had 14 deaths in two weeks. 44 residents normally. Tested positive patient sent home from hospital was the cause.
Other homes have experienced higher numbers of deaths.
Care homes do experience death. But not on this scale.
To knowingly accept covid positive patients in a covid free home is negligent.

Agree with those saying that we've focused too much on keeping life going at all costs, rather than quality of life.

The trouble is that usually it's not a straight choice. Measures to improve quality of life- physio, good nutrition and dental care,
treatment for arthritis etc often extend life too.

And vice versa- there is such a thing as palliative chemo, for example, which can improve quality of life a lot and quantity a bit. Plus, nobody has a crystal ball. Mum had very aggressive treatment for an otherwise- fatal cancer in her early 60s. She had a good quality of life for 11 years then got another type of cancer, received palliative treatment including chemo, and died 6mo later in a brilliant palliative care ward, walking until a couple of days before her death and eating- by herself- the day before. Perfectly judged care. If she had happened to develop dementia in her mid 60s, like dad did, and survived for years declining and declining then she probably would have wished she hadn't been treated the first time but nobody could know that.

Take blood pressure meds, for example. Yes, they extend life but it's not as if an older person who elects not to take them is guaranteed to run around happily to 70 or 80 or 90 then drop dead of a big quick clean stroke. Untreated high blood pressure could just as easily cause retinal problems and make them go blind and cause a series of subfatal strokes that leave them incapacitated for years before they finally die.

In reality, all lives are not equal because we don’t live in ideal vacuums, we live in complicated, inter-connected societies.

To present an ethical dilemma; if resources are finite and there’s a choice between saving an (otherwise healthy) 5 or 85 year old, almost everyone with a functioning moral compass would choose the child. Even if the 85 year-old was ourselves.

It isn’t really a difficult decision; it’s the natural order of things. As animals we are biologically programmed to prioritise those who will continue the germline at the expense of the old and sick.

@Porcupineinwaiting What maths? Be specific.

We do know that 95% of deaths in the countries with the highest infection rates are in people over 60 and more than 50% of those are over 80. Because the older you are, the more likely you are to catch it and die from it.

So no, COVID doesn't mean certain death in an elderly person but certainly a much higher risk of death.

Elderly people in care homes even more so as they are there because they already need care 24 hour care. Because they are already frail, impaired, usually with multiple comorbidities. So not certain death in that population but very, very likely.

It is grossly offensive to suggest I believe people in care homes are disposable. I'm explaining WHY these decisions have been made.

I'm a GP. DH is a Consultant Anaesthetist working in ITU. Bit of an essay here, but I feel this is important.

I can only speak for my area, but we have 6 elderly care homes in our practice area, and over the past 4 weeks we have discussed what to do in the event of COVID-19 infection with EVERY patient of ours in those homes, or with the family if the patient does not have mental capacity for the discussion. We have written many emergency health care plans (EHCPs) and DNAR forms.

When the realities of what 'admission for treatment' means are properly discussed, we've had only one patient who wanted to opt for admission, and that only up to non-invasive ventilation. Most frail elderly people don't want to be separated from their regular carers and familiar environments, and many already had EHCPs in place. Remember that you only tend to end up in a care home if you couldn't manage independently with carers attending four times per day. Unless you have fairly advanced dementia, that generally means that physically you're very frail.

Very few dementia patients would be able to tolerate the nasal oxygen or CPAP, which is uncomfortable to wear, and requires you to sit/lie still. Sedating people seems to cause a rapid deterioration, which is why ventilation is a last resort, but this means they'd be potentially very frightened, in an unfamiliar environment, and unable to tolerate treatment, as they wouldn't understand what was happening.

As GPs, we are in daily phone contact with the care home staff by phone. We are taking turns in the COVID-19 home visiting service, which is staffed by district nurses, palliative care specialists, GPs and elderly care specialist nurses. We are providing palliative care medications/ syringe drivers if needed. If we run out of syringe drivers (which is a possibility), then we have figured out alternative medication regimens. We can alleviate pain, agitation, breathlessness, nausea, secretions etc, as we usually would for patients at the end of their lives. We are trying our best to provide some emotional support to the care home staff. All the care homes in our city have the same access to PPE as the GP surgeries.

The thing with COVID-19 is that if you're sick enough to need admission, you will almost certainly need critical care, whether for high flow nasal oxygen, CPAP or (if unavoidable) ventilation. Hospital doctors are reporting that the vast majority of patients that are sick enough to need admission are needing critical care, low flow oxygen doesn't make any difference. It isn't that we're admitting 'late' particularly, that just seems to be the nature of the illness: if you're going to deteriorate, it happens fast and hard.

Ventilated patients with COVID-19 need to stay under for a very long time (2 weeks on average). There are very few very elderly people that would be able to get off a ventilator after that long, whatever the reason for ventilation, as even well people become de-conditioned very rapidly during ventilation. It is thought that the prolonged duration of ventilation is one of the reasons why it has such a low success rate.

We are not 'leaving the elderly to die', we are trying to ensure a comfortable, dignified death for patients for whom the chances of survival even with maximum intervention are minimal, and would lead to a massively reduced quality of life even if they did survive. Patients who are old, but previously fit and well, are being admitted if they want to be. No-one is declining care on the basis of age alone.

Interestingly, some Italian doctors who work in the UK are saying that part of the reason Italy had such overwhelm of the health care system is because they don't practice the same 'ceiling of intervention' discussions that are part of normal care for the frail elderly in the UK. Therefore at the start of their epidemic, they intubated and ventilated a large number of frail elderly, before they knew how bad the peak was going to be. When they started seeing massive numbers of sick patients, they had already filled their critical care capacity with people whom they then couldn't extubate.

This is a brand new infection. We are learning as fast as we can, and trying to make decisions based on the best evidence we have available at the time. I completely agree that patients who are known to be COVID-19 positive should not be getting discharged to homes with no COVID-19 cases, and that we need to support carers who are simply not used to have to deal with palliative care for so many people simultaneously, but beyond that, we are doing the best we can in both primary and secondary care to ensure that people get the care that is best for them as individuals.