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.

I am talking about policy - and if you read my OP you'll see that that is the term I use, from the start.

FluffySocks confirms that there is very good medical care; but there are also many other posters with equally coal face experience & knowledge (if we believe what everyone says about themselves ) who are speaking of negligence in policies applying to the vulnerable in care homes. I found @Bargebill19 's post, for example, quite shocking for its evidence of the negligence at a policy level.

@Somebodysringingabell

Every 85 has an underlying health issue, its called being 85.

The deaths announced today for yesterday state *Of the 740 new deaths announced, 40 patients aged between 45 and 93 had no underlying health conditions".

Seems that not everyone 85 or older has underlying issues after all.

Ps are you the same person who started a very similar thread yesterday but had it taken down because it wasn't going the way you wanted??

Oh FFS. Fair enough to disagree and not think as I do about this issue, but play the ball not the woman - argument ad hominem is never a good look.

I have read your posts OP. Your arguments were that elderly care home residents were just being left to die as their lives were less worthy

Exactly. You then went on about how at 85 you would want to live no matter what, despite not acknowledging that at age 85, people with advanced dementia in nursing homes would likely be too frail and ill to be able to receive ventilation as fluffy has so eloquently explained.
We are not talking about healthy and independent 85 year olds here, we are talking about 85 year olds in nursing homes who have multiple comorbidities and are extremely frail, unwell, confused and nearing the end of their life anyway. The fact is- most people at that age with that prognosis would not want to be ventilated, most would be horrified by the thought of it and that is completely understandable because all it would cause is pain and suffering.
All of us would love to get to age 85 and be as fit as a flea, spritely and completely independent at home, but that is sadly not what actually happens to the majority of people at that age.

OP - its been explained repeatedly WHY the policy was constructed.

Are you STILL after all the information you've been given not understanding why? Are you still thinking elderly care home residents should be moved to hospitals?

@NotEverythingIsBlackandwhite

FFS. Are you not very bright? Every 85 year old has an underlying health condition called being 85. Literally every cell in their body is not working as well as a younger persons.

That's what ageing does. Everything declines. Literally everything.

The fittest 85 year old still cannot compare in terms of health with even an unfit 20 or 40 year old.

Organise a race. See who wins.

Somebodysringingabell Not what I said now was it? Are you another who doesn't understand how viruses work?By the time anyone becomes symptomatic after contracting COVID they have been infected and spreading it for up to 2 weeks. Sending an elderly care home resident to hospital at that point doesn't protect other residents as they are likely already infected.

I wasn't talking about people being sent into hospital, maybe try reading it again. I was talking about somebody being discharged from hospital to a care home without being tested, becoming symptomatic soon after and infecting other people in the home. Can you explain why that has been happening.

Seems that not everyone 85 or older has underlying issues after all.

No underlying health issues apart from being 85+ do obviously not spring chickens with years of potential life.

It's a bit like the people in the papers who "die of covid with no underlying conditions". Then you see a picture of them and they are massively overweight. Being overweight might not be a diagnosed health condition but it sure as hell impacts on your ability to recover from coronavirus.

There was an interesting piece on the French lunchtime news about some of the people who had come out of hospital after intubation. They were in convalescent nursing homes having intensive physio and occupational therapy to get over the effects of the treatment.

Are you still thinking elderly care home residents should be moved to hospitals?

I have not said that at all. Read my posts.

Please stop this attack - it's not dignified.

Oh for God’s sake @YogaFaker, stop with the political histrionics ‘criminal level of neglect’.

I’m a Brit in Switzerland, married to a Frenchman with many friends & neighbours from all over the globe. The UK government isn’t doing a better or worse job than anywhere else; everywhere is taking a slightly different approach. My friend’s elderly father in Aosta, Italy died at home from COVID-19 last weekend as they wouldn’t take him into hospital; he wasn’t considered a priority for treatment as he was 80.

This is an unprecedented global pandemic and it really, really isn’t the time to be political point-scoring. It’s in very poor taste, so please stop.

But it’s not about people dying in care homes with covid19. It about deliberately introducing it into a covid negative care home and the inevitable spread. Introducing it by sending hospital tested covid19 positive patients from hospital to a care home.
Yes I agree that any member of raffle could unknowingly introduce the virus.
But that’s not always the case.

I agree testing should be much more widely available, that's the only way we're going to get a clear picture of the epidemic in the community, and I can see why the idea of testing asymptomatic patients before transfer to a care home is appealing, but remember that there are limitations:

1. Current tests may not be that sensitive in asymptomatic or mild cases (plenty of anecdotal evidence of health care staff testing negative, then going on to develop 'full blown' COVID 2-3 days later).
2. There seems to be around 48 hours turnaround time for tests, so the patient may be negative when the swab is taken, but catch COVID during the 2 days they're sat in hospital waiting for test results so they can be discharged.

@EmMac7, I see what you're saying, but many people seem to be getting swabbed in A&E/MAU, then sent home to await the results, rather than being admitted to an inpatient bed. I've looked briefly at the ICNARC data just now, but couldn't see a statistic for the proportion of actual inpatients who are admitted to critical care. I'd be interested to know that if you have that? Around here, it seems that the respiratory wards are full of people on high flow oxygen, but most of the overflow ward capacity is unused at present. If you're having a different experience, again I'd be very interested, as we're somewhat behind London's infection curve here.

I'm not in London, so I don't know why the Nightingale hospital is not being utilised more if the ITUs are heaving, but my understanding is that Nightingale is for patients who are already anaesthetised, intubated and ventilated, not the awake patients on CPAP or high flow nasal oxygen, which will be the majority of critical care patients.

It's not an attack. Its the fact that you repeatedly have failed to say what you think SHOULD be happening.

You said the policy was 'leaving care home residents to die'. So obviously you think they should not be dying in those care homes so where would they go? Hospital is the only other possible alternative so don't suggest now that wasn't what you were saying.

It was you that said 'I hope when i'm 85 and need medical intervention I don't get treated by the people who think my life is worth less than a childs'.

What elderly care home do you think has 85 year olds and some children? None.

So you were obviously talking about medical staff outside of care homes for the elderly, ergo hospitals.

Again, if you think elderly people in care homes dying of COVID are like 'lambs to the slaughter'. What were you suggesting as an alternative? You're now saying you didn't mean they should be treated in hospital so what DID you mean?.

@fluffysocksgoodbookwine

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.

Ventilated patients with COVID-19 need to stay under for a very long time (2 weeks on average).
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.
I've read that people will suffer with lung damage after being ventilated. Is ventilation something that you would consider we shouldn't do at all for any patient then?

As a carer if you spend the night looking after and cleaning up someone with diarrhoea and then go down with it yourself you would be unpaid for three days and up before a disciplinary panel if this absence led to you falling foul of absence triggers. A verified operation/car accident etc can also lead to warning under these triggers. Carers are used to being treated like shit. It is nothing new and quite refreshing that anyone is bothered about us (for a change).

Sorry side tracked by general discussion. I think decisions on care should be based on the individual and a blanket decision based on the fact that someone resides in a care home should be unlawful. Care home residents are citizens of this country and deserve the same consideration from the NHS as anyone else- even if that decision is palliative care.

Is the lack of PPE in care homes the only reason why people can’t be isolated when they show symptoms or return from hospital without being tested/waiting for results?

If a resident was quarantined in their room in the home and their carers wore PPE to care for them, this shouldn’t then mean everyone else in the home catches it.

@fluffysocksgoodbookwine

Another thank you for your post.

If any good comes of all this, it might be that people become more informed about what is involved in these decisions about medical care.

I've read that people will suffer with lung damage after being ventilated. Is ventilation something that you would consider we shouldn't do at all for any patient then?

We don't know yet what the long term sequelae will be for people who are ventilated and survive, but some people will have good results even after prolonged ventilation, and not everyone will need 2 weeks of ventilation, that's an average. It's a decision that needs to be made on an individual basis. The problems being:

1. By the time you're sick enough to need ventilating, you're unlikely to be able to think through that decision
2. We simply don't know yet how people will do long term, because this virus has only been around for a few months, which makes having risk/ benefit discussions really hard.

As with all ventilation, there will be muscle wasting/de-conditioning that gets worse the longer you are ventilated. There will be a risk of long term lung damage, a risk of hypoxic brain damage, a risk of damage to your kidneys and lungs, but as yet we can only make a best guess as to how that risk balances for each individual.

If it were me, being relatively young and healthy, I would want to be ventilated if it came to it, but would expect to need months of rehab and physio afterwards, and to possibly never regain my baseline level of health. That is something I'd be willing to risk, on the basis that I think I could cope with significantly reduced physical health, and there's a (currently unknown) chance that I could make a recovery to a good level of function in time. The idea of significant hypoxic brain injury terrifies me, but I'm not going to decline treatment on that basis alone. Someone else might feel very differently.

RandomlyChosenName - I don't know how easy it is to quarantine a patients in a care home, in terms of where and how the carer gets in and out of the PPE before entering and exiting the room. I suppose it depends one the layout of each home. I also think dementia patients wander around a lot so might be hard to keep in their room.

I do however know that both my grandfathers care home (which was for fitter elderly people that needed care - he'd had a stroke) had a shared bathroom facility so that would be a complication. My grandmothers care home was for much ill-er patients so she didn't use bathroom facilities at all so she could have been sectioned off.

@RandomlyChosenName

You sound like my manager who liked this to handling salmonella infected chicken. - it’s not like that at all.
We don’t have enough of, or the right type of ppe. We don’t have en-suites - so all waste is walked through the building for disposal.
No machine washable or disposable mops.
Building aren’t maintained or even built t to allow hospital style disinfectant cleaning. - lots are old 1960 type buildings or converted houses.
Try isolating a dementia sufferer who just wants to walk up and down the corridors in and out of every room. Continuously. You can’t lock people in rooms. Plus there is not enough staff to constantly monitors such residents. It’s a nightmare waiting to unfurl.
Your only real line of defence is to not bring covid into the home in the first place. Certainly not knowingly do so.

Its the fact that you repeatedly have failed to say what you think SHOULD be happening

No, it's the fact that you are demanding an answer from me, that is little to do with my OP. You are making up what you seem to think I'm saying.

And @Nixby3 I will not dignify your insinuation with an answer except to say that troll hunting here is discouraged, and do an AS if you're so concerned about what other threads I've started [clue: none].

But it’s not about people dying in care homes with covid19. It about deliberately introducing it into a covid negative care home and the inevitable spread. Introducing it by sending hospital tested covid19 positive patients from hospital to a care home. Yes I agree that any member of raffle could unknowingly introduce the virus. But that’s not always the case.

In the home where my relative lives they locked down early, no visitors even the GP, staff moved in. The only way infection got in was someone discharged from hospital to the home when he was asymptomatic. I don't care what anyone says or thinks, in my opinion that was wrong. I feel so sorry for the staff when they have done so much to keep the residents safe and now several are sick.