Matt Hancock is really struggling to get his words out today!

[Teddypops]

Gosh he is struggling. Forgot the name of one of the advisers.

Alsohuman

I know how palliative care works in care homes, during normal times. As I said, I have worked in them as the only registered nurse. We could not prescribe and instigate any treatment. That was done by the resident's go and I administered what was prescribed. My question is what is happening now, during this pandemic. Not what happened prior to that.

It was reported on the news this morning that care homes were refusing to take residents in with active Covid. One said paramedics arrived on their door saying they had to take them. In a home that hasn't got the facilities for isolation that seems like murder to me, they could be killing every resident in that home.

Just think if a member of your family with active Covid was left on your doorstep when you were in the shielded group. Do you think that would be OK and if not why is it OK for the residents in a care home to be exposed to that risk.

Prescriptions can and are emailed.

Hearhooves, in my relatives home they haven't had any deaths although they have cases due to someone with Covid being discharged from hospital with no testing so no one knew they were positive.

For the people with Covid they are having GP consultations online, no GP or community nurses going in. The staff have moved in, no visitors since about 10th March, could have been the 11th. Home have set up facilities for facetime or similar. My relative with advanced dementia and other health conditions, nearly 90, has come through Covid. I can't praise the staff enough, they are so dedicated and caring. They do have PPE, they had their own supply but of course because of the gentleman who came into the home infected and spread it the PPE has disappeared at a rapid rate. They have received some, which I think they are more than entitled to considering the negligence of the policy to discharge patients untested. They have also bought some but it isn't easy and is at least 10 times more expensive than before the pandemic.

I would have confidence in them dealing well with end of life care. For homes being paid £400 a week with lack of staff and facilities I would be worried.

Alsohuman

I would be reporting a Dr if they simply emailed a prescription for end of life drugs to a care home without seeing the patient, if that patient was not terminally ill. Bloody hell, how is anyone guarding against a Harold Shipman type character in a nursing home if GPS are willy nilly emailing out prescriptions for morphine for patients not on end of life care plans? They surely aren't just taking the word of a care home manager?

1forsorrow

I'm glad your relative has recovered. Did they give them any treatment? Could they have oxygen?

It's very wrong that patients with Covid are being discharged into nursing homes. This is a scandal and I sincerely hope that journalists are scrutinising it.

They’re doing video consultations.

They’re doing video consultations

How are they examining a patient by video? So they are putting patients on end of life pathways without examining them and without being certain of a diagnosis? What if they've got bacterial pneumonia that could be treated with antibiotics?

I wonder how many of these patients are actually having a consultation, of any kind, being prescribed and actually receiving decent palliative care?

GPs cannot always get PPE, they won't want to go into care homes with it and neither should we expect them too.

Its a shocking state of affairs.

How do you assess an elderly very frail care home resident who probably has dementia ? You can’t listen to their chest or have a proper head to toe examination nor can they tell you how they feel.
I also wonder what the care is like for the care home residents with covid. Your average residential home will not be geared up for oxygen or drips because they don’t operate to provide nursing care. How do you keep hydrated a frail very confused resident who can’t drink because they are so breathless. They can’t swallow either so struggle to take medication like pain relief, antibiotics. They may need regular oral morphine so who gives that.....
The thing is I get that hospital admission wouldn’t be a good idea. Many patients can’t tolerate face masks (particularly cpap ones), they pull them off because they are oxygen deprived - imagine that if your patient is already confused, agitated. Massive moral dilemma in the making.

How are they examining a patient by video? So they are putting patients on end of life pathways without examining them and without being certain of a diagnosis? What if they've got bacterial pneumonia that could be treated with antibiotics?

Never heard pneumonia referred to as “the old man’s friend”? They’re not putting people on end of life pathways. They’re assessing their chances of survival and easing their end. If my mum had got bacterial pneumonia I’d have vetoed antibiotics. This is illustrating exactly where we’re going wrong with extremely old and frail people. Often the greatest kindness you can offer them is to let them go in peace.

Hermanhessescat

I agree with everything that you've said which is why I think these residents probably aren't getting much palliation at all.

I dread to think what stories will come to light in the future from this.

Alsohuman

Have you seen someone die from pneumonia without treatment?

And why is everyone assuming that these people are frail? They may well not be. A lady of 102 was discharged from hospital recently. She got hospital care and recovered. How have we just accepted that anyone in a care home will be denied medical treatment and left to die?

Euthanasia isn't legal in this country because people fear that adequate safeguards can't be put in place and yet within weeks we've just accepted that people living in care homes can be left to die?

I’ve seen people kept “alive” long after they should have been allowed to slip away.

Not all 102 year olds are frail but they have no reserve left to fight the kind of infection that sends you into ICU however spritely they are.

For frail 80-90 year old care home residents with multiple
co morbidities, possibly dementia, where are they supposed to get the care they need ? I’m not advocating denying it to them but not sure how it could be provided, particularly if gps and district nurses aren’t allowed in. Very often the care home staff just don’t have the basic nursing skills to look after those patients, however hardworking and well meaning they are. I’ve seen this from personal experience with my own mum.

I’ve seen people kept “alive” long after they should have been allowed to slip away.

And so have I. Some in their 20s. Should we deny medical treatment to everyone because some people are kept alive longer than they should be?

The point is, we are supposed to have individual care here. Drs have denied any blanket rules on who is eligible for treatment insisting that it's based on an individual's circumstances. How can that be true then for people in care homes? Who is taking the decision on each individual as to whether they are sent to hospital? Who is diagnosing each patient and deciding that they have COVID19? Basically, who is accountable for taking the decision to withdraw or withhold medical treatment?

Hermanhessescat

This is what concerns me. What level of care are these people receiving? Is anything being done to relieve their suffering or are they left struggling to breathe, in pain and scared until their bodies give out?

Who is taking the decision on each individual as to whether they are sent to hospital?

The care home staff in liaison with the residents’ families. Same as always.

Drs have denied any blanket rules on who is eligible for treatment insisting that it's based on an individual's circumstances. How can that be true then for people in care homes?

I agree, it's a scandal that care home residents who get Covid seem to be immediately classed as 'end of life care' and, until people made enough noise, were being used to mask the mortality rates. Not all residents are elderly and even those that are vary hugely in their levels of fitness and quality of life.

Who is taking the decision on each individual as to whether they are sent to hospital?

The care home staff in liaison with the residents’ families. Same as always

In my experience families have no say in it at all and care home staff very little unless they really put their foot down. The decision lies with GP's and Hospital admissions

And when I say staff put their foot down that was before Covid - I doubt they have much say at the moment at all

In my - admittedly limited - experience, the family has the final say. I most definitely did.

My family did not, despite our pleas and despite the support of the home.

The care home manager at mils care home ( she wasn't in it that long) told dh ' she has a few weeks left' . He went home and ten minutes later she died.
You can't tell at the end of life what might happen. Good points about euthanasia: seems to be ' ok' now we have this virus doing the rounds! Usually it's ' can't have that , the relatives might abuse it ' arguments to make it legal and it's voted down every single time in parliament.

Good points about euthanasia: seems to be ' ok' now we have this virus doing the rounds! Usually it's ' can't have that , the relatives might abuse it ' arguments to make it legal and it's voted down every single time in parliament.

Exactly. I really hope that independent people are scrutinising this

I think he looks quite unwell. I’m not a fan by any means but he looks completely buggered.