Stupid question about care home residents

[HMSSophie]

Why are people with Covid in care homes not being sent to hospital? If they are critically ill, why are they kept in the care home?

This might be a stupid question. But if a care home resident had eg gallstones they'd be sent to hospital

They might not be critically ill. Some residents are going to hospital. Some residents may have made a choice not to go to hospital. Someone with gallstones wouldnt necessarily go to hospital.

Some are sent to hospital, it’s complete bullshit this idea people have gotten that people in care homes are left to die there by default. But when people move into care homes, a discussion takes place between them (if they have mental capacity), their family and their doctors regarding whether it’s in their best interests to be a) hospitalised and b) if they are, given invasive procedures such as resuscitation and ventilation, on the basis of whether they will likely make a good recovery. In many cases it’s decided that it wouldn’t be in their best interests because it would cause them both physical harm from which they’d never fully recover and, in the case of people with advanced dementia or severe learning disabilities, enormous emotional and mental distress.

Well there must be a point where they are critically ill because they then die. So if someone at home is told to ring 111 if their Covid gets nasty (can't breathe turn blue etc) why doesn't the same happen for care home residents?

countess'that's illuminating thank you.

This happens Covid or no Covid. Often, palliative care in the place a person knows as home is the best end to their life. If there are good medical prospects for an alternative, people will be taken to hospital and given the care there that the doctors treating them decide is appropriate. Again, this sometimes may not be resuscitation or ventilation.

When my Dad got symptoms early in the outbreak the GP told my mum he wouldn’t be taken to hospital and we would just have to wait & see how he coped. I was horrified as I would have wanted him to be given the best chance and care in hospital. My mum however agreed with the GP because he has advanced Alzheimers she said it wouldn’t be fair as he would be distressed and wouldn’t be able to communicate with anyone and she wouldn’t have been able to be with him. I was shocked as it just never occurred to me that he wouldn’t be taken to hospital. Thankfully he seems to have recovered but we still can’t visit him. I miss him so much.

Moving people into hospital and giving invasive medical procedures, isnt in everyone's best interests. And ots always been like that.

No grandad was in a home. He got up at 3am to use his bathroom. Fell over and hit his head. He had to go to hospital to be stitched. Whilst there he had a stroke. It was decided to keep him at hospital rather than move his home. But a discussion between us and the doctor reuakted in the me making hi.conforgable and hom dying 3 days later.

He had a big bleed in the brain and the surgery, had little to no chance of working and there's was no point putting uon through it.

This was 4 years ago. People are often kept in their home, assuming the home can provide the care needed. And many can.

I know of a care home resident who was deemed not critical enough to go into hospital who died less than 24 hours later. Tragic and that’s in a care home where covid is rife

Because if they are in a care home already their chances of surviving it are poor.

People who live in care homes have a pretty fragile hold on life generally, by and large.

I have a theory that deaths might actually be lower than usual later this year because C-19 is killing people who would have died soonish anyway. (With some exceptions obvs)

Some hospitals are sending suspected covid cases to nursing homes.

At my relative's care home they have ventilators and on site doctor and nurses. I don't think they have sent anybody to hospital yet. Only 4 cases in the home though.

@Swingingsally * with full PPE & agreement from the care home. It's not like they're deliberately sending them there to spread it or die

I suspect the high care homes number is mostly due to patients not wanting acute hospital interventions. Some will sadly have declined too fast to be intervened. COVID is awful for that

Lots of care home residents are transferred to hospital too. Unfortunately they are a very vulnerable and susceptible group when in comes to this virus

Alot of care home patients are already on "end of life" care plans. There is no point sending them to hospital for anything. Because they are dying, it would actually be cruel to send them for tests and interventions that ultimately will not work but will cause more pain and distress, and in an environment they don't know with no care staff they know either

Guidance from the British Geriatric Society:
"11. Care homes should be aware that escalation decisions to hospital will be taken in discussion with paramedics, general practitioners and other healthcare support staff. They should be aware that transfer to hospital may not be offered if it is not likely to benefit the resident and if palliative or conservative care within the home is deemed more appropriate. Care Homes should work with healthcare providers to support families and residents through this."
www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-care-homes#anchor-nav-key-recommendations

To be fair @CoffeeRevelLove, early on in this Pandemic, there were reports of hospitals sending elderly people to care/nursing homes for care as it was felt that for some older people there was nothing medically that could be offered in hospitals and their care needs could be better met in care homes.

Fair enough. No issue with that.

However, some of these patients hadn't had any testing done prior to transfer, or they had been tested but no results available prior to transfer, therefore, there was no way of knowing if these new admissions to the homes were introducing Covid 19 to that home.

It was only when the homes kicked up a fuss and said they wouldn't take any more admissions until there were tests and results available that this practice seemed to have stopped.

Sadly, in some instances, it will have been too little, too late.

And when you say full PPE you won’t find the airtight masks in every care home - gloves and paper masks maybe. Nursing homes are different. In fact you don’t find full PPE in most hospital wards. My dp had Co I’d and was admitted to a general ward for 3 days pending the test result.

*Covid

Despite many believing otherwise lots of care home residents are far from end of life. As a PP mentioned many aren't even elderly. Residents can be younger people with disabilities - physical or mental. Residents have care needs but that's not necessarily end of life.

Some residents may not benefit from ventilation but they might with oxygen. In fact evidence now suggests many Covid patients of all ages are better off with oxygen treatment without needing ventilation. I don't know about everywhere but hard hit areas didn't have hospital capacity. They were overwhelmed. People were being turned away from hospital until a stage where survival less likely. Everyone whether in a care home or not.

It looks like some care home residents were deemed unworthy of medical care. Terrible if that's what happened. I hope I'm wrong and I hope going forwards things are handled better for everyone.

@StillDumDeDumming

In our area, no symptomatic patients were sent to care homes. Now there's a bit more understood and they think there's asymptomatic COVID patients, they are testing everyone under the new guidance.

Re PPE : that's because PHE guidance isn't for the 'tight' masks unless they are doing aerosol generating procedures. The surgical ones are the approved mask to wear for day to day care and is deemed as effective as the other mask in that scenario

I worked in care homes and as well as our residents dying under our care, we would have people sent from hospital for what they would call TLC. Which was just giving any care, including pain relief needed.

Care homes can provide a better death than hospitals. They are set up to be able to do that. So if treatment for recovery isn't appropriate, they are set up to look after the resident until the end.

Around March 7th the point scoring for hospital admission was highered and underlying health issues were disregarded. Which is why we had a spike in at home deaths. It was put up to 6/7, it has now been dropped back to 4/5, but the overall health of the individual is now taken into account. It was because we didn't have space or treatments etc.

I don't think a lot of people realise the extent of 'Nursing' that goes on within care homes. It's why there is a Nurse on every shift, to oversee the Care and the workers are a lot more skilled than they are thought to be by many.

As well as paramedic scores, there's also hospital scores for treatment at usual times, not just in times of crisis, but they tighten up in times of crisis.

I watched Parliament when this first statred and our home in Wavertree, Liverpool was being brought up by the local MP and Corbyn and they were fobbed off by Boris. I don't think the care homes being cleared out was of concern to certain sections of government.

I think that the deaths of medical staff came as a surprise, but Boris's attitude mirrored Trump's at the start.

I've was a carer for years and now have a grandparent in a care home. I don't expect they would move my relative. They are very frail and had a stroke fairly recently on top of increasingly progressing Alzheimer's. I think moving to hospital at this point would actually not be in their best interest. The shock, the discomfort when all the equipment in the care home is designed to meet their needs regarding body positioning etc. The staff who know them. If anything is remembered about where they are, which I think it might be sometimes, then at least they might feel safe in a familiar place. Being honest, although it's painful to think, they wouldn't consider any kind of intervention anyway, bar making them comfortable. And they can do that in the care home. Drs will prescribe, visit etc. Oxygen can be brought in. Palliative care can be arranged.

It's always been this way, weighing up if it would be more detrimental to move somebody.

@CoffeeRevelLove - that makes sense. Although some still where the full gas mask version in a and e. I had to go to a and e with dp because he has aphasia. But he was still on a general ward within 2 metres of other patients and he was sent home to me with covid test pending which turned out to be positive (that was this month)

Also my brother was nursing 6 patients in a psychiatric institution- they managed to get them into something resembling isolation, but he didn’t have PPE at all because he is a nursing assistant - though he still had to care for these residents. Not all of them died but some did. He’s expecting more. They now have the PPE.

my other brother also working in psychiatric care has no confirmed cases but only had plastic aprons not masks or gloves. He now has Covid symptoms awaiting the swab result. They are both NHS. Maybe your area is better - we are in a very large town outside of London. I don’t think we’ve been the worst hit.