Why are care homes being so badly hit?

[ssd]

I know the elderly are very vulnerable and PPE is inadequate, but is there any other reasons? How is covid happening in all these care homes?

Article in today's papers says that it has been discovered that hospitals discharged patients to care homes knowing or strongly suspectin that they had Covid, and did not tell the care home staff.The CQC are involved and there will be an investigation.

Now also, these care homes where vulnerable people are infected and in many cases dying are serving as foci of infection from which Covid is, in turn, spreading into the local communities.

We desperately need regular tests for all care home staff regardless of whether they are showing symptoms. It's very likely that some carers are asymptomatic carriers and bringing in the virus completely unaware that they are a risk. Only regular testing for everyone in care homes (residents included) will enable us to get this under control.

@HappyHammy

In a residential home you are at the mercy of community nurses and the papers report gp havent been able to see sick residents.
I don't understand why a GP cannot go into a community residential home and see sick residents.
I don't understand how a GP can certify a death with any certainty as to the reason for it for a patient in a residential or care home if they haven't examined them.

What we haven't heard much about is the inevitable huge loss of life there will have been amongst people who have carers come into their homes.

Home care workers - by the nature of their work - travel between multiple homes in a day, often by public transport (they don't get paid for their travel time btw).

As home care has been increasingly and dramatically outsourced to the private sector, provision has declined significantly. Staff usually have to pay for their own essential training like food hygiene and moving and handling. They often have to provide their own gloves and aprons too.

Many are employed on zero hours contracts, so no work = no money.

Home care staff no longer have the support that they did when employed directly by the LA, in terms of sickness pay etc.

The same fragmentation has taken place within the care home sector which is now largely driven by profit. All the statutory agencies that used to be much more involved like social workers, district and other nurses have been cut to the bone.

Systems supporting vulnerable people that are as fragile as this didn't have a chance against CV19.

www.bbc.co.uk/news/health-17264349

The government guidance initally was to empty hospitals quickly and not test people on discharge. Therefore people have been transferred to care homes, under pressure from health and social care, regardless of whether they have been positve or not, symptomatic or not. Of course where it was known people were postive care providers were informed by hospital discharge staff so they could take steps to isolate and protect. Some PPs have accurately described the issues in managing covid+ patients in care homes. I have heard second hand that some care workers did not want to be tested as they are on zero hour contracts and frightened they'd have to stay off work unable to earn if they are asymptomatic yet test positive.

Current guidance is not much better (social care action plan). Everyone has to be tested 48 hours before discharge now but can be discharged to a care home without having had the results. The guidance says this will be in a few cases. In reality my experience is that this is the majority who have been tested prior to discharge. Recently all residents in several homes I know of were tested and results showed a large proportion were postive but not symptomatic. Because people in care homes havent been routinely tested since the beginning, the only indication of someone being postive would be the presentation of symptoms. Therefore inadequate protective measures has meant the spread of covid with devastating effects in care homes.

The emphasis has been on ensuring hospitals had capacity with little thought on the impact on community services.

The emphasis has been on ensuring hospitals had capacity with little thought on the impact on community services.

^^Completely agree.

homes being forced to accept untested symptomatic residents

Well how exactly? Mums care home didn't accept non-resident hospital transfers, or indeed anyone wanting to join from the community. Those residents needing hospital care had tests before being allowed back in. Both sets of olds have been in and out of hospital for various things in the last 6 weeks, none had symptoms, and all had tests, they were all negative.

What we have to understand is that hospitals and trusts and care homes, rightly or wrongly, all take decisions based on their own assumptions. Some do a good job, others do a crap job. Some will perhaps be prosecuted for "lack of care and diligence", but others have been doing an amazing job.

It's difficult to know what happens unless we are there. I know that hospitals do not discharge norovirus patients back to carehomes until they are 48hrs clear but MRSA patients are transferred to and from hospitals now.

@Baaaahhhhh some homes have a contract for x number of beds so the LA are/were forcing them to accept patients or they were in breach of contract.

On TV news 2 or 3 weeks ago one care home manager had told hospital resident with active covid couldn't return as they didn't have facilities to adequately isolate. The doorbell went and paramedics standing there with the resident and told her she had no choice, they were leaving him.

Impressive isn't it?

Tests are carried out in hospitals though. Has there actually been a Govt directive that the elderly shouldn't be tested? Can the Govt even tell hospital staff what to do and not do? I'd be very surprised if that was the case. I think it dates back to when the number of tests were very limited so if people didn't have symptoms they didn't deem it necessary to test them.

I think there's a lot we aren't being told that will all come out in the wash several years down the line probably. If it has been caused by discharges from hospital of untested cases or ones that become positive later on I don't think they'd make a different decision in retrospect - this is akin to the treatment decisions made in italy effectively, just a quiet way of refusing to treat a group of individuals in hospital. The situation in Italy was terrible but I don't think it is the same as deliberately sending people with an active infection into a home full of vulnerable people. They weren't just refusing to treat people, they were actively sending them into the worst possible place to send someone with an active infection, well the worst if you aren't deliberately trying to infect the vulnerable.

As pp said. Some hospitals never tested discharged patients even when they had spent a week or more on a covid positive ward - then sent them back to covid free homes and ... as happened to the home I worked in....

• hospitals knowingly discharged covid positive patients back to covid free homes.,

And MANAGEMENT accepted them because they wanted the money.

Lots of homes were covid free for ages. A lot can pinpoint when their outbreak started and it has to do with hospital discharged. Some are due to staff especially agency who work multiple homes every week and thus take the disease from one home to the next and so on. But most homes avoid agency workers as they cost more to employ and they don’t know the quirks of the individual home or residents. So biggest cause - hospital discharges.
Nightingale hospitals won’t cope with dementia patients. - not that many ordinary hospitals can either.

Only staff found aresol generating procedures need the full ICU kit.
So UCU staff where it's are ventilated.General anaesthetics but and patient tested and negative can be treated as previously(although staff in anaesthetics have seen to consequences so still at least wear a ppf3 mask),Dentists.
Not care homes and wards caring for covid patients were it is gloves,waterproof masks and aprons.
I find not using the word treatment really hard but as said before there is no treatment just alleviation of symptoms.
We have no idea about care homes in Italy,they are not included unofficial figures and are recorded regionally.

In our Trust everyone is tested,this protects patients and staff.
We have discharge 2 patients admitted over100 and survived.There is no plan not to treat the elderly as even if they had covid this may not be the reason for admission.
Just because Covid is here doesn't mean the other crap has gone away.

HeIenaDove Thu 07-May-20 20:34:28
inews.co.uk/news/health/coronavirus-latest-covid-19-epidemic-care-homes-thousands-dead-warnings-2845247

Coronavirus latest: Week by week, how the Covid-19 epidemic in care homes left thousands dead — despite warnings in January
Boris Johnson has told Parliament he 'bitterly regrets' the death toll in care homes

An epidemic of Covid-19 has been allowed to flourish in care homes despite warnings as far back as January that the sector was particularly vulnerable to the disease

The Government’s own data has revealed that there were no care home deaths attributed to coronavirus when the UK went into lockdown at the end of March, yet a failure to introduce widespread testing and PPE for staff and residents, as well as an official order allowing Covid-positive patients to be discharged from hospitals into care homes, appears to have contributed to the deaths of thousands of vulnerable elderly people by the end of April

Figures show that the peak of deaths in care homes came two weeks after the peak in hospitals in the middle of April, suggesting there were missed opportunities to protect residents and staff at the end of March when the lockdown was implemented.

On Tuesday, the Government issued figures showing the steep rise in care home deaths in April. In the week ending 17 April, 3,390 people died from Covid in care homes, rising to 5,890 for following week

Boris Johnson told Parliament that he “bitterly regrets” the “epidemic” of coronavirus in care homes, while Health Secretary Matt Hancock said the Government had “worked very hard to protect people in care homes” “from the start”.

But ministers were given repeated warnings that the care sector was vulnerable, including by the Government’s own emergency group of advisers, more than three months ago

The scientific advisory group on emergencies (Sage) began meeting to discuss coronavirus on 22 January, and the issue of care homes being vulnerable was “flagged” “very early on”, according to a briefing chief scientific adviser Sir Patrick Vallance gave last week.

Yet on 25 February Public Health England issued advice saying it “remains very unlikely that people receiving care in a care home or the community will become infected” with coronavirus

On 3 March, the Government’s own coronavirus action plan said that “health and social care services will work together to support early discharge from hospital

Call for a ban on visitors
On 12 March, former Health Secretary Jeremy Hunt, now chairman of the health select committee, called for a nationwide ban on external visits to care homes, which was not introduced until the nationwide lockdown 11 days later.

On the same day, the Government switched focus from testing in the community to hospitals, while only sample testing was carried out in some care home settings.

In the middle of March, the NHS issued an order to transfer 15,000 patients from hospitals back to the community, including care homes, to free up space and allow the NHS to operate within capacity - one of the key planks of the government’s coronavirus strategy.

On 25 March, in response to a question from the Labour MP Peter Kyle, the PM said care home testing would be rolled out “as soon as we possibly can” while PPE would be delivered “by the end of this week”
Significantly, on 2 April, the Department for Health issued a guidance note saying that for patients being discharged from hospital, “negative tests are not required prior to transfers/admissions into the care home”.

On 5 April, i asked Jenny Harries, England’s deputy chief medical officer, when blanket testing would be introduced in care homes. Dr Harries would say only that there was sample testing of up to five people per care home setting.

On 15 April, it was announced that care home residents and staff could be tested if they had symptoms. This was not extended to all residents and staff, regardless or not whether they had symptoms, until 28 April.

At PMQs, Mr Johnson claimed that care home deaths were now coming down, but the government was unable to provide figures showing the death rate had slowed .

This week the Department of Health said while patients who had tested positive for coronavirus would continue to be discharged into care homes, they would now be notified so they could take action

'Unfolding tragedy'
Shadow Care Minister Liz Kendall said: “The Prime Minister says he ‘bitterly regrets’ the crisis in care homes, but the warning signs of this unfolding tragedy have been there for many weeks.

“Boris Johnson was warned about the lack of testing and PPE at the last PMQs he did, six weeks ago.”

Nuffield Trust chief executive Nigel Edwards said: “Serious questions should be asked about the timing and effectiveness of Government’s social care response.

The government was reportedly warned in January that the social care sector was at particular risk from the effects of this virus. This reality, coupled with structural, funding and staffing problems significantly pre-dating Covid-19, have created the tragedy we see today in care homes.

Apart from the obvious - elderly, susceptible to any infection etc. I think it's because many residents have living wills which may stiipulate when and whether reehusitation should take place. Mother in Law had strict documentation drawn up when she entered her nursing home which amounted to Do Not Resuscitate.

"My nursing home was 'pressured' (so they said) to admit a person from hospital who'd been on a respiratory ward for pneumonia. Not tested for covid. She came in, next day spiked a temperature, and died a few days later.'
Hospital error. They should have been tested in light of the Covid outbreak. Also it doesn't matter how much pressure is put on the nursing home. They need to be professional and should have refused admission.
Poor decisions all around.

"Early April, we sent a resident to hospital because they fell over. This person had a chest x-ray whilst there. A & E doctor said it looked like pneumonia but couldn't rule out covid. Guess what?! No covid test done."
Doctor error. He should have ensured a test was done and they weren't discharged unless and until they were free of the virus.

Nightingale hospitals won’t cope with dementia patients. - not that many ordinary hospitals can either
there is no solution is there :(

The solution I suggested to my area management was to send all covid positive hospital discharged to one of our homes which ALREADY had confirmed tested positive residents. This would keep the covid free homes - covid free. In other words sacrifice one home to save the rest - I was told I was stupid and silly.
My suggestion would have also kept the ‘ money’ coming in to the firm.
Isolation ward in old care homes just don’t work well - homes are really difficult to keep hospital clean when you have residents that wander due to their dementia. Infection control is extremely hard to do. That’s before you have the problem of ppe. We were issued with one disposable surgical mask and told to make it last weeks.

"I think it's because many residents have living wills which may stiipulate when and whether reehusitation should take place."
A DNAR decision is a written instruction to medical staff not to attempt to bring you back to life if your heart stops beating or you stop breathing, in essence, for when you have already died.

It doesn't mean if you have a virus which can be deadly don't bother to give non-invasive oxygen therapy.

It doesn't mean that if you have a bacterial infection too, that antibiotics shouldn't be given.

It isn't a directive to prevent any medical help at all from being given.

I can understand someone not wanting an attempt to be made to revive them when they have died. However, failure to hospitalise the elderly and frail and provide non-invasive oxygen therapy is condemning them to death when they might otherwise recover.

"The solution I suggested to my area management was to send all covid positive hospital discharged to one of our homes which ALREADY had confirmed tested positive residents. This would keep the covid free homes - covid free. In other words sacrifice one home to save the rest - I was told I was stupid and silly."
Do I understand you correctly - do you mean so that all the Covid residents in that one home die?

My answer is much simpler. Hospitals should not discharge covid-positive patients.

The solution I suggested to my area management was to send all covid positive hospital discharged to one of our homes which ALREADY had confirmed tested positive residents.

But what about the effect then on the viral load in the home and what that meant for the people in the home who didn't have coronavirus?