Why are care homes being so badly hit?

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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?

@NotEverythingIsBlackandWhite 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.

Maybe you missed my post about some homes having contracts for x number of beds with LAs, some LAs forced them to accept patients if those beds weren't all occupied, using breech of contract I assume, I've heard home managers saying that on the news.

Also the home that refused an admission only to answer the door to find paramedics depositing the patient they'd refused on their doorstep and telling them they had no choice. Who was being unprofessional there?

I think some of the stories that are going to come out will be truly shocking.

Goodness me. People in care homes are people, not inconvenient virus carriers that can just be dumped wherever they're the least hassle/risk to others.

Yes to testing all patients before hospital discharge and not discharging those who test positive.
nhere should also be PPE/additional staffing in place in homes so that Cv19 residents can be nursed in isolation by a small group of carers who aren't in contact with other residents.

Although that would of course involve central government financial input, which simply won't happen.

It's awful. Staff worked so hard to keep CV19 out of their homes and they didn't have a chance.

@Bflatmajorsharp Totally agree Elderly people are not bloody chess pieces.

People living in a confined space, no ability to socially distance do to nature of care required.
Lack of staff testing.
Staff who cannot afford to self isolate or go sick due to low risk ages and reliance on SSP.
Pressure on staff to carry on coming to work due to staffing issues.
Reliance on agency staff who go to different homes taking the virus with them
Greedy private care home owners who fail to invest in their staff putting profits above everything while charging people over £1,000 a week

Also my dad was on a covid and they were talking at one stage about possibly sending him home to my elderly mother when still testing positive. I rang up to check if this was right and it was. The next day they said he couldnt possibly be sent home with covid then they said it would depend he might be able to go home with covid. They then said he was too frail to come home to my mum and it would be better to go into a care home yet he was still testing positive. Anyway to cut along story short they changed the testing in hospital from weekly to fortnightly. Unfortunately my father died before he got to go either home or to a care home. It really does seem like they are making things up as they go along and things certainly don't go in the elderlies favour.

In other words sacrifice one home to save the rest - I was told I was stupid and silly

In other words sacrifice one school to save the rest - I was told I was stupid and silly

In other words sacrifice one nursery to save the rest - I was told I was stupid and silly

Just trying something See if it flies.

The damage was done in the early days when the whole focus was on freeing up capacity within hospitals in readiness for the influx.

19th March, Covid 19 : Hospital discharge service requirements document states:
"Unless required to be in hospital, patients must not remain in an NHS bed".

So, where do you send an elderly person who doesn't need medical care as such, but perhaps needs a hand with the basics in life?
A bit of help to wash, dress, get to the toilet etc.

Pre-Covid 19, that person would probably have remained in hospital while their care needs were being assessed and a care package could be arranged and put in place.
That process would involve several disciplines of staff and outside agencies as well as, naturally, the patient and their family, if they had one.
The process would usually take several days, if not weeks, and, if particularly complicated, could take months.

But, from same document as above,

"Hospitals must discharge all patients as soon as they are clinically safe to do so. "(Note the wording - "clinically safe" not just "safe" - there's a difference).
"Transfer from the ward should happen within 1 hour of that decision being made (ie. the decision that someone is clinically safe for discharge), to a designated discharge area.
Discharge from hospital should happen as soon after that as possible, normally within 2 hours".

So, hospital staff had approx 3 hours to organise discharge of an elderly person with care needs.

They would be discharged to a care home.
If they had been tested for Covid 19 (and it was a big IF in the early days as only symptomatic hospital in patients were being tested), chances were, there were no results available to send with them.

The whole focus and efforts were on ITU's and ventilated patients.

Elderly care has for years and years been the Cinderella service within the NHS (along with Psychiatry) and this Pandemic has just shone the spotlight on it.

As a PP said, the VE day fuss and cheap words and the "let's all worship at the feet of Captain Tom as he walks round his garden" just sticks in my craw.

Old folk will be ok as long as they're no trouble but God help them if they need a hand.

@Wingedharpy Had a bit of a disagreement about exactly that with some people on a local fb page. They were dismissing the care home deaths. "mistakes are natural" apparently.

They got the hump (especially one who now wont leave me alone) when i pointed out that only yesterday they were celebrating VE Day, and that if these deaths were happening in childcare settings they would be screaming for heads to roll. Yet on Friday they were waving Union Jack flags , stuffing their faces with cake and singing We"ll Meet Again. Hypocritical cunts who are too thick to know what cognitive dissonance is. They probably think its a fucking pop group!

Liken it to schools regarding how impossible social distancing is but the residents at at very high risk and there you have it. Plus the number of care homes still grouping residents together for meal times and the like. A local care home to me had residents outside the home for VE Day party all huddled round a table together- but it’s ok because families and public were 2 m away!!

Elderly care has for years and years been the Cinderella service within the NHS (along with Psychiatry) and this Pandemic has just shone the spotlight on it.

I think is absolutely true, and it is clear that it wasn't just a 'mistake' to send people into care homes with covid 19, it was a (criminally?) negligent decision. I suppose the one thing I'd say is that at that stage everyone was looking at Italy and saying that our hospitals, too, would be a 'war zone' and so keeping those patients in hospital might also have looked like a terrible decision at the time, and keeping someone vulnerable who might not have had covid in might have seemed like condemning them to death. The hindsight of the fact the hospitals never got overwhelmed in the way expected makes it seem like a clearer cut decision than it was.

Because staff are either bringing it in (without knowing themselves of course), or they're still accepting admittance from hospitals.. which commonly where elderly go to if they've been hospitalised and then end up in a care home, then it spreads rapidly.

Some care home managers have done nothing to stop it. Flouting the rules!

A lot of shocking posts on here. That link from @Bool was particularly shocking.

On the point of testing, in an ideal world it would be like a diabetic blood sugar test. Instant. So everybody knows. I would say it is not as straightforward as that. At the start, there were at least 5 days between test and result. What do you do while you wait? How do you ensure you don't catch it?

Testing now is supposed to be 8 hours. Dh (front line nhs) was tested last week. 2 days for results. Not ideal and difficult to manage.

I also think there is a lot of misunderstanding about people's prospects. What is considered appropriate treatment and what isn't. How that changes with age and illness.

That a dnr doesn't equal no treatment, but does mean no resuscitation. That for many, ventilation would not be successful. My understanding is pre covid someone would be on ventilation about 3 days. Covid average is weeks (up to 6ish). Stats from new York (from memory) on ventilators for 65 yrs up were about 97.2% mortality.

jamanetwork.com/journals/jama/fullarticle/2765184#245591033

So yes. I really hope we have a proper investigation to see what went wrong. Am sure things did, whether accident or design. But the elderly are very vulnerable to this.

Sorry for the epic post

If it were my parents, I would want them kept out of hospital, as long as possible. Preferably with oxygen (If needed), isolation and ppe. I do realise that is not always possible or available in care homes. Neither has it been possible or available at all times in hospital.

Well going by the comments today its easy to see why our local Tory MP keeps getting elected despite doing fuck all for the area.

I suspect they will hum a different tune if one of their vulnerable/elderly relatives gets infected.

No more replies yet. I guess my points about how they would be humming a diff tune if it was a childcare setting or a school were uncomfortable reading. At least they havent been deleted...........yet.

Seen this on the main thread.

BanditoShipman Sun 10-May-20 13:00:32
CNN is reporting 70 cases of children in New York that have been hospitalised with symptoms that resemble Kawasaki disease. I think 3 have died (just caught tail end of news) 🙁 70 seems really high

Watch the care home dismissers turn on a dime if this takes off in the UK!

Watch the care home dismissers turn on a dime if this takes off in the UK!

I'm not a 'care home dismisser' but I don't see what the two have got to do with each other?

There’s a obvious solution to an outbreak in a school - they would close the school and the children go home and they and their families all isolate at home. If the virus predominantly affected children I would imagine schools would remain closed. But generally it’s possible for children to be cared for by their generally young and relatively healthy parents. What exactly is the alternative to a nursing home? They live there. You can’t close it and you can’t isolate the residents for multiple obvious reasons. Most of the residents can’t be cared for by anyone else like family or friends. You can prevent admissions to homes and keep clinically fit people in hospital, yes. But then the elderly wards in hospital just have the same problem of rampant spread and meanwhile we run out of beds for people who need and would benefit from actual medical treatment. In the real world, where carers quite rightly don’t want to live on site for minimum wage, where there is no ICU grade ppe going spare, where many residents can’t isolate because they can’t physically care for themselves, where we don’t have indefinite space in hospital, where is unethical to lock residents in rooms or drug them into compliance, what’s your suggestion?

If you cant see then im not going to spoon feed Done enough of that.

@Lifeisabeach09
As it looks like there is a link between vit d deficiency and severity, do you think care homes should start giving supplements or do they already?

For the next wave the gov need to release patient's somewhere else eg a hotel. Yes expensive but hotels probably empty (somewhere without air con though.)

For the next wave the gov need to release patient's somewhere else eg a hotel. Yes expensive but hotels probably empty (somewhere without air con though.)

But who is going to look after the patient in a hotel? The whole reason that lots of people are in care homes is because they need round-the-clock care - most of them wouldn't be there in the first place if someone popping in occasionally to check on them and drop round food was enough.

I agree with what HelenaDove said earlier, that older people aren't chess pieces to be moved around whether is convenient for others.

Leaving aside the practical problems ie who will care for people in a hotel, fit adaptions like rails and higher toilet seats, adjustable beds, air mattresses, storage of medication, provision of provide meals that the person can eat and offer the appropriate support, provision of other equipment that the person needs etc etc (the list is long!) what effect would this have on the person's well-being and mental health?

Additionally, if the person has capacity to choose where they live (which most people do, even if they have a cognitive impairment like dementia) it would be unlawful to force them to live in an hotel.

What should happen now, let alone for a second wave, is that staff and residents of care and nursing homes should be tested daily with regular temperature checks. Any staff member testing positive should go home, self-isolate and work if possible and well enough (manager may be to do budgets/ rotas etc).

Residents who test positive should be nursed in isolation by dedicated staff who have full hazchem PPE and not come into contact with other residents.

This would require significant financial investment, an excess of qualified and experienced care staff and a belief in the value of all life.

So sadly no way will it happen.

Staff worked so hard to keep cd19 out of care homes. They would have been more successful if they weren't forced to take patients who were infected or may have been infected from hospitals into an already hammered-by-cuts-and-driven-by-profit sector.

As Wingedharpy says, there was a requirement for the NHS to discharge everyone possible as soon as possible. This wasn't 'guidance' it was 'requirements'. Hospital staff had no choice.

www.gov.uk/government/publications/coronavirus-covid-19-hospital-discharge-service-requirements

At the same time, care homes were strongly encouraged to accept discharged patients whether they had symptoms or not, whether they were tested or not. Unlike the NHS document, this is guidance rather than a set of requirements, however as 1forsorrow says, many care homes are bound by local authority contracts so would not have had much choice.

www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-homes

Do you think there's still a bit of a postcode lottery going on?

My Nanny is in a Care Home (Dementia) and had a fall Sunday night / Monday morning. Paramedics came, stitched her up etc but then couldn't get her blood pressure back up, so off to "green" A&E she was sent...

All was good and she was given the OK to go "Home" around 3pm on Monday afternoon, but the Care Home (rightly, IMHO) refused until she had a clear Covid test. This resulted in an overnight stay in the hospital (on a "green" ward) whilst the results were awaited.

She is now, after a negative test, back Home where she has been quarantined with 1:2:1 care. She has had a further (negative) Covid test in the home and will be reintroduced into the "general population" in a few more days provided she has another negative test.

Also, I totally get the idea of making one home in a group into a Covid site? Surely that's pretty much what hospitals have done?!