Covid and care homes

[AInightingale]

Apparently there is an outbreak of Covid at the nursing home where my mum lives. I thought they were calling us to tell us to stay away for a bit, but apparently visiting is ok (there will be masks etc). What I find odd is that two residents on her floor have been taken to hospital with it, as a 'precaution'. Is this care home procedure? Aren't the hospitals overstretched enough?
She has been vaccinated multiple times but I do understand the virus is always mutating. She declined very badly after a hospital stay last year and the hospital in their catchment area is miles away from us (and madly, madly busy at the best of times). So far she is testing negative.

I'm sorry if this sounds selfish but I thought elderly people were best being treated in situ with the virus? (Unless they have very severe breathing problems naturally.) The home she is in had an appallingly high death toll during the pandemic so I am wondering if this is just extreme caution? Just seems odd.

I doubt very much if Covid positive residents are admitted to hospital as a precaution. They would be admitted if they were too unwell due to breathing difficulties to be treated in the care home and maybe required oxygen therapy.

My daughter is a nurse in a large city hospital and they have had multiple outbreaks of Covid in recent weeks. Mostly patients contracting it after admission to hospital for other reasons. It’s a logistical nightmare to try to keep Covid positive patients segregated from other patients to reduce the spread. There is no way they’d admit Covid +ve patients as a precaution unless they were very ill and requiring treatment.

They are being evasive @AInightingale, the residents in question are probably really poorly with it but the home are not allowed to give confidential information. They all stay in their rooms at my Mum's home .

That sounds worrying. My DH, who lives in a care home, caught it a few weeks ago, as did some other residents. Everyone was looked after in situ. Visiting was allowed with masks (no, thank you - I stayed away!) The home has great infection control procedures - they eradicated it within two weeks.

I’m guessing they were taken to hospital as it’s hit them quite badly and they’re unwell. This is the relevant guidance for care homes now. www.gov.uk/government/publications/infection-prevention-and-control-in-adult-social-care-acute-respiratory-infection/infection-prevention-and-control-ipc-in-adult-social-care-acute-respiratory-infection-ari#What_to_do

The precaution being that people who are seriously ill need medical care as a precaution to try and stop them dying.

I think this is it.

Care home staff are not generally trained in palliative care. Residents who are seriously ill, are better off in hospital.

During Module 6 of the COVID enquiry, on care homes, I went in the public gallery and listened to the owner of a nursing home, a nurse herself describing how her patients died of COVID. It was one of the most harrowing things I have ever had to listen to.

Leaving aside, the discharge of patients from from hospitals into care homes, without testing; care home residents were going to catch COVID off the staff; and the bigger the care home, the quicker they were likely to catch it, because of the high number of staff and all their personal contacts. Family visitors, who just went to see their loved one and their care staff, didn’t really make any difference to COVID transmission, unless the rate of infection where the family lived was more than 30% higher, than the area, where the staff lived.

Care home staff are not generally trained in palliative care. Residents who are seriously ill, are better off in hospital.

That’s not my experience I’m glad to say. I witnessed first hand on a daily basis the excellent care lovingly given to a family member who died in a care home last year. The nurse in charge of each shift along with a team of lovely carers couldn’t have provided better end of life care.

As next of kin I could have asked for him to be admitted to hospital but he wouldn’t have received the same standard of palliative care. He died peacefully in familiar surroundings and surrounded by love.

Hospitals aren’t admitting people to hospital as a precaution. My Dad, older man with serious health issue but only needs help from a cleaner was admitted to hospital recently with covid. He has become very dehydrated within less than 24 hours. After some fluid he was home within 48 hours.

Huge numbers of people in the general population and hospitals will have covid. Our local hospital has wards just for covid patients.

My brother thought it was to get the affected people well out of the way of the other vulnerable elderly people, but I was thinking myself it must be because of breathing difficulties or complications of co-morbidities. It is worrying that it is still affecting older people so badly, but I guess even a nasty strain of flu will do that.

Is it a care home or a nursing home @AInightingale ? My understanding is that care homes are not equipped to deal with medical issues as they don't have nursing staff on site. The care home my elderly parent is in for respite calls the GP or District Nurse team for medical stuff and then they decide the course of action.

I also looked at a nursing home for them. That had 24 hour on site nurses. Their policy was to keep residents in and look after them using nursing staff in cases of illness.

It's both, @unsync. One part is for people with lower dependency, one is for people with dementia with higher care needs but who are generally mobile and can feed themselves etc, and there is a nursing care/ very high dependency unit. My mother is in the middle tier which is where the outbreak has been.

@AInightingale That's odd then. They should just move them to the nursing floor. Maybe there's no capacity or they are in respiratory distress and need ventilation. I hope your mother is OK. It's such a difficult thing isn't it? You end up second guessing everything.

Or they don't want to run the risk of spreading it to another floor, possibly - hospitals are more able to isolate patients.

I should think the people who have gone to hospital have been admitted because they need treatment not available in the nursing home, and don’t have a hospital avoidance plan in place.

My mother is seriously ill and is infinitely better off in a familiar place because her comfort is more important than her survival. GPs are palliative care experts and can support the home.

I think, as mention before, because of medical confidentiality you don't really know what is happening. staff will have a bland statement to give that doesn't really tell you anything.

It’s the same as if they had any other viral infection

IME these euphemisms can be a bit misleading if you're new to them.

I remember being rung up (when I was young and green) at 3am to be informed a relative was "poorly". Now it was 3am, I wasn't with it to say the least. I was just bewildered and remember thinking, "Poorly? He's got terminal cancer FFS!" Ofc the next morning I woke up and thought, "oh shit!" (Luckily he survived that particular crisis), but heaven forfend they speak plainly at 3am!!

It probably depends on the care home. The home my mum was in was residential including dementia, but not nursing. However they also did end of life care. My mum went into hospital with an infection but given her advanced dementia, hospital staff said she wouldn’t get better and she returned to the home on end of life care. I was pleased she was able to be in the surroundings she was used to with her things and the staff she knew.

They would just isolate the residents in their own rooms, as they did during the pandemic. A hospital would not take residents from a care home just so they didn’t spread it to another area of the home. I would imagine that the residents concerned are having breathing difficulties.