Covid-19 Update

Coronavirus, Residential, Nursing and Dementia Care & people living in Devon Care Homes (written by the South West Care Collaborative, 15th April 2020)

There continues to be some very disturbing, conflicting and often confusing material in the news and media recently. We understand the reasons why people are concerned about Covid-19.

People of any age can be seriously affected by Covid-19, we know there are identified vulnerable groups generally and especially the most vulnerable is people who are frail, elderly and living with health conditions, thus often living in 24/7 residential care.

As a collaborative, we would like to set out how we are addressing matters in response to the concerns raised.  

1.     Coronavirus – It is true that Care Homes are not immune from Coronavirus, and despite stringent efforts and difficult steps to restrict the virus, such as: re doubling infection control processes, restricting casual visiting, monitoring / isolating staff, ‘barrier nursing’ of residents where appropriate, Homes are still experiencing the virus however, in relatively modest numbers.

2.     Prevalance – Sir David Behan, former head of CQC, chairman of the UK’s biggest Care Home group ‘HC-One’, with a huge number of Residents, (with some 20,000 beds), have had 2,447 cases thus far over recent times affecting 2/3rds of their Homes. This shows approximately 12% of their Residents had been affected over time, and that they have sadly lost just over 1% of their residents to the virus.

3.    How well can Care Homes cope? Care Homes are used to working under pressure and often with infectious conditions. Care Homes are extensively trained, regulated and used to coping with serious annual infectious outbreaks in society such as ‘flu of various types, Norovirus, colds, chest infections etc., affect us all.

4.    Is Covid different? – Yes. Covid is a virulent, highly contagious and serious virus that impacts the most vulnerable groups, and that is especially people who are frail, elderly and living with health conditions such those who will need 24/7 residential care because of these conditions. 

5.     Anxiety – As Care Home Residents are amongst the most frail and vulnerable, everything around this generates heightened anxiety for those concerned. What we continue to do as always however, is to manage the impact of these conditions ongoingly and support everyone to the best of our ability, no matter what.

6.     Staffing – Staff numbers are affected in some way, but generally not unmanageably. Some staff with certain conditions are isolated for 12 weeks, and some staff are having to self-isolate periodically because of symptoms of themselves or of family members. There are generally in manageable numbers. Generally Care Homes have to cope with sickness as does everyone else.

7.     How are staff responding – Staff are covering each other determinedly, and what is key is that the overwhelming attitude we are seeing in the sector is that the people working in it, strongly put others first, want to be there to deliver the best for their Residents and care about them deeply.  This is our experience, it is what our staff want to do, and that has not changed despite all the anxiety.

8.     NHS – As a group we wish to pay tribute to the intense work our colleagues are having to manage in the NHS. We would especially like to pay tribute to all the front line NHS staff who are showing the same selfless commitment, but under the most extreme pressure, especially those who are caring for the most seriously affected, often the most highly contagious patients ongoingly, yet are still going flat out, with some risk to themselves.  This is incredibly humbling.

9.     Covid Reporting – It is unclear why community cases of Coronavirus are not being captured as frequently , but we do know Hospital figures are immediately available, and used as key indicators but wider community figures are not.  Many argue systems must be put in place to record the impact of the virus in the community, including care homes. We understand this will soon be available.

10.  Care Home Visiting – The social distancing measures include restrict visiting relatives in care Homes to try and restrict the virus. Exceptions can me made of course, as circumstances warrant.

11.  Impact of social distancing – To what extent this is impacting people case by case will be different, but it is of course causing anxiety to some family members, and this can impact the wellbeing of some Residents. However, Homes in the collaborative are happy, engaging and loving Homes and can sustain a hugely positive impact on the health and wellbeing of everyone, not just people with dementia, and that is every single day, which is our main aim.

12.  Partnership working – Families, friends, as well as staff and residents, working together in a form of partnership spirit with each other, can still help to support Residents to thrive as well as support cognition, communication and engagement. That element hasn’t changed, in fact quite the reverse.

13.  Means of interaction –  Homes have stepped up their activity, have been imaginative and used other devices such as portable phones, Facetime, Skype, Facebook etc., which has been amazing.  One recorded activity undertaken generated some 14,000 views! Life can and does go on, as far as possible, and Care Ho es are very aware of how important this is.

14.  PPE – So far, we have managed to source the PPE we have needed. It is however still very difficult to get. Some key elements of PPE are normal.  Some ae new for us. Some are once only, some are re-useable. We believe the consumables are being re stocked by manufacturers as production ramps up.

15.  Covid tests – these are not generally available yet and that is generally unhelpful. However, it is said they soon will be. However, we are also becoming increasingly aware of even the most subtle signs of the virus and how to act where appropriate as if people had the virus. When serious concerns have been reported, Public Health England has arranged testing of people with those concerns. We are aware that a new testing centre for front line staff is now operating in Plymouth and a new centre in Exeter is soon becoming available. A Nightingale Hospital is soon to be opened at Westpoint, Exeter.

16.  Do Not ‘Resuscitate / Hospitalise’ Directives. These are advance decisions, primarily led by Residents choice with family input where necessary, and subject to GP recommendation. There are fears in the news that people in residential care and / or living with dementia will be denied lifesaving hospital treatment if they get the virus and are pressured into signing these. This is not our experience, and we seek to ensure clinicians work individually and sensitively case by case with family involvement. This is what happens.

A decision to hospitalise is a very serious one, and the prospects of success is carefully analysed. Sometimes it is not the best option.  Few people want to be hospitalised unless there a very good reason, and hospitalisation itself can itself be quite traumatic. Many people prefer to stay at home where they can be cared for in familiar surrounding with the people they know well. There are many instances of people recovering from this viral infections in Homes with GP support and we have confidence and trust in the variety of GP’s who care for our Residents.

17.  Devon –  Devon and the South West does seem to have a lower prevalence of Covid-19 than some other locations. Devon also has one the highest number of “Outstanding” Care Homes of any County.  Similarly, all Devon hospitals are working within capacity. Let us hope this continues.

18.  Overall – We agree the current situation is very difficult and the system was already overstretched before this. Whilst there are questions to be asked about our preparedness as a system, the time to debate this will come. But overwhelmingly right now, the clinicians and healthcare workers in Health and Social care are rising selflessly to this challenge and we are very fortunate in having that.

How Covid-19 is changing life in our care homes

George Coxon, care home provider, speaks out about the plight of care homes, talks about how staff and residents are adapting to life in the coronavirus epidemic, and the importance of person-centred care.

Recent sad news about the effect of Covid-19 in care homes means there is a sudden new interest in our sector. We need to stay focused and calm – we will beat this. And we will do all we can to stave off the virus in the many homes which are still clear of it. We can battle solidly and resolutely to beat it in homes that have the virus.

Our priorities are twofold – keeping our people (residents and staff) safe is paramount. That means keeping families well informed, included and involved for those residents needing palliative care. The second is speaking out about our plight – being clear about the need for proper support and national assistance for PPE and appropriate testing. We need a national care home strategy urgently addressing low pay and a sustainable long-term plan in an integrated system.

Care homes are people’s homes. But we struggle to be seen in anything like the same positive ways as the NHS for what we do. We have thousands more beds, and more staff are employed in social care than in the NHS. We look after the most vulnerable people for longer. We know them as we do our own families, sometimes even better than our own families – the emotional bonds are so strong that dealing with loss and grief for those who die will be extremely demanding for our staff too.

Planning for all eventualities

In our two homes the approach is robust but sensitive. Reinforcing increased and intensified good habits, hyper-vigilance and restrictions of visits must not cause undue distress or alarm to our residents or staff.  It’s ‘business as usual’ as well as redoubling enhanced infection control practices, being ever more diligent in sanitising and washing hands for example.

We are taking regular temperatures of both residents and staff– not previously done as commonplace. This requires a kindly approach offering a reassuring word and smile, not a furrowed brow when carrying out a deadly serious ‘intervention’.  The word intervention is one of those words that epitomises the difference between living life in a homely care home and being a patient in a hospital.   We are getting through more hand cream than ever – for staff and residents alike – and along with our retained pampering days we are now adding creaming and massaging of hands to our nail varnishing routines. 

There is no doubt the risk of catastrophising the spread of the virus is very real. We are currently in a nervous state of a calm trepidation – planning for all eventualities, sharing and learning from others, avidly following respected scientific advice & the daily ministerial briefings, whilst retaining a strong determined resilience for our ethos of calm and cheerfulness in our work.  Being over prepared for the arrival of the virus is considerably better than being underprepared but overload of information and potential ‘fake news’ also carries great risk.

We are equipping ourselves as best we can with PPE. We have our own supply of ‘reservist reinforcements’ – people offering support for when we have staff missing due to illness or socially isolating.  We’re thanking all those in touch for kind words and offers of back-up, with many making masks and offering to collect items as needed.

 

Combining safety and fun

One of the hardest and most important changes, of course, has been limiting visits. So far families and loved ones have been extremely stoic and understanding of this predicament.  We are using new ways to keep in touch – getting technology to work for us, emailing very regular updates and sending pictures of brass polishing, plastic cup stacking, and other exploits that we know offer huge reassurance.

I have been well known for talking about how having fun in care homes is as important as being safe. See the set of articles I coordinated for the British Geriatric Society last year. 

Now more than ever we must combine both safety and fun. Everyday life, although inevitably somewhat consumed by the fear of seeing the virus enter my two small non-nursing care homes, must maintain the light hearted, cheerful, good humoured atmospheres and routines so vital to health and wellbeing for all.

We know we will survive this terrible and testing time. The changes in care homes must and will not lose too much of the excitement of doing what we do well with enthusiasm, kindness and pride.  Our legacy will be how we stayed strong and calm in ensuring our residents are still having fun at the same time as being safe. 

Coronavirus, Dementia Care and people living with dementia in our care homes

Southern Healthcare

There has been some very disturbing material in the news and various media outlets recently and we understand the reasons why some in the media have suggested that the elderly and people like Alzheimer’s sufferers in the UK have been left vulnerable. Our views on this are somewhat more balanced and we would like to set out our own thoughts as to how we see things.  

  1. Coronavirus – It is true that Care Homes are not immune from Coronavirus, and we are having to deal this under intense pressure. That said, we are quite used to trying to cope with other serious outbreaks in society – ‘flu of various types, things like Norovirus, colds and chest infections, as we all do, and which can affect us all.
  2. Impact – It is also true that our Residents are amongst the most frail and vulnerable, and everything around this generates a heightened anxiety for everyone concerned. What we aim to do however is to minimise the impact of these ongoingly and support everyone to the best of our ability, no matter what.
  3. Care – We are all coping with a new invisible virus that is highly virulent, infectious and very serious. Care homes are not immune from this and are reporting cases of the virus. However, we are supporting people with symptoms, the manifestation of which can be often be quite subtle with people who are already frail.   
  4. Staffing – Staff numbers are affected, but not unmanageably. Some people with certain conditions are isolated for 12 weeks, and some people are having to self-isolate periodically because of symptoms or themselves or of family members. Staff are covering each other and what is key however, is that the overwhelming attitude in this sector is that people working in it, put others first, and want to be there for the people we care about.  This is our experience, despite all the anxiety.
  5. NHS – What we do is not as intense as our colleagues are managing in the NHS. We would also like to pay tribute to the front line NHS staff who are showing the same selfless commitment, but under the most extreme pressure, especially those who are caring for the most seriously affected, most highly contagious people continuously, and are still going flat out at very high risk to themselves.  This is incredibly humbling.
  6. Covid Reporting – We are not clear why community cases of Coronavirus are not being captured, and are told it is because Hospital figures are key indicators, and immediately available. They say systems must be put in place to record and measure the impact of the virus in care homes and the community, including the death figures. We agree, and understand this will soon be available.
  7. Visiting – The restrictions of social distancing includes social visiting to relatives in care Homes to try and restrict the virus, except in exceptional cases. How well this is working case by case we cannot say, but it is of course causing distress to some family members and to some this can impact wellbeing. However, this is much less so if the setting is happy, engaging and loving which when present, has such as a hugely positive impact on the health and wellbeing of everyone, not just people with dementia, and that is every single day. That’s our main aim.
  8. Partnership working – Families, friends, as well as staff and residents, working together in a form of partnership spirit with each other, can still help to support people to thrive as well as maintain cognition, communication and engagement skills. That element hasn’t changed, quite the reverse and we have had to step up, be imaginative and use other outlets such as phones, facetime, skype, facebook etc., which has been amazing.  One activity we undertook had some 14,000 views. We have had lots of these conversations, skype / facebook / whatsapp chats etc., but little difficulty.
  9. PPE – So far, we have managed to source the PPE we have needed. It is very difficult to get. However, certain key elements of the PPE we now have are re-useable. We believe the consumables are being re stocked by manufacturers as production ramps up.
  10. Covid tests – these are not generally available yet and that is generally unhelpful. However, we are all becoming increasingly aware of even the more subtle signs of the virus and have to act where appropriate as if people had the virus. When we have reported concerns, Public Health England have quickly arranged testing of the people with whom we have concerns. We are aware that new testing centres are now operating in Plymouth and a new centre in Exeter is soon becoming available, as is a Nightingale Hospital to be set up, somewhere in Exeter.
  11. Do Not ‘Resuscitate / Hospitalise’ status. These are advance decisions, primarily led by Residents choice with family input where necessary, and subject to GP recommendation. There are fears in the news that people living with dementia will be denied lifesaving hospital treatment if they get the virus and are pressured into signing these. This is not our experience, and we seek to ensure clinicians work individually and sensitively case by case with family involvement . A decision to hospitalise is a very serious one, and the likelihood of success is carefully analysed. Sometimes it is not the best option.  Few people want to be hospitalised generally unless there a very good reason, and hospitalisation itself can be quite a traumatic experience. Many people prefer to stay at home where they can be cared for in familiar surrounding with the people they know well. There are many instances of people recovering from viral infections in Homes with GP support and we have confidence and trust in the variety of GP’s who care for our Residents.
  12. Devon –  Devon and the South West does seem to have a lower prevalence of Covid than other locations. Devon also has one the highest number of “Outstanding” Care Homes of any County.  Similarly, all Devon hospitals are working within capacity. Let us hope this continues.
  13. Overall – We agree the current situation is very difficult and the system was already overstretched before this. As a Provider, we took formal action with three others on funding and decision making 9 years ago. There are still serious questions to be asked about our preparedness as a system, and our Societys’ attitude to Healthcare and elderly care generally. The time to debate this will come. But overwhelmingly right now, the clinicians and healthcare practitioners in Health and Social care are rising selflessly to the challenge and we are very fortunate in having that.   

Means of contacting the Homes and Residents:

The Old Rectory Exeter

Our resident phone is an iPhone so people can Facetime and also video chat /video Whatsapp. 07747864152

This is the link to the Facebook page https://www.facebook.com/TheOldRecExeter/?ref=bookmarks

Parkwood House

Parkwood is taking Residents calls on a portable phone though the landline, and using skype on a tablet.

The facebook page link is

https://www.facebook.com/ParkwoodHousePlymouth/

Sefton Hall

Sefton Hall has several phone numbers for the residents.  These phones are in the different areas/floors of the home and the relevant number will be given to each relative on request.  We will suggest suitable times to avoid peak times and is working really well. 

There is also Skype and the Skype address has also been given to those relatives who wish to use it.  The times are booked in with the Activity Co-ordinators.

This is the link to facebook:

https://www.facebook.com/SeftonHallDawlish/

The Seaton

The residents phone has been set up with a process in liaison with all relatives, extended family and friends and its working very well. As the phone is carried by senior staff we would not want to change the process now so would not want to put the phone number on the website for all and sundry , however if anyone wishes they can still enquire on the home line and I can email more details to them if needed.

The Seaton facebook is @TheSeatonNursingHome

Geoffrey Cox
MD Southern Healthcare
9th April 2020