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Tue 31 March 2020
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Stephen Colegrave considers why care homes are environments in which it will be crucial to stop the spread of the Coronavirus and how care workers are heroes too.

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Coronavirus has reminded us just how precious the NHS is. Its frontline staff are making heroic efforts to deal with this pandemic and hopefully our support for the service will continue after we have beaten this crisis and result in its proper long-term funding.

But, another huge sector of health and care is just as precious and in need of support and appreciation: the care home and domiciliary sector (care provision in people’s homes).

It has an even larger workforce than the NHS – 300,000 more at 1.6 million – and provides 400,000 beds, which is more than the NHS.


A Key Vulnerable Group

By looking after many of our most vulnerable, care homes and care domiciliary services are also on the frontline of the battle against the COVID-19 outbreak.

In care homes, about 80% of the residents have dementia and many have multiple long-term conditions. Aneurin Bevan saw care homes as ‘palaces’ for the elderly, but they have increasingly become places full of people with complex health conditions and poor mobility. But they still work hard to make people feel at home.

Care homes are facing even more problems than the NHS in getting Personal Protective Equipment (PPE) for staff and also desperately need testing and greater support from the Government.

On Monday, the Spanish Defence Ministry said that elderly patients in retirement homes had been found abandoned and, in some cases, dead in their beds by the military while it was disinfecting care homes. Fortunately, the situation in the UK looks much better and the sector more resilient, but we must ensure that care home managers and staff are properly supported at this difficult time.


Biosecurity a Necessity

Extra care needs to be taken at care homes as they are closed communities that can breed infections if they are not properly controlled.

“Closed communities of whatever form whether care homes, prisons or even hospitals can potentially generate their own outbreaks,” according to Professor John Ashton, a former director of public health. “Care homes can either be very secure or vulnerable.”

Care homes are inspected by the watchdog, the Care Quality Commission (CQC). During inspections, infection control is an every day consideration.

“Care homes are good at infection control and they are used to controlling flu etc.,” says Vic Rayner, executive director of the National Care Forum (NCF). “And staff have training in pandemic protocols and infection control.”

The NHS and care homes will have to take biosecurity even more seriously with the spread of the Coronavirus.

“Biosecurity is the biggest factor in stopping them being places of vulnerability,” Professor Ashton. “Not wearing uniforms on public transport and changing into new shoes and uniforms at work. PPE is an important part of this.”

Care home residents – particularly those with dementia – require more interaction and handling than usual by staff, with some estimates of close interactions occurring more than 10 times a day, so making sure that PPE is available will be essential. There are indications that many care home and domiciliary workers are concerned about this and, like NHS staff, where PPE is available there are worries about the quality of the equipment.

“We are hugely concerned about care homes’ ability to access sufficient personal protective equipment (PPE),” says Rayner. “This concern has been exacerbated by lengthy delays in sourcing supplies. Government has a key role to play in supporting the sector in getting the right equipment. It needs to step up its game and ensure that any commitments made are honoured quickly.

“The recent announcement of a free issue of PPE to the care home sector was undermined by lengthy delays, with some providers only just receiving the stock a full 12 days after the announcement, and the free issue only covering face masks, which are just one component of the required PPE for supporting people with COVID-19.”


Testing Non Existent

Care Homes also need testing, to improve the capacity of their staff and to help manage infection.

Like the NHS, virtually no care home or domiciliary staff or carers have been tested. This means that, if frontline staff have the Coronavirus symptoms or live with someone who has them, they have to isolate themselves for up to 14 days, putting further pressure on an already stretched workforce.

Currently, without testing, admissions to care homes from hospitals need to go into isolation as there is no way of knowing whether they are going to infect the other residents. This is creating extra work for staff. Without testing, residents who contract the Coronavirus cannot be isolated until they are symptomatic and are therefore at risk of spreading the virus to others. Nor can hotspots of care homes, like other organisations, where the Coronavirus is more prevalent and needs even greater management, be identified.

Health Secretary Matt Hancock has said that the Government is purchasing millions of test kits and expanding testing, but – so far – this does not seem to have reached care homes. It is important that they are not forgotten.


Better Connected

Care homes are not islands. They are part of the local health and care community and rely on support from local GPs and community health teams.

Care homes are the homes of their residents and, just like anyone else, they have the right and should expect to be able to access their local GP and health services. As the Coronavirus progresses, this is going to become harder and the only way to cope will be to find new ways of working.

 “As the number of people with symptoms increases, it is going to be hard for GPs and Community Health Teams to spend enough time in care homes so digital working is going to be important,” Rayner says. “We need help from NHS England and NHS Digital to help get all care homes up and running on NHS Mail so they and the local community healthcare teams can access remote working tools. Hopefully this crisis will result in greater take-up of these digital services which would be a positive legacy of this.” 

Professor Ashton is keen for care homes to be more closely connected with their local health and care community in more ways than just digitally. At present, different care homes in different localities have different relationships with GPs. Some have one GP practice that they are closely linked to and others have many different GPs visiting them, with none taking specific responsibility for the relationship.

Care homes will have a qualified nurse, but residential homes – which also come under the ‘care home’ category – won’t as they provide a different level of care, but they may have just as many vulnerable patients.

“Care homes need more support from the rest of the health and care community,” says Professor Ashton. “In 2006/7, when I was public health director in Cumbria, we divided the county into six districts and found GP leaders for each district to work with care homes and across the health and care system. Four of us, myself as public health director, a GP, a paediatrician and a hospital director, shared the medical director role for the county and, every week, we ran a virtual round across all the hospitals, care homes and GPs This gave proper GP oversight of care homes and this is what we need now.”

This type of oversight is needed now more than ever. If the NHS could create a better system for this, it could be a great legacy for care homes in the future.


Duty to Heroes

As the Coronavirus continues its spread, we owe it to the hundreds of thousands of people who work and reside in care homes across the country to ensure that they have the right protective equipment, testing and support from the NHS as quickly as possible – not weeks or months after announcements are made.

If this can be done, our care homes will continue to be ‘palaces’ of security for our loved ones. And let’s recognise and applaud our care worker heroes just as much as our heroes in the frontline of the NHS. We shouldn’t be letting any of them down.


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