Kinder to leave elderly people with coronavirus in care homes?

I guess that shows that some care homes are better than others, Notanan. Why on earth wouldn’t they put plans in place as soon as a resident moved there? Are these things not taken into account on inspections?

Yes each resident should already have an plan re resusitation and whether or not they would want to go for hospital treatment if ill on admission, and reviewed regularly. It really is basics. It SHOULD be standard as it is best practice.

The rush to get everyones DNR status in place during Covid just shows how many never bothered with best practice before.

Makes you wonder, how many people had care that went against their wishes, or got flu or noro etc needlessly from staff who never cared about PPE until it was to protect THEMSELVES not just the residents.

Running out a couple of weeks in? Yes, blame the crisis! Reasonable.
But the ones that said they had "no PPE" at the START of the crisis? Well what the hell were they doing before? Not bothering?

Demand for PPE is higher, usage is higher, but it should still have been there at the start and used al beit less frequently.

notanan, she is neither unwilling, nor unqualified. They simply do not have any PPE
A basic requirement to enable them to do their job safely

Under our present system, care homes (I use the term to include those providing nursing care) are not part of the NHS in the same way as hospitals. They are privately owned and run often as part of a chain. We all know how eye watering care home fees can be and that the staff in the majority are not qualified nurses. I am not disputing the level of dedicated and compassionate care they may give but I think we would all agree that their qualifications as qualified care assistants are probably similar to that of HCA’s. They are also not highly paid and many care homes have a high turnover of staff, relying on bank/agency staff as well as being dependent on EU staff -some of whom may have gone home fearing for their future security in this country. I imagine staffing levels are a major problem at the best of times.
It was a disaster waiting to happen
There must by definition be profits to be made and I would lay much of the blame attached to being unprepared at the door of the owners and management. I don’t know how they organise their sourcing of supplies but even the “flu season” should not see them unprepared for what we used to refer to as “barrier nursing”.
Yes, it was a major mistake in March to decide to send patients back from hospital without testing for the virus, but the subject of what is called “bed blocking” is an old one and, tbh we also needed to clear bed space in wards. Hospital is not the place to be if you don’t need to be there.
No easy solution, no hard one either but I agree with notanan when she says it does come down to PPE supply if best practice was being followed before.
Doesn’t answer Jane10’s question though does it. I can only agree with her original post.

Yes I agree with you Mazie, my stepdaughter is a manager in a care home. She and her staff have inadequate PPE, her hands are blistered and sore with washing . She agrees that she is not qualified to deal with this

Why is handwashing new to her?
In what way isnt she qualified?
What did they do for PPE previously? Did they run out of that or did they never have it to start?

I have every simpathy for care homes that have run out and struggled to replenish supplies given the circumstance because they are using more PPE than they normally would this time of year

But shame on the managers who say they are not set up for contagous infections, that their staff arent trained, or that their usual PPE isnt adequate.

This sort of care is their bread and butter. It literally pays their bills. Every year they admit people who managed at home until winter pneumonias and flus hit. Every year infections that can be fatal to the elderly rip through care homes. They shouldnt only consider training and PPE now that its an infection they themselves dont want to catch!

Certain care homes not allowing their fee payers back home from hospital if they think they might be harder work than when they took them in is no new thing. Also happens every year.

I suppose it’s going to depend on a number of factors.For anyone with dementia past the earlier stages, hospital can be a terrible place, since they probably won’t have a clue what is going on or why, and will be unable to remember instructions, or to leave cannulas/catheters/dressings alone. My poor old FiL in later stages was constantly pulling a catheter out.

By a certain age and stage of dementia I was very clear that there was to be no hospital for my mother, unless it was absolutely necessary, e.g. in the case of a 2nd broken hip. Her care home was very good and I trusted that when the time came, palliative care in familiar surroundings would be best, and we were all thankful that that turned out to be the case.

I don’t know the answer to this but it’s not a peaceful death is it if you can’t breathe and your lungs are filling up you are going to die a horrible death without hospital equipment BUT I also don’t think very old, ill or demented people should be kept alive for the sake of being able to ...for what !
I would think all care home should have immediately made a area in the home an isolation area not always easy but dedicated rooms and dedicated staff so there is no crossover with other staff and other elderly in the home should be achievable and of course the lack of PPE was and is a huge problem and a disgrace to the government

notonan you re being very harsh on dollymc s post surely what she is saying is her stepdaughter is not qualified as a nurse much less an ITU nurse I ve worked in care homes and caring for the elderly ps daily needs is very different to nursing someone dying of an easily transferable and very painful sometimes slow death Why would you suggest she is not doing her job properly before this pandemic problem
You query no PPE at the start what the hell were they doing before, not bothering care homes normally wear throw away gloves and aprons but that’s very different from the PPE needed for this pandemic so I m not sure what you are meaning A care home is not a hospital or even a nursing home

Back to the original question I think these care home patients testing positive should be housed separately for as easy a death as possible but not by trying to save them for perhaps 6 months painful life.... perhaps the underused Nightingale hospitals could have been used for this Unfortunately in life we don’t always get the peaceful ‘they just fell asleep’ death that we hope for

I think the government and others in charge of organisations have sleepwalked into this whereas some countries have cracked down immediately

notonan you re being very harsh on dollymc s post surely what she is saying is her stepdaughter is not qualified as a nurse much less an ITU nurse
Its not ITU care. Nobody staying home with CV is having any sorylt of advanced treatment. Or even care requiring qualified nurses unless they need palliative care meds which can be done by visiting nurses.
Its BASIC basic care.

You query no PPE at the start what the hell were they doing before, not bothering care homes normally wear throw away gloves and aprons but that’s very different from the PPE needed for this pandemic so I m not sure what you are meaning A care home is not a hospital or even a nursing home
They should have had higher level PPE like visers etc for productive TB or flus which are common in care homes. Also for people with infectious pneumonias if they have nebulisers etc.
Yes they wouldnt have enough of it to deal with CV.
But none of the PPE required for CV is new stuff. Its what is used for flus and antibiotic resistant pneumonias. IF best practice is followed.

If the never had it before. They werent training their staff in best practice. They werent protecting their residents from other infections.

How many vulnerable elder people did they cross infect back before they were worried about protecting themselves ?

They wouldnt have been using it daily. Or for everyone at once.

They wouldnt have much of it in stock. But they should have had some

It should not however be new to them.

The trouble with isolating people within care homes is that a good percentage of such people have dementia and simply will not understand or remember why they need to stay in their own rooms. Locking them in or otherwise confining would in many cases result in acute distress, agitation, or even furious and possibly violent anger.

My mother’s care home was purpose built for dementia, with plenty of ‘wander’ room, since wandering or pacing up and down, is often a feature of that horrible disease.

With people who are simply frail but have marbles intact it would be a different matter.

Leaving highly contagious people in the community will only ensure that it continues to spread. Which is exactly what it is doing. Infected people need to be isolated. What about the staff who by and large care for the residents, paid minimum wage? They are not nurses.

I agree with your last sentences Daisymae the majority of care staff in residential homes are poorly paid and not given much in the way of training. I have said this before but its true, we leave the care of the most vulnerable in our society to the least skilled.
Why can the Nightingale hospitals not be used to help with the care of sick elderly people

Why can the Nightingale hospitals not be used to help with the care of sick elderly people
What a horrendous place to be if you dont need to be there for medical intervention!

The trouble with isolating people within care homes is that a good percentage of such people have dementia and simply will not understand or remember why they need to stay in their own rooms.

And you think its better/safer ti have them wandering in acute hospitals or nightingale ITUs instead?

I posted this question after seeing on Twitter the abuse one of the medics got after saying that people with coronavirus should not be admitted to hospitals from care homes.
My instinctive response was that it would be unkind to say the least. I'm glad that most of you agree with me as, having read the abuse, I'd thought that maybe I was missing some crucial point. Looks like I wasn't!

Don't the comments on this thread serve to demonstrate that the issue of social care has been kicked into the long grass for far too long?

The funding arrangements don't work, market forces don't work in such a setting, staff are poorly paid and often poorly trained. Now they have been shown to be inadequately supported through this pandemic, second class to the NHS.

It doesn't seem that HMG had given any real thought to the care sector until too late in the day, when the numbers in hospitals were decreasing, and press attention has turned to the care sector.

I do hope that this crisis will give politicians a much needed kick to review and to improve the care infrastructure and bring it in from the wilderness.

The present system doesn't work.

I have plenty of training.
I'm confident that I can provide palliative care, as has always been the case in homes.

My rate of pay has absolutely no bearing on the level of care I take.

There shouldn't be a total ban on people being admitted to hospital from care homes.
It should be based on what's best for the individual person.
Not everyone living in a care home has dementia, and they may not even be all that old if they need care because of physical problems.

Maybe covid will persuade this government social care and medical care are interdependent. And maybe pandemic will persuade this government nurses and other care staff need enough wages .

Blue Belle has named the elephant in the room.

Is there any evidence terminal care alleviates the suffering of drowning in one's own ling secretions?

I understand there are very efficient tranquillisers. Are tranquillisers sufficient to stop suffering?

lung

I agree it would be cruel to send someone who is going to die into a hospital setting - they should be 'at home' with people who are familiar and in familiar surroundings ..... I wouldn't want it for my family if in that situation.

My SIL is a Senior Carer at a care home - they had PPE 'in a box' ready for if Covid19 broke out, but weren't to open said box until they had a case, They do at least have visors, but no gowns - then he comes home to my daughter and Granddaughters! He has also had a certify a death on Facetime so that the poorly paid GP (who will have got a tasty fee out of it too) didn't have to come in and put himself at risk!! I told him to ask for half the fee next time time or make the GP come and do what he is paid extra for! It is now spreading and they have had positive cases, although he hasn't been able to be tested (as would have to drive 2 hours there and back and have no car!), he may well have had it as went through a week of mild symptoms - who knows? He now needs an anti-body test, nothing else is worth doing now.

Notanan2 I agree with most if not all of what you say. It is not an easy situation. Frail elderly people especially with dementia will always be at risk in their care home from any infections. Unfortunately Covid19 is the worse. Shoving them all in a Nightingale Hospital is not the answer -they will be confused and not get the same homely care and reassurance from their everyday life in their care home although admittedly not all care homes are the same.
Saving these people is often not much of a possibility and that being so we need to find a way of making their deaths as easy as we can. My mil was in a care home and our GP asked us about DNR explaining that she would not do rescuscitationfor her own parents as the procedure is “very rough” for the very elderly and leaves them in a worse condition. Palliative care as appropriate needs to be made available to all who need it wherever they are.