Kinder to leave elderly people with coronavirus in care homes?

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!

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

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.

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.

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.

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 ?

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

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.

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 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!

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?

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.

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

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.

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.

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?

Thankfully, I’ve little experience of care homes although a family member was in one last year for the final weeks of a terminal illness. I was horrified when I visited, and even more so when I was told it was the best of the bunch.

So she is either "not qualified" because she never bothered to learn best practice until it was risky to her personally not just a risk to her staff and residents.

Or. When she says "not qualified" she really means not willing: she wants it to be someone elses job!

Grannynannywanny

Regarding the care home managet who said she wasnt "qualified" to do that. Why not? Was she not doing it properly before for people with other productive or infectious respiratory issues?

There are no NEW skills needed.

Any PPE issue should solely be an issue of supply/stock.

She and her staff should have already been familiar with using it. Just less frequently. None of it is new kit. Its all stuff they should have been familiar with from using it for flu or TB positive residents who use nebulisers or residents with productive coughs or other antibiotic resistant strains of pneumonia etc. All common in care home settings. The only difference should be that more people need it at once!

So for her to say now "not qualified" to give that type care, means they werent giving it properly before.

Because there is nothing that a covid +ive patient needs that wasnt previously needed by care home residents. The challenge of Covid is the QUANTITY of people needing it all at once. There is nothing new about the care or skills or qualifications required for those tasks at community level.

Surely that should be standard practise in all care homes?

It should have been. All along. Regardless of covid. But it clearly wasn't given the rush to "catch up" on all the undone reviews during the pandemic.

Just goes to show that care homes were not giving best practice care in the first place and are now blaming covid for things that should have been in place as standard all along.

Notanan It’s inaccurate to say a care home resident who is dying from covid 19 has no specialist nursing needs. Staff must be in full PPE to tend to them and keep them comfortable. It’s a well established fact that supplies of PPE to care homes have been inadequate. But they must do their best under extremely difficult circumstances to provide compassionate end of life care while at the same time try to prevent the infection spreading to other residents and staff. Are you aware of how many care staff have died in recent weeks in care settings? They are striving to care for their patients with compassion and kindness often risking their own safety. Numerous examples of care homes where staff have volunteered to live 24/7 on the premises since the start of the outbreak and haven’t seen their own families. They are sleeping in bunk beds and in some cases camper vans in the car park. I don’t recall ever seeing that happen under “normal” circumstances

My newly qualified medic daughter has been going to care homes as part of her training. In this area at least, all residents have a DNR directive to say what their wishes are in that instance and everyone also has a directive to say what they wish to happen in the event of future illness.

Surely that should be standard practise in all care homes?

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 .
Why is that new for her? Was she not washing her hands between patients and tasks before CV? If her hands are suddenly reacting to doing the correct amount of hand washing as per universal precautions, then she obviously wasnt bothering to do it before.

She agrees that she is not qualified to deal with this
A person who is not for hospital treatment and is ill with or dying of CV has no extra needs than any other elderly person who is ill or dying of a respiratory disease.
Its very very basic care
How was she caring for people before if shes not qualified to care now? Did nobody ever get ill or die in her care home before? I doubt it. Care is care.
CV+ residents who arent for hospital treatments have no specialist nursing needs . Just basic good care. What part of that is she not "qualified" to do? Sounds more unwilling than unqualified. There are no qualifications required beyond basic care skills.

Simply being in hospital makes frail people and people with dementia deteriorate .

Not allowing people to stay or to come home as soon as theyrr not being treated is cruel and wrong. It is their home

Someone who goes into hospital for CV treatment from a home caught it in the home so for the home to then refuse to allow them home because they have CV is illogical and immoral. Their "household" already has it

Everybody should have the right to be allowed to die in their own home if time allows.

Care homes have no right to effectively evict someone for being ill or dying by dumping them in acute hospitals. Or by refusing to have them back if they are not getting any treatment in hospital.

There is NOTHING nice or comfortable about being in an acute hospital unless you are there for medical or surgical treatment.
If you arent there for treatment, you are better off at home.

Evictions were supposed to be banned during lockdown. Some care homes seem to have not got that memo.

Only people for treatments should be admitted to hospital from their homes

Many people who are in care homes have signed a DNR so will not be offered Intensive Care Treatment, or even be sent to a hospital, they will only be offered Palliative care. So the death rate will be high.