Shocking reports from care homes

Care homes already regularly care for people suffering with or dying of infectious pneumonias.

CV isnt any different in terms of individuals care needs than flu etc

There arent any extra skills or tools. No specialist treatments or techniques.

By the point it gets to the pneumonia stage for someone in a care home, isolation or specialist masks etc would be locking the stable door after the horse has bolted. All it would achieve would be to make the care more dehumanised.

You know in a hospital, if someone on a normal ward gets CV. The bay isnt then split up, they are already exposed so isolated together in bays not all moved out to side rooms. Because its too late, at that point. Same goes for care homes.

Its too late once CV is known or suspected.

Bigger care homes who know their own layouts could put things in place like floor/cohort isolation where carers are permanantly assigned a floor. And that floor has its own meal sittings. But nobody can tell/teach that its too dependant on individual layout and logistics

Large numbers dying alone everyday, care staff who aren’t properly equipped or trained

What training?
There's no training to be had.
Carehomes already look after people with infectious diseases: MRSA, TB, MARO, ESPL.
As there is no treatment/cure for CV what training is there?
All there is on offer is basic care. The same care needs their service group already have.

They already have and use basic PPE
The same PPE hospital staff would use on a ward.

They dont have the specialist PPE that you might see on telly. Theyre worn by anaesthetists putting in a ventillators etc. But they DO have "PPE" and use it daily. Nobody has been changing pads with their bare hands all along.

Its all so very sad. Three of my GC are carers, on in a home for people with dementia. All three just go to work and then straight home with no shopping for food as they are afraid of taking the virus into the home. At the moment I do a massive shop on a Friday for the three girls and my son as they are now all living in one house. My son comes over and picks it up from the drive way, a wave and he's gone. I just hope they all stay safe.

Please remember when commenting that for some of us GNs this is not an academic discussion to be picked over, but rather our daily reality, with our spouse or other loved one ensconced in a care home. We cannot visit, can only see and talk to them via skype. There is much talk on Alzhemiers Talking Point of bringing them home to self isolate together.

So, anyway, I've no skin in the game with this with and due to idea. I just think it's an important distinction and I don't think it's one made by ignoramuses.

People are said to die with rather than due to some cancers nowadays.

Until pneumonia was easily treatable with antibiotics, it was a very common final cause of death among old people.

I think the idea I mentioned up thread is that covid19, like pneumonia in the past, is an added burden of illness for people who are seriously ill already.

The cause of death of my paternal grandfather was given as heart failure. His heart failed because he'd been fighting (yes, that word; nowt wrong with the expression) emphysema for several years. So it was really emphysema that killed him. The Coal Board eventually admitted this and made compensatory payments to widows or other descendents of him and other miners accordingly. Their lives were shortened by disease caused by their working conditions.

I forget where I was reading about people dying with covid19 and those dying due to it. I mentioned it on another thread but can't remember which.

I suspect that many more people have died in hospital, where they may have been for other reasons, and the death was put down as pneumonia even before the extent of this was properly realised.

I can't agree with that Baggs. I think the converse is true.

People can live for many years with underlying conditions controlled with medication and could probably continue to do so.
As Tony Benn's consultant said to him when discussing his illness "You will probably die with this illness, not from it* which proved to be correct.

However, having an underlying condition could make someone more susceptible to the virus which may or may not kill them.

Well if covid-19 accelerated their deaths, whether by weeks, months or years, then surely that was the cause of it. Everyone dies, the fact that they are elderly means their days would be numbered anyway like the rest of us isn’t a good enough reason for shrugging this off. Large numbers dying alone everyday, care staff who aren’t properly equipped or trained, families having to say their goodbyes through a window, surely this constitutes a crisis.

How is that a fact?

I think this could be about the fact that many old people die with COVID-19 rather than because of it. As I understand it that means that the underlying cause of their death is something they’ve had all along and the COVID-19 virus just makes the underlying problem worse, bad enough to kill them.

I don’t think that deaths in care homes are the only ones affected by this. I suspect that in due course there will be a great deal of research about the effects of COVID-19 on people with underlying serious health issues, and who were also old.

What is also unacceptable is the carehomes where people caught coronavirus from refusing to have them back to die at home, when they were admitted with CV its not something they caught in hospital. So their carers were already either exposed or were the ones who transmitted it.

Evictions were supposed to be banned during lockdown. Carehomes need that memo

Trying to admit people from care homes just because they have any CV symptoms doesnt even protect the rest of the carehome!

What little we do know about CV is that by the time you havw symptoms, you'll have already shared CV with your household. So isolate together as there is no point separating once sympoms develop if you've had contact up to that point.

So sending them off in an ambulance to sit on an isolation ward for pointless monitoring if they wouldnt have ITU if they deteriorates, serves no medical or infection control purpose, so would just be cruel! And the carehome they were shipped out of will already have it anyway.

Care homes have more single room capacity than hospitals too.

There is no special training. There is no cure. A person who isnt going to be ventillated wouldnt have people using specialist PPE with them in hospital either.

What do care homes want hospitals to do for people that they have no cure or treatment for?

Its a choice between wait and see and palliative care. And care homes are already equipt and trained for those two options. There is nothing else. That is all anyone has in their tool box for CV in cases where ITU wouldnt be considered.

Hospitals got nothin new or special that care homes dont have.

And yes, that is terrible. And scary. Its a horrific disease. GOD WILLING we will in future have some sort of treatment other than: wait it out, try and survive, ITU if orans fail. But wr dont yet and carehomes cannot be offloading people to die in isolation wards rather than their own homes.

Some ARE being admitted to hospital: the ones who are for escalated care

Otherwise why admit to hospital? To die on an isolation ward instead of their own homes?

There IS no treatment. The people in hospital with CV arent getting "cured" there. They are just there to monitor whether they need ITU support or not.

So why admit someone who will is not for that sort of escallation?

Maybe, if a cure is found that can be done at ward level, but until then people are only admitted to hospital if they are for hospital treatment

Its not a holding pen for people who care homes dont want to treat.

Hospital staff looking after CV people who arent been ventilated dont wear any special PPE that isnt already available in care homes for other things. Just normal bog standard gloves and aprons and surgical masks, maybe visers if they cough. Things that care homes mostly stock for personal care and other infectious diseases

They would be cared for by HCAs mostly if they werent having any hard core intervention, many NHS HCAs also work in care homes so its the same people

They would not be cared for by people in filter masks and full length haz suits. Whether in hospital or not. That is for people having ITU level support. So why put them through that?

There is nothing a hospital ward can offer a person with CV who isnt going to be admitted to ITU if they deteriorate. Nothing extra. Except a horrible experience.

Thanks to the responses to my concerns, I think if mum had not fallen and ended up in hospital, we would have coped with supporting her at home. The care agency who were going in three times a week at weekends had offered three visits a day but now they have suspended the contract ( standard procedure if a client is in hospital for two weeks or more so we don't need to pay) I doubt they will still have the capacity.

My sister could continue being mums main Carer three or four days a week provided that she and her family ( hubby, two teenage children and her sister in law who has moved in for the lockdown) remain healthy but there is no guarantee that we could keep mum isolated and safe. So we have to accept the decision and hope that mum remains healthy and is well looked after.

She is a very healthy, mobile and feisty 87 yr old so she will fight her corner!

I agree Callistemon, safer at home. I'm very worried about the emergency measures in place for care.

Minimum staffing levels (daytime only, there weren't any for night anyway) and standards of care (already disgracefully low) no longer apply.

Norovirus (winter vomiting bug) has a history of spreading like wildfire in institutions with shared facilities and staff. Residents have been confined to their rooms to try to contain it. This must be happening now for the virus.

That is very worrying, Teacheranne. A relative of mine is at a stage where she should possibly be in a care home but that is not possible at the moment and, on the whole, we think she is probably safer at home even though we worry she may try to go for a wander.

teacheranne this so sad for you and your mother. I cant give you any advice I'm afraid but just wanted to acknowledge you

Where's jura when you need her!

I think I agree with what she posted a while ago; if you were extremely elderly, near the end of a good life, unable to look after yourself and needing aid for help with normal every day functions therefore in a nursing home, would you want to be resuscitated? Would you want to take up a ventilator knowing someone younger might need it? Knowing that only 44% of people who are ventilated survive anyway? Seeing anxious, stressed, overworked doctors and nurses trying to save you when there are so many others who need their care?

I don't think I would.
I would want someone kind and caring to be with me if my family couldn't be, but in fact, if I got to that stage, I would choose DNR.
It is an important question that needs to be asked, particularly now.

I thunk that the situation in care homes is appalling and needs addressing. Most of the residents in these homes are paying up to £1200 a week for this dreadful treatment.

My mum is in hospital waiting for discharge to a care home - it has been agreed that she can no longer live alone due to her Alzheimers, falls risk and her determination to carry on going out shopping several times a day! She will be tested for Covid 19 before she leaves but it is likely that she will go to a care home that already had the virus among some residents.

I am so worried, we have no choice in where she goes, we won't be able to visit her and mum will be confined to isolation in her room. At the moment she is really happy in hospital with lots of people to chat to, regular meals and unlimited tea and biscuits. She is a bit of a wanderer around the ward and corridors so the nurses allow her into the day room to sit with them at meal times and to watch TV.

She will be so unhappy confined to her room and I worry that she will become aggressive then they will end up sedating her. But she cannot go home and this awful virus has left us with very limited options.

It's as if these people have been abandoned and i want to fight it. I have already written my both my MP ( no reply) and mums MP who just gave a very bland, noncommittal response.

My FiL care home have no cases as yet but they did say they will not be taken to hospital if they have a DNR on their care plan. My FiL requested this so we know he isn’t going to hospital and many families know this too.

There was a woman on the local news last night who is a cook in a care home. She has decided to self-isolate there with the residents as have other staff.
She has small children herself and hasn't seen them for weeks.
Staff like that deserve our utmost admiration.

I know all about some of the disgusting conditions that carers have to battle through when my D worked for a well known private company years ago as an agency worker.
Some of the things she used to tell me had us both in tears and I had threatened to open up but we never knew if it was management at fault or the bloody-mindedness of the one's in charge of each individual home.