Releasing people from hospital into care homes

It really is shocking that the LA cited on Any Answers was offering a financial incentive for a home to take in covid positive residents.

Andrew Marr was good this morning. Zahawi said they couldn't test before discharging to homes as they only had 2000 tests a day. Andrew Marr said during the relevant period, I think March and April, 2,500 were discharged from hospital to care homes so they did have enough tests and by the end of the period they had many more than 2000 tests a day.

So glad to hear them called out, calmly and politely but called out.

Heard on any answers this afternoon that a care manager was offered considerable financial incentive by local council to take in extra residents. She refused. All in all it was a very informative programme on this topic in general and many contributors had experience rather than theories.

Casdon just wanted to add none of the residents in the care home where I work are self funding.

Casdon

theworriedwell virtually nobody (except a few self funders) in a care home is self caring, or they wouldn’t be there, and the number of residential homes (less dependent) as opposed to nursing homes has diminished over the years as more people are looked after in the community, which has resulted in increased dependency levels in care. Most people discharged from hospital into nursing homes do need full nursing care or at least substantial nursing input into their care or they wouldn’t get a bed. District nurses provide the nursing care in residential homes, as part of their normal workload.
I certainly don’t blame nurses, or care workers, or doctors for what happened. It was a government decision to have patients sent back to care homes to create space in the acute hospitals, they are accountable. Having seen Aveline’scomment I’m at least glad that in Wales patients weren’t discharged to care homes with a known COVID status.

I didn't suggest they were self caring, I said they didn't all need nursing care. Obviously we care for our residents but that doesn't mean they need nursing care. Staff checking they can get up, serving them meals, helping to the bathroom. You don't need 3 years study for that. One med trained staff member can sort out med rounds.

maddyone

Thank you for explaining the situation as it was in your care home theworriedwell. Possibly not all care homes were in the same situation as yours. I appreciate that not all care home residents require nursing, but many do, especially when recently discharged from hospital having been ill. We cannot generalise as there are many care homes across the country and from news reports at the time, it appears that they all coped differently. Some were lucky in that their preventative measures kept their homes free of Covid whilst others, despite everything they did, found that Covid got into their home, with various results.

I’m pleased to hear that there were no deaths in your care home.

I've never worked in a care home that had nurses, there are plenty of them. Even if they quarantined those people it would have reduced the spread.

I have a relative in a care home, in her home the staff moved in for lockdown to protect their residents, they slept in caravans on the car park. Covid got in, you guessed it, it came from a resident discharged from hospital.

My home had pressure to accept a new resident from hospital who couldn't go home. We couldn't have taken them if we wanted to as we were full. Homes are registered for a certain number of beds. It was suggested we could just open another room. No we couldn't - no breaking our registration.

I heard the manager of one home saying she wasn't told a resident was being discharged. The doorbell rang and the ambulance man presented her with the resident in a wheelchair, she said she didn't have facilities to isolate him and couldn't take him. She was told he was being left there and she had no alternative.

I know of another case where the hospital waited till mid evening when they were pretty sure the manager wouldn't be around and told the staff member on duty the discharged had been agreed. Fortunately the staff member phoned their manager and she made it clear a discharge had not been agreed.

A protective ring round care homes? Oh how we laughed.

Hardly any district nurses here any more, my friend is one and often has to work alone and the team is almost minute

I've seen a couple of very interesting interviews on tv this week. Early morning stuff; I think GMB. First was a doctor on the Covid front line who said she had declared her unhappiness at her patient being released to a care home but it seemed to be out of her hands. Second was a care home manager who declared her disquiet at having patients from hospital to her care home without tests. Think she said she was 'forced'. I know nothing of regulations in these arenas but these were front line people who were seemingly on the same wavelength. Their comments certainly resonated with me.

As someone else said, hindsight is a wonderful thing. I don't think blame should be apportioned to nursing or care staff who worked under such difficulties.
I hope we can learn from this debacle and even more I hope we never have a situation like this again.
Matt Hancock and others are of course paid big bucks to take responsibility.

theworriedwell virtually nobody (except a few self funders) in a care home is self caring, or they wouldn’t be there, and the number of residential homes (less dependent) as opposed to nursing homes has diminished over the years as more people are looked after in the community, which has resulted in increased dependency levels in care. Most people discharged from hospital into nursing homes do need full nursing care or at least substantial nursing input into their care or they wouldn’t get a bed. District nurses provide the nursing care in residential homes, as part of their normal workload.
I certainly don’t blame nurses, or care workers, or doctors for what happened. It was a government decision to have patients sent back to care homes to create space in the acute hospitals, they are accountable. Having seen Aveline’scomment I’m at least glad that in Wales patients weren’t discharged to care homes with a known COVID status.

At the very beginning of this we had people discharged from hospital into our care home without being tested, consequently most of the staff and the residents got Covid and some residents died and some staff were very very ill. Personally I have had Covid twice now but with no symptoms ,I do think now I am suffering with long Covid as I’ve got very achy legs and I am very tired most of the time but I am still going to work.... for Hancock to say that care homes were ring fenced makes me sick

Can I just make the point too that it wasn't just care homes for the elderly that were affected. It also affected home for those with varying disabilities and advice to those homes was completely over looked too, even months into the pandemic

Blinko

This whole debacle is illustrative of the Government's total lack of understanding of how the Care sector works.

It is currently operated at arms length, by the private sector on a piecemeal basis, with different care homes doing different things at all levels. Hence some are excellent, others not so.

Which is why it all needs a complete overhaul and closer alignment with the NHS. And HMG has yet again kicked a review into the long grass.

You have to wonder whether some people with 'the right connections' are making a great deal of money out of the current social care system...

I completely agree with this also. Some care companies seem to use an interpretation of the law in which suits them too ime and that definitely got worse during the pandemic

Thank you for explaining the situation as it was in your care home theworriedwell. Possibly not all care homes were in the same situation as yours. I appreciate that not all care home residents require nursing, but many do, especially when recently discharged from hospital having been ill. We cannot generalise as there are many care homes across the country and from news reports at the time, it appears that they all coped differently. Some were lucky in that their preventative measures kept their homes free of Covid whilst others, despite everything they did, found that Covid got into their home, with various results.

I’m pleased to hear that there were no deaths in your care home.

Sarnia

I suppose as Minister for Health, the buck stops with him. Nobody seems to have joined the dots when it came to sending people back into care homes. We now know what a catastrophe that was. I just hope that everyone who takes part in any investigations and inquiries concerning the pandemic are open and honest. Yes, mistakes have been made. We were dealing with an unprecedented situation but lessons need to be learned for the future. When the decision makers come out and say that tens of thousands died unnecessarily, it must be heart-breaking to those who lost a loved one.

I completely agree with this Sarnia

Liz46

Let's hope there is a sensible enquiry with a view to learning for the future rather than heaping blame on people who were doing their best in a very difficult situation.

Casdon, you just reminded me of a recent conversation with a neighbour who has to free up beds in psychiatric wards. He has the difficult job of choosing who can go and dreads ending up in court being blamed for releasing someone who then does something awful. He is taking early retirement because of the stress.

Isn’t this all down to care in the community.which basically meant throwing psychiatric patients out into the street and not actually caring for them at all. Not the fault of your neighbour but if whoever thought care in the community was a good idea.

AcornFairy

Very difficult situation. The testing capacity was lacking in those early stages, while at the same time hospitals were under great pressure to admit sick covid patients - which meant that beds were at a premium, so discharging recovering patients was a choice. Decisions had to be made fast and of course some were unwise. Hindsight is helpful for the future but blame is a dodgy concept.

I'm fed up hearing about hindsight. I was having conversations about why weren't they setting up suitable quarantine for discharged patients over a year ago. Maybe I should have Matt Hancock's job.

Casdon

Doctors on the front line had no choice Liz46. The instruction was to discharge to create more room for the patients who were flooding in at the front end of the hospital system. The patients who went to care homes weren’t fit for hotel quarantine, most of them needed full nursing care so the only available option was to return them to the homes they lived in. People who were symptomatic weren’t discharged, but many had been infected already. The care homes had inadequate PPE didn’t isolate people on discharge from hospital initially, and didn’t segregate staff who also inadvertently became infected and passed it on to others. It was a tragic situation.

Full nursing care isn't provided in many, probably most, care homes. For people who needed nursing care then suitable quarantine could have been organised but of course it is easier to just let the elderly die and blame care workers.

maddyone

What a difficult situation it was. Not enough tests or PPE and probably some lack of understanding about Covid and how it spreads. Of course Matt Hancock must bear responsibility as he was in charge, but the situation was difficult. I don’t think the patients could have gone into hotels to quarantine because they were old and required nursing care although not medical care. The care homes probably had insufficient PPE and the staff perhaps a lack of understanding or ability to quarantine the patients.

Not everyone in care homes needs, or gets, nursing care. I work in a care home and we have no nurses and our residents would have managed in quarantine the same as they did in the home when a hospital visit resulted in an outbreak. The only difference would be in a hotel they would have ensuites which not all our residents do so our quarantining of residents was clearly not 100% and couldn't possibly be which is why it spread. Fortunately no deaths.

Our understanding was fine thank you, we just weren't prepared to deny residents access to a bathroom for 2 weeks.

In Scotland people were knowingly released into care homes with a covid diagnosis. Big scandal up here.

Failing to ensure that those going into care homes were covid-free was a major blunder. Once that ball started rolling there was no way back.

It’s not down to nursing staff EllanVannin, and it’s unfair to blame them. An instruction was given that patients had to be discharged if they were medically fit, without COVID testing being available.

What a difficult situation it was. Not enough tests or PPE and probably some lack of understanding about Covid and how it spreads. Of course Matt Hancock must bear responsibility as he was in charge, but the situation was difficult. I don’t think the patients could have gone into hotels to quarantine because they were old and required nursing care although not medical care. The care homes probably had insufficient PPE and the staff perhaps a lack of understanding or ability to quarantine the patients.

It's worth clarifying that Matt Hancock is being accused of lying. That should be provable or not.

How on earth is it down to nursing staff? If you mean a lack of them then the buck still stops with Matt Hancock and the government.