What started as a sense of unease about the extent to which care homes are getting the Government help they need is turning rapidly to anger and real alarm (writes Age UK charity director CAROLINE ABRAHAMS).
Some 400,000 older people live in care homes in this country and the vast majority are vulnerable by any definition; most have dementia or other forms of cognitive decline, often in combination with serious long term physical health problems like diabetes and heart disease.
Existing problems
Even before the coronavirus crisis hit there were big worries about financial resilience and the capacity to deliver consistently good care across the care home sector. Although care homes are by no means all the same some problems are common to most: difficulty in recruiting and retaining enough good, trained staff being near or at the top of the list, leading to under-staffing and over reliance on expensive agency workers.
For those care homes that take any State funded clients there have also been big and growing problems making ends meet while delivering decent quality, since the State is an exceptionally mean paymaster, in apparent denial about just how much this costs.
Meanwhile, we have somehow got ourselves into a position in which care homes are operated for the most part by many small private providers on the one hand, and a number of corporate chains on the other, with the owners of the latter often based abroad and involved in complex financial arrangements, as a result of which it can be hard to see where accountability lies and what priority is really being placed on delivering good care to a highly vulnerable group as opposed to turning a buck.
From bad to worse
Then coronavirus arrived. Given how unwell most care home residents already are and the fact they are clustered together, plus the deficits in the care home workforce, it was always going to be very important to make sure everything reasonable was done and done quickly to help care homes keep the virus out and, if and when it got in, fight it effectively so it infected as few older people and staff as possible.
However, a month or so into this crisis now it is becoming apparent that many care home are struggling: in particular, they can’t get enough Personal Protective Equipment (PPE) to keep staff and residents safe and they can’t get tests to see who has got the virus and who hasn’t.
In some cases it seems they are being told that it is their job to provide end of life care for residents who are sadly dying from the virus, without enough back up support from GP and community based palliative care services, and without the possibility of these older people being admitted to hospital.
Where are the funds?
In addition, while local authorities have been given extra funding from central Government to support social care, some care home providers are complaining they are yet to pass it onto them, while meanwhile their costs are rising due to an increased reliance on agency staff due to significant numbers of their usual staff being off sick or self-isolating, plus the rise in the national minimum wage.
That’s not the end of it though: tragically, the need to protect residents led to a ban on families visiting, though recently rescinded in exceptional circumstances such as when someone is dying: however, without there being enough PPE it is hard to see how this can really work. And finally, although it is quite clear that the virus has affected significant numbers of care homes and some residents are sadly dying, we do not know how many because official figures are not being collected.
A let down
In short, it’s a mess and one that means care home residents, their families and staff are all being badly let down. It would not be an exaggeration that some are paying with their lives. Why has this tragedy come about? Probably in part because there is simply not enough PPE and testing period, and what there is has gone to the NHS first, understandably. An additional problem is that the care home sector is so fragmented that delivering any kind of national response is very hard.
In addition, there was seemingly a degree of hesitation over the question of what responsibility the Government actually bears for this sector, given that it is largely privately rather than State owned.
Tragically, it seems all too easy for the care home sector to fall between two stools: neither genuinely in the community on the one hand, nor in the NHS on the other. This is not a new problem: for many years for example, some care homes have found it hard to get good GP support for their residents, despite the latter’s obvious vulnerability – something the NHS was in the process of addressing when the virus hit through its ‘Enhanced Care in Care Homes’ initiative. The fact this was even needed though shows up the strategic problem, which is, at heart, attitudinal as well as structural.
Care homes need support
In the short term it is imperative that the Governments acts now to give care homes the practical – testing and PPE – support they and their staff and residents are entitled to expect.
In some cases it may be appropriate for residents to stay where they are without being admitted in hospital but this should not be a blanket decision, nor should care homes be left to manage without proper GP and community health service support.
Action is needed to ensure the money that is supposed to support care homes actually does reach the front line – and more of it may be needed too. And a system is required to count the numbers who are sadly dying in care homes, to demonstrate they really do matter and to aid planning both now and in future.
Longer term the clear implication is that never again can we leave vulnerable older people, and the workers caring for them, so exposed as they have been to coronavirus. The care home sector – social care more generally – is too fragmented for what is in reality an essential public service on which hundreds of thousands of people depend.
The State’s responsibility must be made clear and this and future governments must accept it – but that’s for tomorrow. Today is first and foremost about saving lives.
CHARITIES wrote to the Secretary of State for Health and Social Care yesterday. Their letter said:
Dear Secretary of State,
We are writing together as charity and care sector leaders on behalf of the hundreds of thousands of our most vulnerable people reliant on social care and the hundreds dying in care homes, supported by an army of incredible, often low paid and undervalued care workers who are not trained to deal with death on this scale.
We appreciate the time you and your Ministers have given us this week in seeking to determine a plan for social care during coronavirus. Like you, our priority is keeping people safe in the face of this terrible pandemic.
We are appalled by the devastation which coronavirus is causing in the care system and we have all been inundated with desperate calls from the people we support, so we are demanding a comprehensive care package to support social care through the pandemic.
As a first step we urgently need testing and protective equipment made available to care homes – as we’re seeing people in them being abandoned to the worst that coronavirus can do. Instead of being allowed hospital care, to see their loved ones and to have the reassurance that testing allows; and for the staff who care for them to have even the most basic of PPE, they are told they cannot go to hospital, routinely asked to sign Do Not Resuscitate orders, and cut off from their families when they need them most.
A lack of protective equipment means staff are putting their own lives at risk while also carrying the virus to highly vulnerable groups. Care professionals that have this equipment are using it in line with the guidelines – there’s just not enough getting through to the frontline. Care England estimates that there have been nearly a thousand deaths already, yet deaths from coronavirus in care homes are not being officially recorded or published, social care is the neglected frontline.
Older people’s lives are not worth less. Care home staff are not second class carers. The Government must step in and make it clear that no-one will be abandoned to this virus simply because of their age, condition or where they live.
A comprehensive care package must include:
- PPE equipment readily available to care homes. Without it, all residents’ lives are at risk
- Care home staff, and people being discharged from hospital into care homes, given priority testing, alongside critical NHS staff
- Support to ensure contact can be maintained between care home residents and their families
- Good palliative and end-of-life care for people dying in the care system
- A daily update on coronavirus deaths in the care system, just like deaths in the NHS, so that as a society we can understand the scale of the challenge we face.
We know how hard you and your colleagues in Government are working to protect the country from the worst effects of the pandemic. We would like to reiterate our offer to provide support to develop the strategy for social care at this time of crisis. We will continue to do all that we can to make sure families reliant on social care get the protection that they need.
With best wishes,
Kate Lee, CEO Alzheimer’s Society
Matthew Reed, Chief Executive, Marie Curie
Caroline Abrahams, Charity Director, Age UK
Professor Martin Green OBE, Chief Executive, Care England
Deborah Alsina MBE, Chief Executive, Independent Age
Figures released this morning by the Office of National Statistics show that 217 coronavirus related deaths were recorded in care homes in the week ending 3rd April – a tenfold rise on the week before – Ed.
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