care homes and COVID 19
Discussion
Apologies for starting another COVID thread but am thinking that the forum would benefit from a thread discussing the elephant in the room that has been there from the outset, rather than it being discussed as something within the other main threads. I have experience within them as a working GP but thankfully, my parents aren't in one. Would be interesting to hear opinions on any who have and their opinions one what has gone one.
To kick it off, I posted this on 3.3.20
"Interesting thread, the main part of my job (out of hours GP) is visiting the frail and elderly in nursing homes and they are truly sitting ducks for this. I was in a large home in central London last night and if this gets in to any of these facilities, then it's going to be a disaster (think that cruise ship ++++) and some interesting decisions will be necessary. If even a small percentage of the folk in one home get properly sick then the nearest hospital's critical care will be rapidly overwhelmed. Central London has more of these places than you would know, unless you did. Rather than just advising hand washing etc, If I was to give one piece of advice to the NHS, I would effectively separate these folk from the rest of us for the next month or two, no visitors and staff under strict conditions and with some outside expertise on site with PPE all over the places.
111, as usual is being overwhelmed by the worried well, it always is but over the last week it has gone ballistic, and so the potentially actual cases are being obscured. Old, multi co-morbid Patients are not calling (they generally don't) and this is the real at risk group"
thanks.
To kick it off, I posted this on 3.3.20
"Interesting thread, the main part of my job (out of hours GP) is visiting the frail and elderly in nursing homes and they are truly sitting ducks for this. I was in a large home in central London last night and if this gets in to any of these facilities, then it's going to be a disaster (think that cruise ship ++++) and some interesting decisions will be necessary. If even a small percentage of the folk in one home get properly sick then the nearest hospital's critical care will be rapidly overwhelmed. Central London has more of these places than you would know, unless you did. Rather than just advising hand washing etc, If I was to give one piece of advice to the NHS, I would effectively separate these folk from the rest of us for the next month or two, no visitors and staff under strict conditions and with some outside expertise on site with PPE all over the places.
111, as usual is being overwhelmed by the worried well, it always is but over the last week it has gone ballistic, and so the potentially actual cases are being obscured. Old, multi co-morbid Patients are not calling (they generally don't) and this is the real at risk group"
thanks.
I read in early April that one of the eastern European countries (Slovakia I think) had its care workers move in permanently with the residents. One week on/off and social isolation when not at work. Other than that, no one came in, no one came out. Anything which was delivered was wiped clean and left in a room for 24 hours before it would be allowed into the rest of the building.
At the same time as reading this I was living above a care worker who was on a zero hour contract and visiting several different homes in the same day. I can't think of a better system for wiping out the most vulnerable than having economically vulnerable people visiting multiple care homes out of financial need.
Given that the lockdown has been the biggest domestic emergency since the last World War, It beggars belief that we couldn't enforce some sort of isolation upon care homes rather than seemingly leaving it up to the individual homes themselves.
At the same time as reading this I was living above a care worker who was on a zero hour contract and visiting several different homes in the same day. I can't think of a better system for wiping out the most vulnerable than having economically vulnerable people visiting multiple care homes out of financial need.
Given that the lockdown has been the biggest domestic emergency since the last World War, It beggars belief that we couldn't enforce some sort of isolation upon care homes rather than seemingly leaving it up to the individual homes themselves.
I refer you to this from the care home professional website dated March 16th
https://www.carehomeprofessional.com/coronavirus-c...
Now what are you suggesting they should have done?
care home professional said:
Operators up and down the country have announced restrictions on visits to residents after the number of people infected with the virus rose sharply last week.
Reacting to the moves, Judy Downey, the chair of the Relatives and Residents Association, told The Guardian: “We have tin-pot dictators telling people that they can’t visit their parents and partners based on something they have half-heard.
Reacting to the moves, Judy Downey, the chair of the Relatives and Residents Association, told The Guardian: “We have tin-pot dictators telling people that they can’t visit their parents and partners based on something they have half-heard.
https://www.carehomeprofessional.com/coronavirus-c...
Now what are you suggesting they should have done?
Vanden Saab said:
I refer you to this from the care home professional website dated March 16th
https://www.carehomeprofessional.com/coronavirus-c...
Now what are you suggesting they should have done?
Told them to fcare home professional said:
Operators up and down the country have announced restrictions on visits to residents after the number of people infected with the virus rose sharply last week.
Reacting to the moves, Judy Downey, the chair of the Relatives and Residents Association, told The Guardian: “We have tin-pot dictators telling people that they can’t visit their parents and partners based on something they have half-heard.
Reacting to the moves, Judy Downey, the chair of the Relatives and Residents Association, told The Guardian: “We have tin-pot dictators telling people that they can’t visit their parents and partners based on something they have half-heard.
https://www.carehomeprofessional.com/coronavirus-c...
Now what are you suggesting they should have done?
k off and keep their asymptomatic diseased bodies at home, or else take their precious Mum back to look after her themselves if they're so concerned.For me personally what seems to have gone on in carehomes has been the worst part of all this tragedy and needs a full and thorough investigation. But the cynic in me thinks it will much the same as all other inquiries: lots of time, money and experts and no answers or ramifications except maybe a token, due to retire on a big pension, retirement.
I know from your other posts that you state CV+ people were being moved out of hospital into homes when they trying to make extra space for CV patients...as I stated previously - my wife was involved in this process in the initial stages and she is 100% adamant that, to her knowledge, nobody from her hospital was moved out unless they had 2 consecutive negative tests............to think other hospitals may not have done this shocks me quite honestly....and if true then heads should roll IMO.
Thanks for all you do BTW.
I know from your other posts that you state CV+ people were being moved out of hospital into homes when they trying to make extra space for CV patients...as I stated previously - my wife was involved in this process in the initial stages and she is 100% adamant that, to her knowledge, nobody from her hospital was moved out unless they had 2 consecutive negative tests............to think other hospitals may not have done this shocks me quite honestly....and if true then heads should roll IMO.
Thanks for all you do BTW.
Edited by anonymous-user on Wednesday 6th May 23:38
Vanden Saab said:
https://www.carehomeprofessional.com/coronavirus-c...
Now what are you suggesting they should have done?
done what I suggested on the 3rd March. Now what are you suggesting they should have done?
Our hospital wards failed to stop it spreading like wildfire at the start. A lot I think can be attributed to family and visitors but some of it was also the staff.
There is no way that you would get the staff of care homes to either move in or effectively isolate themselves for the good of their residents. Having been in the ambulance service and witnessed a lot of care home staff attitudes, the majority just wouldnt accept it as part of their role.
Our hospital required one negative swab prior to transfer of patients to care homes.
We need to remember that a lot of care homes are private businesses and the owners/ managers need to take some responsibility for this too.
There is no way that you would get the staff of care homes to either move in or effectively isolate themselves for the good of their residents. Having been in the ambulance service and witnessed a lot of care home staff attitudes, the majority just wouldnt accept it as part of their role.
Our hospital required one negative swab prior to transfer of patients to care homes.
We need to remember that a lot of care homes are private businesses and the owners/ managers need to take some responsibility for this too.
What happened on the week leading up to the 9.4.20 was a tidal wave of illness and anxiety in London, no one knew what was happening as the general population and the medical community had seen Italy.
Bad decisions were made after the 9th though when we had a better feel for what was actually going on.
I still contend that these facilities needed isolating when we started hearing about the type of Patients really affected by this virus, and that would have been in early March. NHSE should not have been waiting for care homes to call for help, they should have been proactive in providing it.
Bad decisions were made after the 9th though when we had a better feel for what was actually going on.
I still contend that these facilities needed isolating when we started hearing about the type of Patients really affected by this virus, and that would have been in early March. NHSE should not have been waiting for care homes to call for help, they should have been proactive in providing it.
pneumothorax said:
done what I suggested on the 3rd March.
I don't think there was the political ability available on 3.3.2020 to isolate the care home population from society.There are financial red lines, there are medical red lines, but there are also political red lines that simply have to be acknowledged.
As the exert shows, families were reacting badly to this mid march. In early march it was still being seen as a sniffle by many.
I think hindsight and political score settling will play a major part in any inquiry. But I would support a genuine review about how to prepare and respond to emergency situations.
Ian Geary said:
I don't think there was the political ability available on 3.3.2020 to isolate the care home population from society.
There are financial red lines, there are medical red lines, but there are also political red lines that simply have to be acknowledged.
As the exert shows, families were reacting badly to this mid march. In early march it was still being seen as a sniffle by many.
I think hindsight and political score settling will play a major part in any inquiry. But I would support a genuine review about how to prepare and respond to emergency situations.
Thank you and I agree but it was so obvious that this would decimate this population that I do think things should have been done differently. There are financial red lines, there are medical red lines, but there are also political red lines that simply have to be acknowledged.
As the exert shows, families were reacting badly to this mid march. In early march it was still being seen as a sniffle by many.
I think hindsight and political score settling will play a major part in any inquiry. But I would support a genuine review about how to prepare and respond to emergency situations.
The "difficult decisions" bit in the opening quote really referred to how one would keep gravely ill Patients in these places and not convey them and be able to square this with families. I do think that we avoided the Italian experience by not transferring many of these people to hospital.In fact I am sure of it.
catweasle said:
For me personally what seems to have gone on in carehomes has been the worst part of all this tragedy and needs a full and thorough investigation. But the cynic in me thinks it will much the same as all other inquiries: lots of time, money and experts and no answers or ramifications except maybe a token, due to retire on a big pension, retirement.
I know from your other posts that you state CV+ people were being moved out of hospital into homes when they trying to make extra space for CV patients...as I stated previously - my wife was involved in this process in the initial stages and she is 100% adamant that, to her knowledge, nobody from her hospital was moved out unless they had 2 consecutive negative tests............to think other hospitals may not have done this shocks me quite honestly....and if true then heads should roll IMO.
Thanks for all you do BTW.
Catweasle, no problem. I know from your other posts that you state CV+ people were being moved out of hospital into homes when they trying to make extra space for CV patients...as I stated previously - my wife was involved in this process in the initial stages and she is 100% adamant that, to her knowledge, nobody from her hospital was moved out unless they had 2 consecutive negative tests............to think other hospitals may not have done this shocks me quite honestly....and if true then heads should roll IMO.
Thanks for all you do BTW.
Edited by catweasle on Wednesday 6th May 23:38
I am not sure how the London hospitals are clearing these people for discharge. What I do know is that many COVID + patients are being discharged back to their usual room in many facilities. It is causing huge anxiety and I suspect will bring another wave in this sector. It will not be as big as the first one though because the really susceptible are now deceased.
glazbagun said:
I read in early April that one of the eastern European countries (Slovakia I think) had its care workers move in permanently with the residents. One week on/off and social isolation when not at work. Other than that, no one came in, no one came out. Anything which was delivered was wiped clean and left in a room for 24 hours before it would be allowed into the rest of the building.
At the same time as reading this I was living above a care worker who was on a zero hour contract and visiting several different homes in the same day. I can't think of a better system for wiping out the most vulnerable than having economically vulnerable people visiting multiple care homes out of financial need.
Given that the lockdown has been the biggest domestic emergency since the last World War, It beggars belief that we couldn't enforce some sort of isolation upon care homes rather than seemingly leaving it up to the individual homes themselves.
in an ideal world, this should have happened. At the same time as reading this I was living above a care worker who was on a zero hour contract and visiting several different homes in the same day. I can't think of a better system for wiping out the most vulnerable than having economically vulnerable people visiting multiple care homes out of financial need.
Given that the lockdown has been the biggest domestic emergency since the last World War, It beggars belief that we couldn't enforce some sort of isolation upon care homes rather than seemingly leaving it up to the individual homes themselves.
K77 CTR said:
There is no way that you would get the staff of care homes to either move in or effectively isolate themselves for the good of their residents.
I don't think it's fair to tar all care home staff with the same brush - this lot did just that:https://www.bbc.co.uk/news/uk-england-lancashire-5...
Perhaps it's a North/South thing?
Ian Geary said:
I don't think there was the political ability available on 3.3.2020 to isolate the care home population from society.
There are financial red lines, there are medical red lines, but there are also political red lines that simply have to be acknowledged.
As the exert shows, families were reacting badly to this mid march. In early march it was still being seen as a sniffle by many.
I think hindsight and political score settling will play a major part in any inquiry. But I would support a genuine review about how to prepare and respond to emergency situations.
I think the government were slow to emphasise the emergency nature of the epidemic. We knew that the elderly were most at risk and should have been able to mobilise state resources in the same way as they call in soldiers to prop up flood defences or stand in for striking fire crew. But considering the governments initial hope was to allow herd immunity to build up, making care homes and some hospitals impregnable should have been a priority even then.There are financial red lines, there are medical red lines, but there are also political red lines that simply have to be acknowledged.
As the exert shows, families were reacting badly to this mid march. In early march it was still being seen as a sniffle by many.
I think hindsight and political score settling will play a major part in any inquiry. But I would support a genuine review about how to prepare and respond to emergency situations.
With testing not yet ready at sufficient scale, and protective clothing prioritised for hospitals isolation was the only tool we had, yet it was left up to commercial businesses and private sector staff, all with bills to pay and fear of lawsuits to act against their commercial interests. I fear an authoritarian nightmare of a government as much as anyone, but on an issue like this you need a government prepared to burn some political capital and hurt some feelings.
I can only assume, others can correct me, that there has never been a plan in place for isolating care homes in case of pandemics, and when the magnitude of the problem became apparent we had immediate massive problems like drawing up a plan to keep workers at home when they need to work, which knocked care homes down the to-do list.
PBCD said:
I don't think it's fair to tar all care home staff with the same brush - this lot did just that:
https://www.bbc.co.uk/news/uk-england-lancashire-5...
Perhaps it's a North/South thing?
I think it will certainly be a badge of honour/shame for carehomes in the coming years. The best will be like thankful villages, the worst will be vilified even if circumstances were beyond their control. I can see a lot of care businesses phoenixing after this.https://www.bbc.co.uk/news/uk-england-lancashire-5...
Perhaps it's a North/South thing?
pneumothorax said:
Catweasle, no problem.
I am not sure how the London hospitals are clearing these people for discharge. What I do know is that many COVID + patients are being discharged back to their usual room in many facilities. It is causing huge anxiety and I suspect will bring another wave in this sector. It will not be as big as the first one though because the really susceptible are now deceased.
The problem is that we are looking at crazy multiple small cogs to this whole thing.I am not sure how the London hospitals are clearing these people for discharge. What I do know is that many COVID + patients are being discharged back to their usual room in many facilities. It is causing huge anxiety and I suspect will bring another wave in this sector. It will not be as big as the first one though because the really susceptible are now deceased.
Without the complete isolation there had to be a level of entry into the homes.
The homes are not equipped (logistically or medically) to handle complete isolation.
Testing of NHS offloads into carehomes wasn’t applied day 1. I believe it was then enforced later (I’ll try and find date).
Many employees are on zero hours. Unless full testing is applied then the incentive is for them to carry on working.
But in the meantime the reality is that carehomes rely on a multiplicity of interactions: family, staff, caterers, cleaners, management.
There are then over 11,000 homes with little government oversight.
I mean, I struggle to see how on Earth how you get on top of all the multiplicity of moving components especially as the government element is regulatory not hands on.
Sorry if that sounds callous but there is a lot of ‘what should the government have done’ when I suspect there is fundamental structural building blocks that made this impossible to manage.
Is Jenrick the responsible minister? Either way I have a suspicion that even if he was switched on enough to grasp the scale of the problem, the levers in front of him would have been inadequate to the task.
Edited by Ridgemont on Thursday 7th May 00:24
Ridgemont said:
The problem is that we are looking at crazy multiple small cogs to this whole thing.
Without the complete isolation there had to be a level of entry into the homes.
The homes are not equipped (logistically or medically) to handle complete isolation.
Testing of NHS offloads into carehomes wasn’t applied day 1. I believe it was then enforced later (I’ll try and find date).
But in the meantime the reality is that carehomes rely on a multiplicity of interactions: family, staff, caterers, cleaners, management.
There are then over 11,000 homes with little government oversight.
I mean, I struggle to see how on Earth how you get on top of all the multiplicity of moving components especially as the government element is regulatory not hands on.
Sorry if that sounds callous but there is a lot of ‘what should the government have done’ when I suspect there is fundamental structural building blocks that made this impossible to manage.
Is Jenrick the responsible minister? Either way I have a suspicion that even if he was switched on enough to grasp the scale of the problem, the levers in front of him would have been inadequate to the task.
Agree, it was an almost impossible task. But we should have really tried. Without the complete isolation there had to be a level of entry into the homes.
The homes are not equipped (logistically or medically) to handle complete isolation.
Testing of NHS offloads into carehomes wasn’t applied day 1. I believe it was then enforced later (I’ll try and find date).
But in the meantime the reality is that carehomes rely on a multiplicity of interactions: family, staff, caterers, cleaners, management.
There are then over 11,000 homes with little government oversight.
I mean, I struggle to see how on Earth how you get on top of all the multiplicity of moving components especially as the government element is regulatory not hands on.
Sorry if that sounds callous but there is a lot of ‘what should the government have done’ when I suspect there is fundamental structural building blocks that made this impossible to manage.
Is Jenrick the responsible minister? Either way I have a suspicion that even if he was switched on enough to grasp the scale of the problem, the levers in front of him would have been inadequate to the task.
PBCD said:
I don't think it's fair to tar all care home staff with the same brush - this lot did just that:
https://www.bbc.co.uk/news/uk-england-lancashire-5...
Perhaps it's a North/South thing?
There was one on the news where the staff were living in tents in the garden. https://www.bbc.co.uk/news/uk-england-lancashire-5...
Perhaps it's a North/South thing?
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