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The care home situation

denial of hospital treatment

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Female
Aely  Female  Hampshire
26-Jun-2020 21:47 Message #4784878
I have just watched the Sky News special regarding care homes. I think many people are aware that elderly "bed blockers" were released to care homes when it was feared Covid19 could overwhelm hospital facilities. It is evident that the lack of testing resulted in Covid being taken into the homes with inevitable consequences.

When I heard , was it Boris himself?, say on tv that care homes had been given a "protective ring" during the worst of the pandemic I cynically thought to myself " yes indeed, to stop them escaping". It seems my feeling wasn't that far from the truth. It has come to light that many care homes were approached and asked to consider putting blanket DNRs on their residents (Do not resuscitate) and were pretty much told that if their residents became ill medical assistance, other than that provided by the home itself, would not be available. Hospital admissions were refused. Oxygen was not made available. Death notification regulations, some of which were introduced after Harold Shipman was convicted of murdering and self registering the deaths of some 200 of his patients, were relaxed, leaving it up to care home staff to pronounce death and do the necessary. This was so that a doctor did not have to visit.

No wonder the death rate in care homes has been so high. The deaths were not all because of Covid19. Nobody knows how many were, or weren't, because there was no testing and no visit by a doctor. One otherwise fairly fit lady with COPD died of a simple chest infection that could have been treated if she hadn't been refused antibiotics. They died because they were a liability and got sick. It could have been me. I live on my own. If I trip over the cat and break a leg, or a wrist, and cannot cope for a while I would do what my aged aunt did when she broke her wrist - book into one of our local homes for a while. Or maybe not...

So much for "cradle to grave" NHS care.
Male
FirmButFair-TrollPatrol  Male  North Yorkshire
26-Jun-2020 21:49 Message #4784881
I was listening to a report this week from care homes saying hey may have to close down because so many of the sick and elderly have chosen to stay with family and care homes have been left with too many empty beds.
Male
BOYDEL  Male  Surrey
27-Jun-2020 08:40 Message #4784898
Social Care per se was never part of the NHS as designed back in 1948 - and of course back then it was far smaller issue as only 37% of people even reached age 60 - and that 60 plus cohort then survived on average a mere handful of years thereafter.

With many households being multigenerational it was often the case that an elderly/infirm relative would be looked after at home - but today many broader families are scattered far and wide to find work - whilst often the 2 adults both need to be working for a decent standard of living.

Even without Covid LSE research shows that median overall survival in Care homes is just 19.6 months - so we expect almost all residents to have passed away by month 39 (bar the statistical outliers).

Nursing homes per se with the most frail residents with multiple comorbidities show median survival of just 11.9 months so we expect to see virtually all passed away by the 2 yr stage.

With a total of 411,000 Care home residents that translates to around 10,500 resident deaths every month (without Covid) and especially with the relaxed criteria mentioned around certifying precise cause of deaths in Care homes we shall never know the true rate due to Covid per se.

Some 90% of residents are aged over 75 and 60% over age 85 - so paradoxically the latter group especially have already outlived the average UK survival of around age 80 (give or take a year or two).

Across the board we know that those who are admitted to hospital from the community with severe Covid symptoms will see a 1/3rd mortality rate - irrespective of treatment type and those on ventilators even higher rates of mortality - with obese patients aged 80 plus having around 73% hospital mortality

If we could turn back the clock to say 2019 - would we/could we do things better around Covid - could we magic up out of nowhere the ITU nurses needed to cope with all the feared admissions due to Covid?

Would we have locked down far earlier and expected wider population to comply - events of last few days and even earlier show Govt was right to be fearful of poor compliance with lockdown?
Male
Pboro Trevor  Male  Cambridgeshire
27-Jun-2020 10:47 Message #4784906
The order was to transfer as many patients, who were not displaying any symptoms of coronavirus, to care homes. At that time there were no accurate tests for the virus. We now know that a lot of these patients had the virus, despite not showing any signs.

I doubt, without an accurate, quick test the end result would have been the same.

Trevor
Male
BOYDEL  Male  Surrey
27-Jun-2020 10:57 Message #4784907
Plus of course - only by mandating Care home staff to permanently live on the premises could there be a g'tee that staff would not bring infection in from wider community - at least not until we had a reliable CV test that would give results in minutes so that staff could be tested daily before being allowed entry to the Care homes.
Male
brisinger  Male  Lancashire
27-Jun-2020 18:11 Message #4784937
The order was to transfer as many patients, who were not displaying any symptoms of coronavirus, to care homes.

No the order was to transfer patients who were sic "medically fit for discharge" or waiting for a "Discharge to Assess" bed. That means that they are fit to be discharged with a care plan which can take ages to be put in place or a D2A. A D2A is a pathway where people who are clinically optimised and do not require an acute hospital bed, but may still require care services are provided with short term funded support to be discharged to their own home (where appropriate) or another community setting. I know because LO was in that position and as primary carer and working on the wards under John's Campaign I was directly involved. At the onset of Covid-19 it was the duty of the Trust and therefore bed managers to clear as many beds within the hospitals who aren't "acute" cases. If they were displaying symptoms of Covid-19 they would be reclassified as "acute" cases.
Male
brisinger  Male  Lancashire
27-Jun-2020 18:37 Message #4784938
A DNAR (also known as DNACPR) does not work that way. The patient or the patient's representative who usually holds LPA has to be informed of the option and a decision it made. A DNAR can only be used when:
1)
A) CPR is unlikely to be successful
B) CPR may be successful, but followed by a length and quality of life which would not be of overall benefit to the person.
C) There is a valid advance decision to refuse CPR in certain circumstances

2)
All DNAR decisions are subject to ongoing monitoring.


A DNR form has to be filled in when the person still has capacity.
Which states: "I request limited emergency care as herein described. I understand DNR means that if my heart stops beating or if I stop breathing, no medical procedure to restart breathing or heart functioning will be instituted. I understand this decision will not prevent me from obtaining other emergency medical care by health care professionals prior to my death. I give permission for this information to be available to local hospitals, out of hours and emergency services or other healthcare professionals as necessary to implement this directive. I hereby agree to the ‘Do Not Resuscitate’ (DNR) order. This directive remains effective until I make clear that my wishes have changed."

They cannot just stop providing medical care otherwise it is classified as murder.
Male
brisinger  Male  Lancashire
27-Jun-2020 19:10 Message #4784943
Even during Covid-19 if a person needs medical care an On-call Doctor has to be called out. Relatives and Social Services would be notified and it would be documented. This also applies to falls and injuries. In certain circumstances Social Services are duty bound to invoke an investigation. Social Services also have a duty of care to investigate any injuries that haven't been documented. Any Care Home not carrying this out would be taken to the Court of Protection. (It's been a difficult journey trying to make decisions when you are in uncharted waters.)
Male
brisinger  Male  Lancashire
27-Jun-2020 19:34 Message #4784944
self registering the deaths of some 200 of his patients, were relaxed, leaving it up to care home staff to pronounce death and do the necessary. This was so that a doctor did not have to visit.

Where ever all this has come from is talking absolute rubbish. The cause of death has to be certified by a Doctor and Next of Kin. The Death certificate goes like this:
1. Date and place of death
2. Name and surname
3. Sex
4. Maiden surname of woman who has married
5. Date and place of birth
6. Occupation and usual address
7.(a) Name and surname of informant
(b) Qualification
(c) Usual Address
8. I certify that the particulars given by me above are true to the best of my knowledge and belief. Signature of informant
9. Cause of death Certifying Doctor
10. Date of registration
11. Signature of registrar.

(CROWN COPYRIGHT)
Male
brisinger  Male  Lancashire
27-Jun-2020 19:38 Message #4784945
On completion of that you can use the "Tell us Once" found on the governments website so they can inform the relevant departments.
Female
JustLyn  Female  Cheshire
27-Jun-2020 21:25 Message #4784947
The thing is, at the beginning of covid, and even now to a degree, there was and is no easy access to testing, so many GPs were and are inexperienced or untrained (realistically so, especially in the beginning) so many were not signed on the death certificate as having covid when died of of another suspected, but in their mind and experience, a more likely cause. Without suspicious circumstances and with the pressure of Covid, also unlikely to go through a Post Mortum.

Then some were diagnosed as positive on symptoms but no test.

My niece, working in a care home observed excessive deaths and difficult deaths, and as beds became available through these excessive deaths, they were under pressure to take emergency discharges of frail elderly who had been tested positive in hospital but fit for discharge where care home managers felt they had to decline acceptance, as at this stage, as as far as they were concerned, with no access to testing, they could have been infecting existing residents. This makes the actions kind of even more shocking and rather ignorant of government insight as even I struggle to believe (and yes it is political) Johnson and Co would construct convenient deaths of who they perceive to be worthless and past it. Though personally, I would choose NCR for myself but not my place to decide for others...obviously.
Male
Hierophant  Male  East Anglia
27-Jun-2020 21:35 Message #4784949
I agree totally with Brisinger - still it was Sky News, they are worse than the BBC and that's saying something.
I would also argue that nursing/care homes are better equipped to deal with infected patients than a hospital, unless the patient requires ICU care obviously.
Each resident has their own enclosed room making controlling spread much easier than in an open ward in a hospital, and homes are well used to dealing with infections at normal times with all staff well trained in infection control methods...
Male
brisinger  Male  Lancashire
27-Jun-2020 23:40 Message #4784958
Because of Covid-19 the plans put in place to discharge LO back home with a care plan had to be put on hold and left us in uncharted territory. Social Services were having to help find temporary care beds in order to clear wards. They were working in the dark as much as us. Anybody who was moved into a care facility had to go in quarantine away from the current residents. When LO was in a hospital ward someone was showing symptoms and they moved everyone else lock stock and barrel to another ward. We were all having to wear masks whilst working on the wards. Anything that could be moved did get moved and the person was quarantined in a side bay whilst they deep cleaned the ward and were sure it wasn't Covid-19. In my experience I think the most likely way Covid-19 gets into care homes is via staff. Often over years of experience staff in hospitals and care homes go in wearing their uniform after travelling on buses and such like rather than changing when they get there and go on duty.
Male
NotHermit  Male  Derbyshire
27-Jun-2020 23:44 Message #4784959
Why did care homes end up in such a mess then Hiero?
Not enough, or indeed any personal protection equipment?
How are they supposed to do a job without the correct tools?

Hiero puts his head in the sand again.

Male
brisinger  Male  Lancashire
28-Jun-2020 00:40 Message #4784961
We were kitted out with PPE, pinny, gels, etc. as I was kitted out in my photo profile.
Male
brisinger  Male  Lancashire
28-Jun-2020 01:05 Message #4784962
It's not for the faint hearted being a 24/7 Alzheimer's carer and I would never look down on people who opt to place them in a care home. It's mentally, physically and emotionally exhausting. Your life is all consuming. I have to say that unless you've been there it's almost impossible to comprehend what it's like. There were times when it was crushing me and sometimes I unjustly lost patience with some posters on here. Even now it's an emotional roller-coaster and sometimes I have to back away from the keyboard. People who have worked as carers and end up looking after the LO's 24/7 have said that their job just hadn't prepared them for how high it raises the bar. For me and other's in the Dementia Angels Facebook group we find one word comes before anything else when you become a 24/7 Alzheimer's carer and that's...Patience. The group's been my lifesaver.
Male
brisinger  Male  Lancashire
28-Jun-2020 01:05 Message #4784963
It's not for the faint hearted being a 24/7 Alzheimer's carer and I would never look down on people who opt to place them in a care home. It's mentally, physically and emotionally exhausting. Your life is all consuming. I have to say that unless you've been there it's almost impossible to comprehend what it's like. There were times when it was crushing me and sometimes I unjustly lost patience with some posters on here. Even now it's an emotional roller-coaster and sometimes I have to back away from the keyboard. People who have worked as carers and end up looking after the LO's 24/7 have said that their job just hadn't prepared them for how high it raises the bar. For me and other's in the Dementia Angels Facebook group we find one word comes before anything else when you become a 24/7 Alzheimer's carer and that's...Patience. The group's been my lifesaver.
Male
BOYDEL  Male  Surrey
28-Jun-2020 08:01 Message #4784969
Hiero - anyone who is amongst the 60% of Council funded Care Home residents is fairly likely to be in one of the cheaper shared rooms - as on average the Councils underfund the Homes by around £20,000 pa compared to normal charge.

Infection control is also highly dependent on all staff taking max precautions when moving between residents - and of course when they move around the wider community - whilst a proper Care Home lockdown would need all staff to have lived on premises for 7 days a week since the Covid outbreak.
Male
Hierophant  Male  East Anglia
28-Jun-2020 08:25 Message #4784972
Well I worked in this sector for 8 years and I never saw shared rooms in any of the homes I visited, although they used to be the norm years ago, and no doubt some still exist.
I would suggest most nursing/care home residents have their own room with en suite shower and toilet.
Of course infection control is dependent on all staff taking max precautions, that's what the mandatory training is designed to instil in them.
That's what makes a complete mockery of "normal" people buying PPE to wear on trips to the shops when they don't have the first idea how to use it and how to prevent infection spread.
Many homes make provision for staff to stay on site during infection/infestation break-outs, such as norovirus, scabies, even in times of heavy snow as the home will not operate safely without the required number of staff in place.

My head isn't in the sand Hermit, I base my opinion on what I see with my own eyes, not what the shitty media feed us...
Male
NotHermit  Male  Derbyshire
28-Jun-2020 09:15 Message #4784975
Hiero is now turning into Donald Trump, its all fake news.
The figures speak for themselves.
Male
BOYDEL  Male  Surrey
28-Jun-2020 09:17 Message #4784976
Fair enough tighter regs around minimum room sizes etc may have phased out many of the shared rooms - but Bupa Care Home survey flags a 1/3rd loss of staff to the sector every 12 months which makes one wonder about commitment levels and adherence to infection control rules.
Female
eurostar  Female  Merseyside
28-Jun-2020 09:27 Message #4784981
We had one home in Liverpool that still allowed visitors the first week of lockdown, many staff went off, 16 residents died and they put an alert out for new staff, it will close down, but the one my daughter in law manages went straight into a lockdown with lots of PPE tests as soon as available and didn't lose one patient, and no covid in the home, as for shared rooms my ex was in one for 15 months, brain injury, and he had no ensuite, but no sharing, that home hasn't lost anyone to covid either, each home is different
Female
JustLyn  Female  Cheshire
28-Jun-2020 09:45 Message #4784986
The reason a care home is less equipped to deal with any infection is they are rarely ran by trained health professionals. There are some good ones, but after working in a couple of them, then working alongside them in primary care, it was obvious they were a service in severe neglect.

Infections spread not because of isolated rooms, which would help to a degree, but I saw shared rooms with 2-3 "cots" in each night room, but unless bedridden, all homes have day rooms where residents migrate to and from.

Since care homes, and some nursing homes have few trained nurses but health care assistants, they often complained to me that they were left out on training, and that was by the motivated ones, some of which were quashed and threatened to keep their mouths shut because management wanted an easy life.

Many were crying out for training during the beginning of covid and could not access it because there were many staff who just knew their competencies had not included infection control at a level as they didn't normally have to deal with infections on a day to day basis, district nurses normally coming to patients who might require dressings etc.

So although airborne infections are more concentrated and mixing where more than one individual is present, even when individuals are separate, it is the carers who pass infection from one resident to the next inadvertently because they just didn't know they would be doing it, and by the time this was recognised, the infection had already been let out of the bag.

Wearing PPE without training spreads infection. We now even have people walking out in fresh air wearing masks when completely alone or even driving alone.

When practising sterile procedures and wearing PPE you would have a sterile field and have a constant presence of mind not to touch that area if you have touched a non sterile area. Many care assistants will not have this ingrained in their training from the start and make mistakes, and just had a rush job and no exams to do the best they can.

At least some knew enough to not accept known infected new residents that the hospitals needed to offload somewhere because they were desperate for the beds during that phase.
Male
BOYDEL  Male  Surrey
28-Jun-2020 10:17 Message #4784995
Excellent insight as always Lyn.

Here is a quote from the Observer in a piece calling for a National Care Service

"The experience of people in care has varied widely from region to region. In some areas, such as Somerset, partnerships have developed, with different bodies trying to integrate hospitals, care homes and home care staff. In others, the divide between health and social care has been stark.

Councils in north-east England threatened to withhold funding unless care homes accepted confirmed Covid-19 patients. In the east of England the owners of a small independent group of homes told the Observer they had been gradually abandoned by the NHS."

With Bupa Car Home survey flagging that 60% of residents are Council funded those Councils in NE England were clearly forcing homes to choose between closure or accepting Covid patients from hospitals.
Male
BOYDEL  Male  Surrey
28-Jun-2020 10:20 Message #4784997
Here is a link to the complete article on Nat Care Service

https://www.msn.com/en-gb/news/uknews/calls-for-national-care-service-as-crisis-leaves-homes-in-critical-state/ar-BB163kN5?ocid=msedgntp

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