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JDC Asks...

Mon 29 Jun 2020

What is the most important lesson to be learned by the care sector from the coronavirus outbreak?

The people who live in our homes are central in everything we do and our biggest issue has been maintaining their rights to health care when they become ill. Residents have been refused Covid-19 testing, paramedics have refused to take them into hospital, a GP bullied a resident into signing a “do not resuscitate” form and NHS 111 told us: “He won’t be going into hospital because he’s old and has comorbidities; he’ll be prescribed anticipatory medication and end of life support.” It’s an attitude that seems to say, “they’re old and they’re going to die anyway”. One paramedic told a resident “I can take you to hospital but can tell you now you will die from this and even if they put you on a ventilator you won’t recover.” Another commented: “If these people were animals they’d be put down.” Such situations are not happening all the time, but it seems like life for older people has been completely forgotten and their views about their health do not matter. Dementia is completely overlooked; it is as if no one understands it or has even thought about the realities. We can care for people with Covid so that their health, wellbeing and quality of life are protected, but if someone with dementia does not understand social distancing and wants to interact with others, how can we protect them? Despite NHS and CCG staff trying to convince us otherwise, our experience in many situations has been that blanket decisions to refuse hospital admission to older people are being applied. This is illegal and totally unacceptable. We have to fight for our residents’ rights and not just accept what other health professionals are saying, but we have been met with hostility, shouted at, told we are being obstructive, not being part of the national effort, or not following the law and guidance, which we absolutely are. Care home residents are entitled to health care and staff in all organisations need to accept partnership working with care homes so that residents receive the health care that is their right.

Kara Gratton is care and development manager at Milord Care.

 

Despite policy and rhetoric about health and social care integration gaining momentum, Covid-19 has demonstrated how far away we are from reaching an equitable system. The NHS has had significant investment to support its efforts with the virus, but investment in social care, family carers and the wider system has lagged behind. The compassion and commitment of those in the wider system has not gone unnoticed as they have risen to the challenge of caring for the oldest and frailest in our society. For many of them this is nothing new. They have been silently fighting another pandemic for some years now with little recognition or support. Worldwide, around 50 million people have dementia; annually, there are nearly 10 million new cases and all will die with, or from the condition. Much of the care and support provided to people with dementia is through social care, charities, families, voluntary and private sector staff but they are not held in the same regard as the NHS. Perhaps it is due to the lack of value placed on older people in our society and/or the fact dementia is noncommunicable. As we learn to live alongside Covid-19, we need to challenge our societal norms and values. We need to recognise the value of a truly integrated system between health and social care, where admiration and investment is accessible to all – not just some.

Zena Aldridge is Admiral Nurse research fellow at Dementia UK and has been working with the Norfolk Admiral Nurse team during the pandemic

 

In May I attended my uncle’s funeral by Zoom: there were five people actually there, and countless others by live stream. Then I Skyped my mother in Portugal, who didn’t leave the house for three months during lockdown but used video messenger throughout to keep her friends updated on how well her roses were doing. And, soon afterwards, I chaired the virtual NAPA team meeting. We are adjusting to our new ways of working and enjoy our daily catch ups, despite being video bombed by barking dogs and restless teenagers. Contact with others is vital for our wellbeing. During lockdown, we’ve had to think on our feet and use the tech that previously baffled us. Every day, NAPA members share spirit-lifting stories of how digital communication is becoming embedded into daily activities - a fantastic substitute for seeing someone in the flesh! But, browsing my Twitter feed, I was reminded that a visit in person is very important too of course. The Old Hall Care Home, a NAPA member, had tweeted a video of a day in the garden. By appointment, family visitors entered through a side gate. Staff in PPE took their temperatures. When authorised, they made their way to a large table, where family members waited. The screams of joy, and the tears of love, were magical. What have we learned? We must embrace the technology and use it to its best ends. But we must also do what we can for residents to see loved ones again, in the safest possible way, to experience the magic.

Hilary Woodhead is executive director of NAPA

 

“Protect the NHS” was a central message encouraging us all to stay at home to prevent the spread of Covid-19 and avoid overwhelming health services. It appeared largely to work as the NHS proved to be a rallying point and people stood outside their homes clapping on Thursday evenings. In fact, the Thursday applause also came to acknowledge the contribution of care workers and represented public recognition that health and social care belong together. Both have provided vital support services during this devastating pandemic. We were ill-prepared for the pandemic, acted too slowly, and ignored the advice to “test, test, test”. But, for me, the biggest false step has been the failure to realise that health and social care services need to be properly aligned. Only when all parts of the system work seamlessly together, with parity of esteem, can the potential of the social care sector be fully realised. The Covid-19 pandemic is a very high price to pay for raising awareness among politicians, policymakers and the wider public as to the consequences of years of undervaluing and underfunding both health and care sectors. An outstanding NHS is only possible if the social care system functions equally well – they are interconnected. It is my sincere hope that overdue reform of social care will now be actioned in ways that appropriately recognise its value to the quality of life of society.

Des Kelly is chair of the Centre for Policy on Ageing and former executive director of the National Care Forum

 

A care home is neither a hospital nor a person’s own home and good practice in dementia care upholds this in normal times. Some people living with dementia have challenges and may walk about or touch things repeatedly. These require skilled approaches in normal times but, in the pandemic, they needed special attention. There has been guidance from various national organisations, but there is a paucity of practical guidance for care homes about how to manage the need for isolation when a person is actively walking about or how to keep a home homely but reduce infection risk. We have seen care homes doing their best to keep people safe. Yet in some cases the virus swept through the home like wildfire while other homes either contained it or kept virus-free. Infection control principles were applied very differently in different homes. Some homes possibly wanted to keep a homely atmosphere and it will be important to work with infection control services to ensure they understand the therapeutic value of a homely environment and produce national guidance for any future outbreak. But there must also be an honest review of the types of infection control measures that were in place in different homes. Such a review must go beyond concerns about personal protective equipment and testing when we come to examine the reasons for this tragedy.

Lynne Phair is an independent nurse consultant

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