We began planning for the pandemic back in late February. This included the obvious need to restrict movement in and out of our care homes in order to protect our residents. We considered from the beginning that while all families would miss the contact, those who were nearing the end of their life would be particularly affected. From the outset we facilitated ongoing visits for these families, through risk assessments, monitoring of symptoms, and suitable PPE for those visiting. This was not always straightforward, as some families were themselves shielding and some special arrangements were made to accommodate them as safely as possible.
In some cases families could do window visits, and if circumstances allowed, visits through patio doors to individual bedrooms. In addition we recognised the effect no visits may have had on some resident’s mental well-being. Where it was clear that anxiety from not visiting was a high risk when compared to the COVID-19 risk, managers adopted a similar approach to the end of life visits, in order to support those finding it difficult.
We started from a positive position as our staffing levels are usually generous compared with some operators and we had low agency use. However, we had a continuity plan in place for each home. At the height of the pandemic we saw some reduction in our staffing in some homes, due to lack of testing and staff having to isolate. We countered this with an approach to recruitment very early on. In March, when hotels and restaurants were closing, we were able to recruit additional staff. We were thinking laterally and using these additional staff to do the non-complex activities. Again where there were concerns, we were clear with families in our communication, what the situation was and how we were managing it. Although there were a couple of homes in which staffing levels were lower, we didn’t have any homes where this necessitated their contingency plan.
Like the rest of the country, early on we had very limited access to testing, but from the beginning our plan was to reduce the spread by careful monitoring of people. We shared these plans with our residents, staff and families. This included regular temperature checks, and advising staff of the correct way to use PPE. Later on, through our own data, we recognised that further clinical signs were apparent in early pre-symptom cases of COVID-19 including a possibility in a change in bowel function and a lowering of oxygen saturation. We immediately included them in our management of the virus. As time progressed and testing became more available we maximised this opportunity and eventually we tested everyone in our homes and reported the overall outcomes to families, along with any changes to our plans.
Very early on we took the position that while there may be some support from the government in accessing PPE we couldn’t be sure that this would be sufficient for our needs. We decided not to rely on this supply chain but to use our own resources to secure supplies. We estimate that during the three months of the pandemic we spent over £10,000 per home more on PPE than we usually would. If you extrapolate this to the whole year across all our homes, this would equate to nearly half a million pounds.
The finances, while very concerning, were only half the picture. Actually obtaining the items became harder as the supply chain had been affected by the demands from the NHS. For a time there were stories in the press about PPE being diverted to the NHS, and care homes not having suitable PPE. We had to work hard, and there was a definite short supply, but we managed to get what we needed. We continually kept our families updated about our supplies, reassuring them that we had enough PPE and of the right type.
We, like most operators, have had cases or suspected cases in our homes. When testing was not available we were making assumptions based on clinical presentation. However, the signs of COVID-19 can be very similar to many other age related complaints experienced by older people receiving care, such as high temperature. We decided early on that anyone who showed any of the signs of COVID-19 would be treated as positive. This included barrier nursing, or in some cases reverse barrier nursing, in conjunction with isolating the resident. We also excluded from the home staff who showed any signs of the virus.
With such limited testing for COVID-19 in care homes early on, those signing death certificates were making a judgement, in some cases based on limited information. While I cannot say we have not had any COVID-19 deaths, the number of deaths across our homes from January to the end of May 2020 is no higher than the same period last year.
We have been open to admissions throughout the last few months. We undertake appropriate assessments, a period of isolation on arrival, as well as the usual testing. Our homes can facilitate Skype visits for residents and family members who wish to view the home. As our homes come out of some of the restrictions, we are also looking to see how we can accommodate socially distanced visits for prospective residents and their families, but clearly this has to be at a point when it is suitable to do so.
Throughout the pandemic, I contacted family members monthly to update them on the strategy we were adopting and on our steps to move homes out of the lock-down and commence visits again, albeit in a gradual way.
We have enabled visiting through a combination of risk assessments. For example, we take into account whether the whole home has tested negative, and whether visitors have been made aware of their responsibilities in visiting. Communication has to be timely, open and honest as families need to understand both what their part is and that things may change if cases start to re-appear in the home or risk increases to a level which affects the safety of visiting.
There is no statutory guidance on visiting at the moment. The only clarity has come from the Care Provider Alliance, driven by some providers desire to ensure we do the best by the residents of care homes. CQC have not provided any advice or made their position clear on this other than to say its up to the provider. Public Health England to date are confusing in their advice and it depends on who you speak to. It appears amazing that we are on the verge of opening pubs and hotels across England, yet our most vulnerable citizens still do not have any official guidance about being able to be visited. This leaves providers potentially at risk of doing the wrong thing.