Plight of care homes must not be forgotten

“These are frightening times to be in a care home. It’s incredibly hard not only for the elderly residents, deemed to be at high risk and fearful for their lives, but for their carers too, struggling away while the focus has been on the hospitals.”

Followers of East Devon Watch will be too well aware of how a frightening situation has been turned into unimaginable horror for the residents, and their relatives, of Budleigh Shandford Care Home being closed by Abbeyfield. Under lockdown there can be no contact with loved ones.

Alice Thomson

These are frightening times to be in a care home. It’s incredibly hard not only for the elderly residents, deemed to be at high risk and fearful for their lives, but for their carers too, struggling away while the focus has been on the hospitals. Of all the key workers battling through this pandemic, residential carers are in a particularly vulnerable position. Low-paid, often young and inexperienced, or immigrants far from loved ones, they are expected to fight on the forgotten front line with little help or medical equipment and to act as angels when they could become harbingers of death.

There are more than 400,000 elderly in residential homes across the country. Everyone applauds the doctors, nurses, emergency staff, teachers and shelf-stackers but the care workers are too easily shunted to the side and neglected.

Many work long hours on zero-hours contracts as “unskilled” workers, helping the elderly to eat, go to the toilet, bath, brush their hair, cut their toenails, or in the case of those with dementia or Alzheimer’s, encouraging them to connect in small ways with life. The workload is exhausting, turnover is rapid and vacancies were already running at 20 per cent. The pay differential between care workers with less than one year’s experience and those with more than 20 is 15p an hour so they aren’t rewarded for acquired skills. In fact, they are often castigated for being uncaring when the majority are empathetic and selfless.

Both my parents are in care homes where the carers have made huge efforts to make the residents feel as comfortable as possible, reassuring them as they nervously self-isolate in their rooms, feeding them as nutritiously as they can from limited supplies and singing with them. For my father, who has dementia, it’s a struggle not to be able to roam the corridors or countryside.

Carers always worry about the welfare of their beloved residents: now, last in the line for testing, they know they could bring devastation to their workplace if they pick up the virus. Or they could catch it while holding the hand of a dying patient, who may be desolate without their family, or in the case of those with dementia, horribly disorientated.

Sixteen residents at a care home in Glasgow died in just over a week after a suspected outbreak of coronavirus. The patients at the Burlington Court care home were not tested for Covid-19 because they were not admitted to hospital; two staff members are also undergoing treatment. It must be horrific to attempt to provide some dignity to the final moments of so many at once, acting as surrogate family to the dying, while also worrying whether you might bring the virus back to your partner or children.

Sam Monaghan, chief executive of MHA, the UK’s largest charity provider of care for older people, said: “NHS staff are used to dealing with a high volume of end-of-life care; social care staff who develop close personal relationships with residents over months and years are not.”

Care staff have often been the last to receive personal protective equipment (PPE) despite dealing with serious cases. Meanwhile managers are worried that residents and families are being nudged to sign Do Not Resuscitate order forms. Many have been told informally not to call an ambulance for those over 75 or expect them to be admitted to hospital, although NHS England says there is no national guidance.

Rachel Beckett, chairwoman of Wellburn, which has 14 homes across the northeast, says: “With no guidance, financial or moral support, we know for now we’re in this on our own. Our carers, who are overworked, stressed and being pushed to the limit, both physically and mentally, aren’t part of the wider story.” Agency workers have been called in but they could become super-spreaders as they move between homes. So managers are appealing for volunteers to sign up to a national care force while staff self-isolate or recuperate from symptoms.

In Europe, the devastation wrought by the virus has caused a care scandal. France’s retirement homes, shuttered from the world, have reported multiple cases of double-digit death tolls. In Spain, military units had to be dispatched to disinfect care homes after staff fled. Twenty-three people were found dead in a Madrid residence.

There are ways to ameliorate care homes’ plight. In Belgium, families of elderly coronavirus patients have started legal action to ensure their relatives get places for intensive care treatment but the majority of frail octogenarians in Britain would probably be horrified to take the place of a young person on a ventilator. As the 86-year-old Joan Bakewell says in an interview in The Times today: “If I was the oldest by far and a younger person needed a ventilator, I wouldn’t be fighting for my life over theirs.”

However, dying residents could perhaps say goodbye to families if there was more protective equipment and staff must be provided with PPE, and be fast-tracked for testing. Volunteers should sign up to help at and grandchildren can write letters and paint pictures. Arts charities are already performing outside windows.

Above all, when this is over, the government must recognise that it is futile to separate social care from the NHS — they operate in conjunction. Care staff need to be better paid and residential homes should never again be seen as an afterthought. We seem to think of ourselves as a nation that doesn’t care about the old but the coronavirus has shown us how much we do.