How we improve Covid-19 care for care home residents

Having just spent several hours wading through the final report of the “COVID-19 Social Care Support Taskforce” one wonders how those working in the service will ever find time to read it – let alone implement all 42 recommendations which are designed to make bad practice safer!

Care homes are not, and were never intended to be, hospitals. The residents are just as entitled to hospital care, if that is what is needed, as are the rest of us. That so many have been left to die in Care Homes, rather than being admitted to hospital, and thereby denied the benefit of oxygen, ventilators and intensive care which might have saved their lives is the real concern. The minute a resident exhibited symptoms they should have been tested and if positive admitted to hospital. The discharge of older people from hospital to care homes, without testing, in order to free up beds for coronavirus patients may also have spread the virus. That not all older people have an “assessment of need” and “verification of wishes” by a social worker prior to admission to a care home whether or not they are self-funders, as envisaged by the 1990 National Health Service and Community Care Act, is a real concern. Admissions to care homes should have been stopped from the time relatives were stopped from visiting.

All staff in Care Homes and those working in Home Care should have worn masks from day one of the pandemic.
There are real concerns about the under-funding of the care sector which go back to the Griffiths Reforms of the 1990s and the transfer of what had been an open-ended entitlement to local authorities as a “cash limited allocation”, the introduction of the purchaser provider split, and Local Authority Social Service Departments fixing their contract price for Care Homes in the private sector below the cost of their in-house provision – so much for the “level playing field” of Sir Griffiths!

Please see my earlier article

* Chris Perry is a former Director of Social Services of South Glamorgan County Council, a former Non-Executive Director of Winchester & Eastleigh Healthcare NHS Trust and a former Director of Age Concern Hampshire.

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7 Comments

  • David Warren 29th Sep '20 - 4:24pm

    As long as we have care homes which are run by private companies looking to make a profit there will be problems.

    The model put in place by the Thatcher government has failed users, their families and the workers. The only beneficiaries have been the people creaming off the profits.

    We need a completely new approach.

  • John Barrett 29th Sep '20 - 5:30pm

    Discharging people from hospital into care homes who either had the virus or had not been tested was, and is, a recipe for disaster.

    The care home sector, private or not, was effectively thrown under the bus early on in the pandemic in an attempt to protect the capacity of the NHS.

    Many care sector workers did not have access to PPE and many residents were let down by the entire health service system, who left them in care homes, when many should have been receiving treatment in hospitals.

    We will never know the full number who were denied the dignity they deserved in their final days, but it is time to rethink how we treat the elderly and what laws need to change in order to ensure we all receive the treatment required while letting those who would not wish their final days to be extended by a few days or weeks, on a ventilator in intensive care, rather than spending a shorter time in the company of their loved ones.

    Testing, to establish what the patient’s condition is and then taking the appropriate action to decide what care they require is how we treat everything else. Telling people who think they are ill to go away and isolate for 2 weeks is a death sentence, if they only have a few weeks to live.

  • Steve Trevethan 29th Sep '20 - 6:21pm

    Thank you for an important article!
    If we believe in competition, then we have a duty to work for networks of local authority Care Homes funded by National Government.
    Such provides:
    * Real competition with for the private sector rather than delusory cartel competition
    * Need based funding
    * Local input
    * Democratic guidance and accountability

  • As a former Cabinet Member for Social Care I very much agree with Chris Perry’s article (and the comments made by David, John and Steve). I thank Chris for raising it.

    This area is more important and has more relevance than any of the motions passed at the online Conference. If Ed Davey is to be ‘a voice for Carers’ he should take the matter up with vigour.

    It is a national scandal that last year, when the National Living/Minimum Wage was £7.38 per hour and the Real Living Wage £9 per hour, the national average wage rate for care workers was £8.41ph…. and obviously in some areas such as Northumberland less than that (£ £8.07ph).

    The so called competitive contract tendering system used by local authorities with private companies helps to drive down those wages in a race to the bottom for a threadbare service. It is a national shame which no amount of clapping can repair – made worse by events in 2010-15.

    If Ed Davey is ever to be capable of adopting the Jo Grimond approach of ‘marching his troops to the sound of the gunfire’ then this is a campaign he should lead.

  • Steve Trevethan 29th Sep '20 - 8:03pm

    The government’s handling of the Coronavirus epidemic is such that it raises questions,

    Is it genuine incompetence?
    Is it a covert policy of herd immunity?
    Is it something else?
    Is it a combination of the above?

    To what extent have our citizens been harmed by their being groomed into believing that they are “customers” rather than “citizens”?

    Only 18% of those with symptoms are actually self-isolating.
    Only 11% of those officially instructed to stay at home do so.
    (Department of Health survey)

    The Johnson government is the worst performing in the E.U. with four times more excess deaths than Germany, two and a half times more than France and more than Italy and Spain.

    A former cabinet secretary says that H.M.G. has been in “fire fighting mode” for too long.

    Is HMG in “fire-fighting mode”, “incompetent mode”, “shifty mode” “panic mode” or some other mode?

    https://www.counterpunch.org/2020/09/29/britain-will-seek-coronavirus-herd-immunity-covertly-or-by-default-thanks-to-an-inability-to-get-anything-done/

  • Not sure I can add much to the debate but this governments handling of the care home debacle, among other similar issues, is a huge indication of their dubious priorities towards the general population and I hope Ed Davey,s vow to keep the pressure on to transform this much neglected and most important sector for us and future generations, will reap some rewards.

  • >“Care homes are not, and were never intended to be, hospitals.”
    It is more nuanced than that. One of the big changes made was remove many geriatric ‘patients’ from expensive hospital beds, for which grades of care home were established. Thus I suggest the point being made is incorrect. However, what recent events have exposed is just many Care Homes are poorly equiped, prepared and operated; plus a cavalier attitude to to moving of people who had come into contact with the virus. Additionally, there is the uncomfortable fact that we’ve been doing ‘care’ on the cheap – hence why this is more than just a failure of ‘privatisation’.

    “Discharging people from hospital into care homes who either had the virus or had not been tested was, and is, a recipe for disaster.”,/i>
    In my area the entry path was the staff who came back from holiday in Italy and went straight back to work as usual…

    “It is a national scandal that last year, when the National Living/Minimum Wage was £7.38 per hour and the Real Living Wage £9 per hour, the national average wage rate for care workers was £8.41ph…”
    About the only sane point made by the Migration Advisory Committee yesterday [ https://www.bbc.co.uk/news/uk-54341298 ] was an acknowledgement that having care worker wages significantly lower than those available at Aldi et al. was not going to attract people into the sector.

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