Tackling the Covid-19 outbreak in care homes: messages from a geriatrician and a health service researcher about how the NHS can help

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When Covid-19 (coronavirus) first loomed large, we were approached by care home colleagues to help facilitate an online community of practice to support them through the pandemic. This quickly grew to include more than 500 participants who regularly log on for discussion, education and support, demonstrating the strong appetite for peer support and advice across the sector. 

Staff working in care homes have played a key role in the response to Covid-19. Care homes have opened their doors to rapid admissions from both the community and hospitals, and staff have worked hard to understand residents’ wishes and to ensure that care plans respect these. Staff have gone above and beyond in caring for residents and have, in many instances, learned new competencies and skills to do so. When personal protective equipment (PPE) has been in short supply, or distribution has been insufficiently responsive to rapidly changing requirements, care homes have acquired PPE, often at inflated prices, to protect residents and staff.

Staff have gone above and beyond in caring for residents and have, in many instances, learned new competencies and skills to do so.

Many care homes and the staff who work in them have been brought to their knees by Covid-19. The emotional trauma of losing a significant number of residents (referred to as ‘family members’ by some homes), who staff have known for a number of years cannot be overstated. Meanwhile, the impact of Covid-19 on staff cover is felt acutely in the small teams that are typical in care homes.

As researchers, we are beginning to get a sense of what staff working in care homes need to support the health and wellbeing of their residents. 

  • Rapid access to PPE. Care homes colleagues have told us that the number of residents with symptoms of Covid-19 can quadruple overnight. When this happens, they need to be able to get additional PPE within hours, not days.   
  • Rapid access to medical advice from general practitioners or other professionals such as advanced care practitioners or nurse prescribers. Residents’ health can deteriorate rapidly, and diagnosis and prognosis are essential to establish what care can be offered in situ and when residents should be cared for in hospital.
  • Rapid access to medicines and support from palliative care teams where residents are very unwell and may not survive. The rapidity of deterioration and the severity of symptoms in Covid-19 are such that this support must be provided within hours rather than days. 
  • Clear and consistent guidance that can be read and digested quickly. Early in this pandemic there was a paucity of care home guidance; now there is a surplus. This guidance is sometimes conflicting, often lengthy and sometimes difficult to make sense of. 
  • Parity of recognition with acute NHS carers. This is so that residents get the priority they deserve within service planning and provision. This can be quite easily done. Whenever a question is asked about NHS services, it should be followed by, ‘and what about care homes?’. Care home representatives need to be present in planning discussions that concern their residents as much as possible. 

Building these considerations into the ongoing response to Covid-19 in care homes is essential. But it’s important that this approach – including integrated approaches to resource allocation, responsive access to expertise, ensuring that care homes are included in guidance and service design – doesn’t stop when the pandemic does. 

People working across the NHS and in care homes should work as one team, despite being in different organisations.

The good news is we do not need to start from zero. We know what is needed for effective integrated working between care homes and the NHS. Research and NHS England initiatives have demonstrated what needs to be in place for residents to benefit from the best possible care and support. Fundamentally, effective working comes down to how we think about and organise services across health and care. This must start with people working in the NHS and in care homes seeing each other as equal partners in supporting residents. This will require people to be brave enough to speak up and challenge narratives that present care homes as a drain on NHS resources. Staff in both settings must normalise working collaboratively, having regular planned meetings with the needs of care home residents as their focus. The work of NHS staff who visit care homes should be valued and this work should never come second to NHS patients in other settings.

Research shows that one size does not fit all, which is not surprising given the heterogeneity of the care home market. How NHS and care home staff work together has to be negotiated but the equality of genuine partnership must drive relationships and behaviour.  

Staff in the NHS and care homes need to implement these suggested ways of thinking and doing into everyday practice. Thankfully, there are lots of examples of this around the country. If the health and care system can build on this progress, some good may yet come out of this unprecedented crisis and the huge efforts being made by care home staff. 

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Comments

George Coxon

Position
Care home activist,
Organisation
Mostly care homes
Comment date
01 May 2020

Really well said Adam & Claire. Took the words right out of my mouth Of course I would expected nothing less from you both Many thanks. Let’s hope what you’re saying adds to the new narrative on behalf of credible, progressive, care home providers who are gaining greater kudos & recognition for the work we do.

Claire

Position
Prof,
Organisation
University of Hertfordshire
Comment date
07 May 2020

Many thanks George, new narrative is definitely something worth working on and getting as a positive out of an awful situation.

Anthony Blackburn

Position
Founder,
Organisation
Golf in Society
Comment date
08 May 2020

Hi, I agree with the need for equal recognition of care home teams. However, after conducting research into pay rates, even the supposed five star care homes are advertising for care assistants at £8.88 an hour. What's the hourly rate for an NHS nurse? If we are serious about keeping people living healthy, independent lives for longer then the community care workforce in all settings needs to a have clear and rewarding career pathway, backed up with realistic remuneration.
For example, the starting rate for my team is £11 an hour, rising to £15 for a team leader. I began my social enterprise with this salary structure because as an experienced carergiver I still only get paid £10 an hour.
You are always going to get low pay rates when residential homes are being commissioned by LA's at less than £20 an hour.
As someone who works at the coalface of care every day, I hope you find my comments useful.
All the best
Anthony Blackburn - Founder - Golf in Society

Sophie Johnson

Position
Senior Health Care Assistant,
Organisation
WUSCT
Comment date
26 May 2020

I work in NHS. I have worked in care homes. The difference is amazing. NHS I get proper training.
I get proper breaks, I get a uniform for every day I work. I get 5 weeks paid AL inc BH. In the NHS H&S is strictly adhered to. NHS has strict procedures for infection control. In the nursing home the PPE is of poor quality Outside of Covid infection control procedures are poorly adhered to

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