Revisiting the care home problem

On 4th March, almost exactly a year after we entered our first lockdown, the UK government published its updated guidelines for visiting residents in care homes.

They’d been giving out ‘you’re soon going to be allowed to visit’ messages more or less since Christmas, picking up steam during February, but in the event this change in measures came virtually without warning. These new guidelines were to come into force on 8th March, effectively giving us one day in which to prepare

As a care home operator, I have to say I am feeling aggrieved, not just by the guidelines, but with the government’s general approach to enabling visiting in care homes.

The importance of care home visits

I am not disputing the importance and value of visits – for residents or their loved ones. We know what visits are about, and we understand the potential impact on health and wellbeing when they can’t happen. Visits are an important part of life, but you cannot tell me they are more important than the safety measures that can make the difference between life and death. There is a developing history of the UK government putting people’s lives at risk, and encouraging visitors to break the social distancing rule whilst visiting underlines this fact.

In our happiest days, at Pelham House we are a care home that celebrates, encourages and facilitates interactions and relationships between our residents and our community. At every opportunity, we hold garden parties, celebrations, dog shows, theme afternoons, musical events, summer fêtes, you name it. Everyone connected with the home comes and joins in. It’s often the highlight of our year.

But times are not happy at the moment – for anyone. Watching the government’s responses and guidelines to care homes over the last year is like following a high-octane yoyo.

At Pelham house, we have taken an approach that blends common sense, communication, caution and consistency in managing risks and keeping our residents safe. We need to accept that things are different and that continuing concerns over visiting are a part of that. Over the last year, we have all had to limit and, at times, completely curtail visiting in order to protect vulnerable people from infection. Although I was regularly in when we had our Covid outbreak, even doing the cleaning, I have refrained from visiting unnecessarily, especially in light of having school-aged children.

There exists a tension between visiting, and life and death. As a home which lost 50% of our residents last year when, despite our best efforts, Covid got in, I think we have a right, as well as a responsibility, to be cautious.

Why I am angry about the new government guidelines

When you read the government policy on care home visits, one of the first things you notice is the complete lack of rationale.

Where is the hard evidence that shows why it’s OK now, when it wasn’t before? And equally, why now, rather than later?

What has changed to make it OK now?

People haven’t returned to work in offices, picking up their daily commute. We can’t travel and move around in a safe and meaningful way. To me, the new policy doesn’t make sense in the context of lockdown. It doesn’t make sense in the context of the continued risk.

One member of staff said to me, “I am not yet allowed to visit and stay over at my mother’s house, who is vulnerable and alone, but people are allowed to enter the care home. This does not make sense. It does not feel right.”

The current national policy on visiting places care home operators like me under enormous pressure in terms of meeting people’s expectations, keeping staff motivated and keeping elderly people safe.

And it diminishes my role and responsibility as care home owner and reflects a complete lack of confidence in the organisation and administration of providers, be they multi-million pound companies like Barchester Healthcare or small fry like Pelham House Care Home

What they have actually done is pass the buck. The measures put the onus on the care home to develop the rules and processes that will allow safe visiting, in an extremely uncertain and dangerous environment.

What they have also done is raise expectations (primarily among relatives, in my experience – most of our residents are entirely accepting of the lockdown restrictions.) This has created huge tensions across the sector between care home staff and some family/friends of residents, who, having heard the announcement on the 4th about the new policy, naturally assumed the doors would be open from 9am on the 8th March for a visit.

That has been left entirely in our court to manage. It took us two weeks to work out how we were going to safely arrange visiting, and in the meantime we had some additional pressures to contend with.

One direct result of the government’s messages on visiting was sharp and somewhat unfair criticism of Pelham House Care Home, from a disgruntled family member. We appreciated the long period of time between now and the last visits at Pelham House, but we needed to prepare properly and safely. It was sad to see how so much tension had been evoked between our position and the needs of this family member, who sadly got The Guardian involved. When The Guardian piece was published, the Department of Health and Local Authority were on to us for an explanation. It’s resulted in a huge amount of pressure, which has already been, for the past year, unrelenting.

There has been a lack of understanding, collaboration and a shared common goal at all levels. This makes me angry as it depletes quality outcomes for those that matter. The nature of the visiting policy and the way it was announced could have been handled much better.

What can we do to facilitate safe visiting?

We understand how desperate people are to see their loved ones, of course I do. There are, sadly but inevitably, people involved for whom time is of the essence. Those who are at ‘end of life’ are entitled, without question, to visits from their loved ones and we support this.

Last time visiting was a concern, the policy was a ‘window visit’, which continues. Visitors could not enter a home, but could sit near an open window, or conservatory door, close enough to see and talk to their loved one, but maintaining social distance (and masked, of course).

Other than in our own policy, there is no government stipulation that visitors should have received a Covid vaccination and a clear PCR test. Surely, a gross error. It is suggested that all visitors should have a negative lateral flow test. This concerns me because of the level of inaccuracy in these tests. At Pelham House, we are paying for the cost of PCR tests for relatives to visit, rather than relying on the lateral flow tests. If it saves the life of even one resident or member of staff, it is worth the extra effort.

Further, as of 8th March, not all our residents had been fully vaccinated. We want all our residents to have had both of their vaccinations before we even begin to consider life returning to normal.

We’ve accepted that visits will happen, but we have to do it in a way that’s safe for everyone.

With safety first at the forefront, we’ve decided to apply some criteria of our own, and we will monitor the situation:

  • There must be no Covid within the home – all residents and staff must have negative tests for visits to be allowed.
  • Visitors will not currently be allowed inside the home – we have a summer house which we can equip and use for visits.
  • Staffing levels need to be appropriate for adequate monitoring of visits.
  • The national R-rate needs to be below 1.
  • The level of Covid infections in our local area needs to be non-pressing – static or diminishing rather than rising.
  • All our residents must have had their 2nd vaccination before we can comfortably accept the idea of physical contact.
  • The option for internal visiting will be dependent on approval from the Care Quality Commission, Kent County Council, Public Health England and our Insurance provider.

What is your response to the new policy, and how are you managing the changing requirements? I’d be interested to start a conversation and share ideas.

April 29, 2021