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Pandemic Spotlight on Care Homes: Leadership and Re-thinking

Author: Professor Bim Bhowmick, former Bevan Commissioner


The locked-down, sunny final weeks of April saw the Covid19 pandemic cause a wave of excessive deaths in care homes throughout the UK. No corner of the nation remained untouched by this generational tragedy, prompting media and public criticism that care home residents have been left behind with very little information, little or no PPE and limited testing. Only in the last few days has there been a belated surge in the numbers being tested and PPE provided.

Headlines such as “Coronavirus – England and Wales care home deaths quadruple in a week” (The Guardian, April 21 2020) have shocked us all and become a deeply distressing matter for relatives, carers and other residents, more so because many have died alone.

Despite the dire warnings from Italy and Spain, care homes were forgotten, with predictably tragic consequences whilst (perhaps understandably) the NHS occupied all minds. Care home residents represent one of the most vulnerable populations in the UK. Their health care should be commensurate with other groups yet tailored to their needs irrespective of age, co-morbidities, disabilities or frailty. While hospital death statistics are slowly falling – it is anticipated that care home deaths will still rise in the near future.

The residential and the nursing home care sector in Wales is volatile and fragile. There are roughly 22,000 care home beds across Wales provided by a variety of providers; single home, small group, large group providers and local authorities. This is double the number of beds in NHS Wales which has clearly failed to be recognised. Not only do they have to manage the consequences of the care of their residents but there is real concern that some of these homes may go under like many other small businesses. This in turn will increase pressure on hospital beds. Whilst there are excellent care homes delivering exceptional care with compassion, kindness and friendship, often the public and professional perception and experience of care homes is more variable. This inconsistency needs addressing.

As populations age, the ability to pay for and to access care becomes increasingly important for health and care to be sustainable.

There is a clear need for greater understanding of future provision and funding of residential and nursing care homes. Future supply of appropriate high quality care home places with optimum numbers of specialist staff-especially nursing- will be essential to look after the most frail citizens discharged from hospital or in the community.

For those homes providing nursing care, a combination of inadequate funding and the challenge of securing staff (particularly registered nurses) has led to the increasing crisis in care-particularly so for publicly funded residents with complex needs. Other compounding factors include a lack of clarity related to care home purpose, organisational structures, operational processes and intended outcomes. There is a lack of leadership in both policy and practice.

It is timely and opportune to catalyse a re-think of the care home sector, which collectively is the largest health and care provider in the UK with circa 410,000 over 65’s living in 11,300 homes. Care home staff need to be educated, trained and recognised as respected professionals and appropriately remunerated.

There is a need to create a ‘Teaching Care Home Centre’ for professional development and to deliver evidence based care maintaining individual privacy, dignity and autonomy in care homes. Geriatricians and old age Psychiatrists should be integrated in the structured planning of care. It is important and right to ensure the advance planning of care for all residents. Cardiopulmonary resuscitation decisions and the right to refuse to go to hospital should be documented on individuals’ records.

There is now a desperate need for a central leadership function to direct and develop safe, effective and efficient operational policy to strengthen and develop the care home system as an important part of a sustainable NHS. The tragedy of this pandemic will provide a number of lessons for the future, it is vital we heed them urgently.