We’ve written a lot about the systemic failings in Government policy regarding care homes (see here, here and here).
However, a recent study on the transitions between hospitals and care homes caught our eye. The sort of study that bypasses the media: two care home providers with 20 to 40 care homes each in the South West and the North East of England participated, and 70 participants were interviewed.
The study exemplifies the impact hospital discharge policies had: “Hospitals just wanted patients out, regardless of Covid status. To be brutally honest, they weren’t interested; they just wanted people out. In those early days, you know, it was very traumatic.”
And how hospitals desperately enacted a policy to clear the decks: “We had a phone call from a nurse from the hospital to say that… this lady was lying beside somebody, less than two meters, who was Covid-positive.”
These instances highlight how thoughtless and reckless the Government policies were. Driven by error-strewn modelling along with a chronic lack of capacity in the NHS, panic set in: hospitals would be quickly overwhelmed. Something had to be done to free up capacity – an easy target was found: the elderly and the most vulnerable and brutally the least able to stand up for themselves.
Hospital discharge service requirements were first published on March 19th. On April 2nd, the guidance said: “Some of these patients [admitted from a hospital or a home setting] may have COVID-19, whether symptomatic or asymptomatic. All of these patients can be safely cared for in a care home if this guidance is followed.”
This policy, which saw discharges to care homes without testing, has been ruled unlawful by the High Court. In Gardner & Anor, R, Lord Justice Bean and Mr. Justice Garnham found that Government policy was “irrational” because it failed to consider the risk to elderly and vulnerable residents from asymptomatic transmission.
It took until April 15th to recommend testing and 14 days of isolation for admissions to care homes. Before this, negative tests were not required prior to transfers and admissions into the care home.
The study interviews show that care homes became no-go zones:
GPs or other healthcare professionals or multidisciplinary, like, podiatrists, everyone has difficulty coming to see the residents as of high demand or they can’t come for whatever reason, so COVID-19. They used to come, now they are no longer able to.
The study also emphasises the inhumane practice of isolating vulnerable people:
Strong feeling that isolating care home residents went against usual practice and, for some, was very hard to endure, especially when they needed human contact and emotional support from family and friends following a period of hospitalisation.
We’ve written about ‘Confinement Disease’, which is likely more harmful than Covid in care homes.
Among long-term care residents in the Southern Ile-de-France region, more than 24 Covid deaths among 140 residents occurred in five days. None were due to acute respiratory distress syndrome, and death was mainly due to hypovolemic shock as residents were confined to their rooms for several days without assistance with eating and drinking.
Confinement leads to feelings of being in prison:
Rather than keeping them in hospital we would send them [to the COVID-19 unit], and then once they’re 14 days clear, I know it’s 10 now, but it was 14, then they would go back to their original care home. But it’s just been carnage, to say the least.
The study interviews also showed how degrading and impersonal confinement practices were:
So they couldn’t have their belongings until it had been left in a certain place and washed at a certain heat and 72 hours before you can have them back. You go in your room, and you can’t see anybody, and when you do, they’ve got masks and visors, and you cannot hear them, and you’ve got all of that.
Socially distancing and isolating the most vulnerable comes with costs. The practice of rapidly discharging patients is unlawful, yet is anyone interested at a Government level in how to better look after those in care?
Patients were discharged from high-resourced hospital settings – where some had time to do Tik-Tok dances – to low-resourced care homes, which worsened as staff went off in their droves — the opposite of what you need, as less care equates to more deaths. Then you isolate vulnerable people who can’t care for themselves – again, the polar opposite of what these people need, preventing much-needed personal care that can be life-saving. Even worse, at the end of life were the restrictions on who could share that moment, hold a person’s hand as he or she drew a last breath, and prevent compassionate care at one of the most important times.
The potential for harm is exceptionally high in care homes; with quarantining, physical and mental deterioration occurs rapidly, and renal failure occurs swiftly in the face of dehydration – the ultimate price to be paid is a lonely death.
Dr. Carl Heneghan is the Oxford Professor of Evidence Based Medicine and Dr. Tom Jefferson is an epidemiologist based in Rome who works with Professor Heneghan on the Cochrane Collaboration. This article was first published on their Substack, Trust The Evidence, which you can subscribe to here.
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