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Care Homes in the Time of Corona

As I contact residents of care homes and struggle with the reality for my own parents, unfortunately at this time remotely, I wanted to add my perspective of the dilemma that residents face and that of their families.

They see the staff struggling to maintain care with increasing need to care, treat and feed them, the majority, individually rather than communally. Without the day being broken up by the various informal and professional visits the atmosphere is a little subdued despite the best efforts and additional tasks of staff to spend time with residents individually to offer them phone or FaceTime with their loved ones and to provide activities, hairdressing and chiropody.

Those residents who are not aware of the need for social distancing, for the protection from Corona Virus, why staff are in gowns or scrubs, and face masks at times, and why they are kept away from their loved ones, this is a particularly perplexing and isolating time.

The question for us as professionals and for those whose loved ones are in care homes is to always weigh up whether residents’ lives are improved and extended by being in a care home at present or whether their lives are improved and extended by means of providing care with the support if they have them, of their family. This measure means the choice when they are unable to make it, should at least be considered even if the answer is straightforward. The balance of protecting one’s loved one from the virus has also to be weighed against the risk of transmission in the community along with weighing the risks that brought them into residential care in the first place. Sometimes it is a clear cut case for others it can be guilt ridden and fraught with questions, risks but also a range of possibilities.

Many care homes are taking very different approaches to the risk of transmission of Corona Virus

The first question to ask is can the restrictions brought about by the risk of transmitting Corona Virus be reduced?

Is there a need for residents to self isolate? If there are no known symptomatic cases of Covid-19 patients, is it necessary if it is difficult for them to socially distance.

Have all residents and staff tested negative for Covid-19? You should not have to be symptomatic to obtain a test.

Is it those only with symptoms of Covid-19 that need to be isolated?

Can communal activities and communal meal times still take place with social distancing rules in place?

Are there opportunities for loved ones to at least see their families if not face to face, through glass or screen, in the garden and over a picnic or if not, then sending packages with meaningful gifts and treats, sending letters and cards.

Have family members had the opportunity to be tested?

I know some families are being allowed in to see their loved ones under strict conditions because not doing so poses a greater risk to their loved one whether it be due to severe anxiety, depression or agitation or very near the end of their life.

And lastly is your loved one suffering more by the restrictions and if so, is there a more appropriate way for them to have care provided? With more of the family at Home, perhaps now with the addition of almost adult children, is it possible for them to be cared for ‘round the clock with the family household for the duration of the outbreak.

Professionals are still in contact with care homes, are still undertaking assessments and reviews.  If you feel that your loved one’s circumstances have changed significantly and should be reviewed then this can be requested if the Council commissioned and funds the care . Alternatively if the resident lacks mental capacity to consent to their accommodation and care arrangements and are  under the deprivation of liberty safeguards or should be, then this can be raised with the care home in the first instance and secondly the Council’s DoLS team through their relevant person’s representative. If you are an attorney or deputy for Health and Welfare then you are in a position to request a review or challenge the current  arrangements on behalf of the resident.

If you are uncertain whether your loved one lacks capacity to consent to their accommodation and care arrangements the Home can undertake a mental capacity assessment to determine this. More on mental capacity assessments in another blog. If they find that the person lacks capacity they need to determine if the care and accommodation is in the best interests of the person and consult with those involved with them. This in turn requires the Home  to  seek authorisation from the Council’s supervisory body to ‘lawfully deprive’ that person of  their  ‘liberty’ considering if it a proportionate response to the harm they may come to if a less restrictive option were available and if it remains in their best interest.

If you want individual advice or guidance please feel free to contact me.

 

Tina Waas

Independent Consultant Social Worker and Best Interest Assessor

0790 601 8238

tinawaas@findgoodcare.com

Care to Have a Conversation about Corona Care

Hi there,

In these unusual times I wanted to let you know details of Public Health England’s published guidance on Home Care Provision, advice for our Carers and Cared For.

But before I do. If you or a loved one have a carer who is self employed or are directly employing a carer in my opinion this advice should also apply. There are clearly difficulties when the paid carer is showing or masking symptoms and are self employed or are on zero contracts. Do as far as is possible seek to ensure their pay is secured or they may feel obliged to work with symptoms present, putting our most vulnerable at risk. Carers may be in short supply. Agencies may be pooling resources and new recruits are in urgent need, with the most skilled carers being focussed on the most vulnerable. Also, personal protective equipment is not yet available to all carers for those cared for who are showing symptoms although Matt Hancock, Secretary for Health and Social Care, said that it would be made available before the end of next week. Hospital provision has been the priority. My advice would be to improvise, in the meantime, following personal protective equipment and personal waste and laundry advice as below.

I hope this advice has been passed to you but just in case.

Public Health England’s Advice

If a member of staff is concerned they have COVID-19 they should follow NHS advice.

If they are advised to self-isolate at home they should follow the stay at home guidance.

If advised to self-isolate at home, they should not visit and care for individuals until safe to do so.

If the individual receiving care and support has symptoms of COVID-19, then the risk of transmission should be minimised through safe working procedures.

Personal protective equipment
Care workers should use personal protective equipment (PPE) for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.

Aprons, gloves and fluid repellent surgical masks should be used in these situations. If there is a risk of splashing, then eye protection will minimise risk.

New personal protective equipment must be used for each episode of care. It is essential that personal protective equipment is stored securely within disposable rubbish bags.

These bags should be placed into another bag, tied securely and kept separate from other waste within the room. This should be put aside for at least 72 hours before being put in the usual household waste bin.

Cleaning
If care workers undertake cleaning duties, then they should use usual household products, such as detergents and bleach as these will be very effective at getting rid of the virus on surfaces. Frequently touched surfaces should be cleaned regularly.

Personal waste (for example, used tissues, continence pads and other items soiled with bodily fluids) and disposable cleaning cloths can be stored securely within disposable rubbish bags.

These bags should be placed into another bag, tied securely and kept separate from other waste within your own room. This should be put aside for at least 72 hours before being put in the usual household waste bin for disposal as normal.

Laundry
If care workers support the individual with laundry, then they should not shake dirty laundry before washing. This minimises the possibility of dispersing virus through the air.

Wash items as appropriate, in accordance with the manufacturer’s instructions.

Dirty laundry that has been in contact with an ill person can be washed with other people’s items. If the individual does not have a washing machine, wait a further 72 hours after the 7-day isolation period has ended; the laundry can then be taken to a public laundromat.

Items heavily soiled with body fluids, for example, vomit or diarrhoea, or items that cannot be washed, should be disposed of, with the owner’s consent.

Individual being cared for does not have symptoms but is part of a household that is isolating

If the individual being cared for and their worker can remain at a safe protected distance from the symptomatic member of the household, then care can be provided without additional precaution. This would apply, for example, where the symptomatic family member can remain in their own room, is using separate bathroom facilities and is observing robust isolation procedures, staying 2 metres away from other family members.

Where this is not possible – and this will vary on a case-by-case basis – the same procedures should be adopted as if the person being cared for did have symptoms of COVID-19 (see above). Care should continue to be taken to limit contact with any household member that has symptoms.

If neither the individual nor the care worker have symptoms of COVID-19 

If neither the care worker nor the individual receiving care and support is symptomatic, then no personal protective equipment is required above and beyond normal good hygiene practices.

General interventions may include increased cleaning activity and keeping property properly ventilated by opening windows whenever safe and appropriate.

Care workers should follow advice on hand hygiene.

 

I hope this helps. If you have concerns or need individual advice please contact me.

Best wishes

Tina Waas

FindGoodCare

0790 601 8238

For You, Me and Our Loved Ones, Care to Have a Conversation About Care?

Care to Share?

There’s no care manual for all things care related is there? And I don’t mean the Care Act guidance although we will touch on that in later posts. If there is, I sure could do with it, as a daughter of  87 and 90 year old parents and even as a professional. A chap only last week said I could  have done with your help this time last year. Where is the help when it is needed? Where is the care when you need it? There are always, of course, a number of  decisions to be made, but finding the right choice for you or your loved one, at a time of crisis, when your time maybe taken up with work, domestic and childcare responsibilities.  To have all your questions answered. Is that really too much to ask? To have the information in one place. When you want to know the next steps, whether you are the one in need of care, or caring for your adult dependent, your parents or your partner, you or your loved one are unique and special and how care is offered and delivered is also unique and special.  The definition of care is ‘the provision of what is necessary for the health, welfare, maintenance and protection of someone’  that’s a big ask, so being  responsible for your own, or your loved one’s care, is a serious matter. Handing over to someone else to care is an even more serious matter and requires careful consideration around what works for you or your loved one. I guess first things first, lets start with the basics and the need to plan for care, ahead of time.

Future Proofing Your Care

Have a Conversation about Care – What would you or your loved one want to happen? What is important to you or your loved one? How and where would you want your care delivered?

Take out a Lasting Power of Attorney –  for Health and Welfare as well as one for Property and Financial Affairs. It gives you or your loved one the opportunity to state their wishes and for you or your loved one, the script to honour them by. This can only be completed if one has the mental capacity to understand what they are signing. If you feel your loved one’s situation is complex and they lack capacity to manage their affairs then it may be necessary in some circumstances to apply for Deputyship. These are explained on the GOV.UK website or for those with dementia get some information by calling or emailing https://www.pathwaysthroughdementia.org.  There is useful information available online. Some of us can act as professional attorneys if there is no one else who can act upon their behalf.

Fire Safetya simple fire safety check  and advice for  vulnerable adults to ensure smoke alarms and carbon monoxide detectors are in place and provided, in the main, by fire brigades across the country.

Safeguard You and Your Loved Ones –There’s plenty of information about keeping safe online, over the phone, from bogus callers and keeping your money and valuables safe and secure.

Information is Power  – Council Information can be found on the local council’s website for the area in which your loved one resides. Usually this will be found under ‘Adult Social Care’. If the circumstances are more pressing and needs urgent attention then you can request an assessment for yourself, your loved one or if you are the carer, from the local Council’s adult social care services. There are lots of enormously helpful websites and local organisations usually designated by the condition they are representing and some have a wider brief. Plenty of information it’s just not in one place.

Declutter – get the home in order, do this together, help each other to decide what to keep or can now let go, if it feels comfortable to do so and it is something that your loved one is agreeable to. It helps bring back memories and can help you to bond. It might not always be the right thing though, if it’s going to be too distressing or your loved one cannot consent. If you need help to do this there are local organisations and some charities that may be able to help. On a more pragmatic level it makes extra space, and in some instances makes for extra rooms that may come in handy. Keep yourself or your loved  one free from slips, trips and falls by removing hazards and mats or stick them down and by keeping floors dry.

Acknowledge the Changes – it’s so difficult to know when one’s circumstances are changing even as a professional. It is so often that I am called in my professional capacity when things have entered into a more critical stage, but it can be difficult to gauge when a certain line has been crossed. That’s why getting informed is important and expertise is essential.

Assistive Technology – to help one remain as independent for as long as possible includes considering devices such as  GPS trackers, sensors, emergency alarms or audio/visual equipment.

Get the Experts In – well I’m bound to say that aren’t I. Whether it’s to reduce muscle wasting, for the provision of equipment such as a stairlift, a walking frame or wheelchair,  a deteriorating health condition,  an assessment, finding good care or quality assuring the care there are experts in their field: physiotherapists, occupational therapists, doctors and social workers, and you can request their help via your GP or adult social care services if you or your loved are deemed to need them.

It would be heartening to hear from you and your experiences. What you need and what’s important for you in this care conversation.

More on these matters in later blogs but I really wanted to start the ball rolling. In the meantime please contact me for signposting or free advice over the phone or for my help, all found in one place and start future proofing your care now!

FindGoodCare

Next time ‘Care to Pay’ The Conversation About Paying for Care

Promise it will be shorter next time.

Best wishes

Tina Waas

Independent Social Worker and Best Interest Assessor

FindGoodCare Ltd

tinawaas@findgoodcare.com

0790 601 8238

Just thought I better add a disclaimer as products and services change and my information is mine alone and I don’t intentionally miss you out of the conversation. Do get in touch. And if I may make a plea to keep it polite and courteous.

Contact me

Please do drop me an email with any questions you have.