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.
Independent Consultant Social Worker and Best Interest Assessor
0790 601 8238