Care homes have continued since the Coronavirus outbreak to both receive back individual residents from acute settings and to continue to have admissions from both the community and hospital settings. This is a critical role for care homes and is in part to make sure that there is no greater pressure on the acute sector than it needs to be. But it should be understood that care homes always have admissions from hospitals. If care homes stop doing this then individuals will be stuck in hospital which would effectively put them at a much greater risk. Staying in hospital longer than you need to is something which we know carries real danger for patients. It is also something which can be immensely distressing for individuals who might be living with dementia.
The difference with COVID-19 is how these admissions are handled. When being discharged from hospital it is often routine for the person to be tested if they have been Covid positive to make sure they no longer have the disease. However, testing will only show whether the person has Covid on that day. It will not show if they had it before or if they will get it. There are also dangers from false-negative tests. What there is are strict clinical assessment protocols which are in place before discharge.
Once someone arrives at the care home they will be isolated and will be barrier nursed as if they have Covid – even if it is recognised they do not – this is a belt and braces approach and lasts for between 7-14 days dependent on the risk assessment of the individual. We have made it very clear that no care home should receive any new admission or returning resident unless staff are clear that they have sufficient PPE to allow this to happen. Some care homes have isolated individuals in separate units with separate nursing teams to reduce the risk of cross-infection.
I would ask those who do not want admissions to happen and returns to happen what they would do with these individuals. They are not objects or commodities, they are human beings, often frightened in an alien environment and wanting either to go home or to get some stability. What would you say to someone who is simply trying to get back to their own home including those who have come through the battle with Covid? Hospital can be a confusing and distressing place for someone with dementia – they want back to what is familiar and safe. And I would ask what would you say to someone stuck in hospital, often with conditions other than Covid, in the knowledge that they are at greater risk of infection and deterioration the longer they stay there?
We need the least restrictive and safest option for the most vulnerable.
Some of the commentary over the last weekend has been inaccurate, alarmist and insensitive. In all the emotion of the moment, we all of us need to remain respectful, to use language which affirms individual worth, and always to seek the best interests of the most vulnerable.
Dr Donald Macaskill, CEO
