Scottish Care are aware of concerns surrounding the recently updated guidance on the extended use of face masks and face coverings in adult care homes. Amongst other requirements, the guidance states that ‘Residents in adult care homes should wear a Fluid Resistant (Type IIR) Surgical Face Mask (unless exempt) when they are in communal spaces.’. 

This guidance was first published in September 2020. Scottish Care made representation at that time for the guidance to be adjusted to support care home residents.

Scottish Care has long argued that a care home is not a clinical setting, but a home to all the residents there. Residents, especially those with dementia and other conditions, need to be supported in a manner that respects their human rights, treats them with dignity and enables them to see all areas of the care home as their home. The requirement to encourage someone to wear a mask or face covering does not respect individual choice or autonomy. In many instances, prolonged mask-wearing can also cause a considerable amount of distress as well as confusion for those with declining capacity.

Scottish Care and colleagues have met with the Chief Nursing Officer and other officials from the Scottish Government yesterday (9 June 2021). During this meeting, we expressed our dismay and disappointment in the distress caused to care homes, residents, staff, and families by the new guidance. It has been established that the position on the requirement of face coverings in communal areas has not changed in principle since last September and the Scottish Government has agreed to work with us to ensure that the wording is reflective and appropriate to reality.

We note that they have since put out a statement clarifying this, stating that:

“Masks are not required in a residents’ own living space or when they are physically distanced from others. If a resident is not able to wear a mask, they will not be required to wear one – this has always been the case in care home settings.”

“A mask should only be used where a resident can tolerate wearing a mask when receiving direct, close personal care where it is not possible to keep a 2-metre distance and will not impact on the provision of care, and when residents in communal areas cannot be physically distant from others.”

 We hope that we can continue to work together with clinical colleagues in the Scottish Government to ensure that any publication of guidance supports the needs of our care homes and their residents. We are all eager to work to a situation where we return to normal living in our care homes as a matter of urgency including the end of social distance requirements.

Scottish Care remains committed to working with providers and partner organisations to developing a ‘care normal’ that promotes and sustains quality of life for our care home residents.

This week sees the relaunch for the Stay in Scotland campaign, encouraging EU citizens to apply to the UK Government’s EU Settlement Scheme.

EU Citizens living in Scotland, who have not yet applied, are being urged to apply now to avoid missing the deadline of 30 June, so they can carry on living, working and studying in Scotland. Irish citizens and people with indefinite leave to remain do not have to apply.

The Stay in Scotland campaign is being run from this week until 30^th June on radio, digital, social, and press.

How You Can Help

• We would appreciate your support in amplifying the message across your social channels, and include the hashtags #stayinscotland and #WeAreScotland.
• Please find attached an example of the social static asset for your own social channels which has been updated to emphasise the approaching deadline.
• Suggested post copy:
  • The deadline for the EU settlement scheme is 30 June 2021. We want you to stay. Get support to apply now at mygov.scot/stayinscotland

Stakeholder Assets

Digital and printable assets providing information and signposting to available support are available via gov.scot, and include:

• Guide for EU citizens
• Guide for employers of EU citizens
• Factsheet
• Leaflets – available in multiple languages
• Posters
• Social media graphics in 8 languages

 Access the Toolkit to Support EU Citizens via gov.scot here

We note the publication of data relating to care home deaths by both the Care Inspectorate and by National Records Scotland.

This data demonstrates the terrible toll taken by Coronavirus upon those who live, visit loved ones, and work in care homes.

Hundreds of people died during the early stages of the pandemic when a lot less was known about the virus than is known now. We have heard from the Scottish Government, acknowledgment that ‘mistakes’ were made in ensuring that care homes were as ready as they could be to receive the hundreds of people who were discharged from NHS hospitals.

We very much regret that due care and attention was not paid in sufficient depth to the needs of the care sector when compared to the preparation given to and focus upon the NHS. Social care as a whole was let down in the early stages of the pandemic, not least by the failures to introduce testing of staff and residents at an earlier stage.

We are also aware of the extent to which we now know a lot more about the risk of asymptomatic spread of the virus, the risk of airborne infection and the importance of using additional PPE in order to protect staff and residents.

It is testimony to the lessons learned and the improvements in practice that have occurred since the first wave that the second wave resulted in so many fewer deaths.

Nevertheless, as was the case in early March 2020 and is still the case today even with vaccination protection, it is a fact that the most vulnerable, the very frail and old, in other words the population of our care homes, were and are at the greatest risk of Covid-19.

The numbers published today do not describe the sad reality that those living in group and congregated settings such as care homes have been disproportionately affected across the world. They do not describe the reality that those who have suffered the most and who have died across the world are those who are very old and frail, and those living with multiple co-morbidities.

The published data indicates more detail on geographical location and spread, the size of the care home, the home operator and the quality of the care home. What it shows is that there are very few lessons which can be drawn from the data in terms of virus impact other than perhaps the size of the care home increasing the risk of infection, the lack of testing and knowledge of asymptomatic spread. Indeed, size of home is an uncertain determinant because larger homes are almost always ones which support those with advanced needs, greater acuity and frailty, and have as a result a more vulnerable and at-risk population. This virus has hit hard against all types of operators, whether public, private or charitable.

There have been too many lives which have been cut short before their time by a deadly virus. Behind each number is an individual who is loved and greatly missed by family and friends. Their loss is felt also by care home staff who have cared for and supported them for many months and years.

The numbers of deaths tell part of the story but what they certainly do not tell of is the amazing professionalism, sacrifice and dedication of frontline nursing and care staff who daily put themselves at risk and on the line to protect some of our most vulnerable citizens facing the threat of this deadly global virus.

As we consider the numbers and reflect on this data, we remember all the lives lost and the dedication of those who worked to save life. As we consider the numbers, we would ask everyone to reach out to support the care homes, staff, residents and families affected and to do so with compassion and solidarity.

It is our earnest hope that the use of this data by commentators, media and politicians will be sensitive and respectful. Lessons have been and will continue to be learned about the impact of this virus on our care homes, but in so doing we must all of us seek to support the women and men who continue to be residents, their families and those who work in our care homes.

Ends./

The new report of the Mental Welfare Commission, ‘Authority to Discharge’, which examines the issue of decision-making for people in hospital who lack capacity and their discharge from hospitals to care homes from March to May 2020 makes for disturbing reading.

Its identification of very real knowledge and skills gaps in discharge practice from hospital to care homes and the community should be a matter of very real concern. Of perhaps even greater concern is the analysis that failures were happening even before the start of the pandemic.

Organisations like Scottish Care have long argued that it is critical that we reform our processes around discharge from hospital, especially for those who may have diminished or fluctuating capacity. This means we need to involve families, relatives and staff from care homes and homecare at a much earlier stage in decision-making.

There are simply too many instances where decisions are being made with a limited knowledge of the best interests and needs of the person involved. A professional knows best attitude has no place in modern care and support. That is regrettable at any time but especially so during a pandemic.

It is important that the eight recommendations of the Report are put into practice but we must go even further so that we arrive at a stage where no-one with reduced capacity does not have people in their corner to advocate on their behalf.

After years of training and learning budgets being reduced or even stripped away in social care contracts it is critical that we invest resource in making sure all staff know not just the letter of the law but what good human rights-based practice really looks like.