Next Wednesday is Care Home Day which this year carries the theme Care Forward. Care Home Day is an annual opportunity to focus on care homes and their vital role and contribution to Scottish society. This year’s theme both recognises the challenges and trauma of the last eighteen months but also seeks to move us forward to a revitalised and renewed care home community. In order to do that I think we need to focus on three areas, restoration, rehabilitation and renewal.
For all of us, I would hope, a day to focus on care homes in the present and future has to start with an honest reflection of where we are now. Our present is one which is far from where anyone would want to be. We are still living in the face of a pandemic with cases on a scale which are disturbingly high and with high levels of community transmission, albeit thankfully low death rates especially in our care homes. We are in an environment where new strains like the Lambda strain dominate a concerned population. We are in a situation where staffing is a real challenge and in the past week, I have heard of more and more care homes shutting up again and excluding family visits on the advice of local public health. We have a tired and exhausted workforce, managers searching for the trust and professional respect which seems to have been stripped from nurses and carers in the sector. We have fundamental problems about the fiscal sustainability of a diverse system with more and more charitable and private operators calculating that they cannot continue to deliver quality care on the resource allocated to them. And against it all we have an approach to infection prevention and control which seems insensitive to the realities of living with dementia and living together in community, in a ‘home’ alongside others.
For so many people it seems as if we have never left the shadows. There are still so many constraints. There is nothing normal or natural about the situation. Having to book a timeslot to make an appointment with love and for a limited period of time seems a huge distance from life as normal. Having to undergo testing and checks, to maintain social distance, to continue to wear masks – which are all immunologically understandable – make it hard to feel that we are in anything other than a twilight existence.
The first priority must therefore be to restore care home life as urgently and as safely as possible to that which people used to experience. Given that the average life expectancy of someone in a care home is close to two years then we have already lost a huge amount of precious time in the last eighteen months. Fundamentally we have to ask the question as to whether or not we have created such a climate of fear and risk aversion, such an impugning of guilt and anxiety upon care homes and their staff, that whilst we are keeping people alive with vaccination and precaution the quality of those lives are ones which are poor.
As we move to a situation where we are required not to suppress the virus but to live with it and balance its harms, we do need to ask questions to those who matter the most – the residents and their families in our care homes. What matters more – being so cocooned that you are safe but detached from contact and family or reducing protection to a level where people can be together in a much more natural and human manner? We have to honestly and in an informed way explore the risk appetite of people and find a space between suffocating protectiveness and dangerous naivety.
Care home life is more than just keeping people alive – it is giving a richness and fulness to the last years, months and days of life – and that depth and richness cannot be achieved without family, friends and presence; it cannot be achieved without interaction and activity, without normality and community. We need to make sure that the right for family to have natural access and contact with their loved ones does not diminish when there are outbreaks and as we prepare for an autumn and winter upsurge of threat.
Critical to restoration has to be an emphasis upon rehabilitation. I have frequently written over the months in this blog about the physical and psychological damage and deterioration caused by both lockdown and the pandemic itself. We are slowly seeing a return of allied health and primary care professionals into our care homes. This must not suffer as priorities begin to be re-directed in the next few weeks and months. Determined and focussed attention needs to be given to a population who have suffered too much and most especially this means attending to the urgent needs of those living with dementia.
But rehabilitation is never just a return to what was or a response to the inevitable decline that a degenerative disease results in. Rehabilitation must also carry with it a re-focus and new direction, a taking into account of changed circumstance and condition. Again, I have written about this before, but every day I am hearing of residents who have been impacted by the deaths of their friends in the care home. We need an urgent prioritisation of grief and bereavement support in our care home sector.
The direction restoration and rehabilitation combined offer us is a dynamic which is about renewing and reforming our care home sector. This is not the space to reflect and argue about resource and recognition, about investing in training and skilling staff, and rewarding them in a manner appropriate to the dedicated skill and professionalism they possess. This is not the space to argue for a more robust wrapping around of community healthcare and social service support for our care home sector. Both are critical but rather, in this space and in this week, we need to urgently focus on how we renew the spirit and positivity, the joy and happiness of the places we have so often in the last eighteen months painted and pictured with words of sadness and loss.
Care homes have to be allowed to re-discover the dynamic of infectious fun and love which is their core. For even in sadness the healing of laughter and enjoyment can bring immeasurable benefit. We have to as a whole health and care and as a political system, to allow care homes to re-discover the art and the gift of making a pile of bricks and mortar into a place where someone feels content to call it their home. We have to allow love to flourish both from the hand of family and staff.
One of my favourite poems is one by Diana Hendry. It is entitled ‘Poem for a Hospital’ but actually I think it speaks just as well to a care home setting – just change patient into resident. It reads:
Love has been loitering
down this corridor
has been seen
chatting up out-patients
spinning the wheels of wheelchairs
fluttering the pulse of the night nurse
appearing, disguised, as a bunch of grapes and a smile
hiding in dreams
handing out wings in orthopedics
adding a wee drappie
to every prescription.
No heart is ever by-passed by Love.
Love has been loitering down this corridor
is highly infectious
mind how you go. If you smile
you might catch it.
On Wednesday as we celebrate Care Home Day we celebrate the raw incarnating of love into tiny action, touch and tenderness.
Love is there despite the smell of chlorine, an infection prevention and control tidiness which seeks to remove the marks of living, which puts in the drawer the mementoes of memory lest they hold infectious risk.
Love is there despite the silence of activity, despite the empty chairs distanced from contact, without the bustle of busyness and belonging.
Love is there in every touched hand, mopped brow, supported arm, reassured fear and eye that smiles.
Love has been there even in the midst of fear and saddening loss and is there still in times of uncertainty.
But that love needs to be brought into flourishing so touch can be close, distance can disappear, and the ordinary gossip of exchange can stretch across the spaces which have been so unsocial and harmful.
We are all longing for the day when we will accidentally bump into life and love without appointment or planning, without testing or trial, without fear and distress. It is the infectiousness of love that we want to catch as we loiter around our living. And on that day, we can truly celebrate the restoration, rehabilitation and renewal of our care homes.
The Diana Hendry poem from Borderers (Peterloo Poets, 2001). See https://www.scottishpoetrylibrary.org.uk/poem/poem-hospital-wall/