Open Covid-19 Webinar with The Care Inspectorate – 24 April

This week’s Covid-19 open webinar will be hosted by our CEO, Dr Donald Macaskill along with guest speakers from the Care Inspectorate, including Peter Macleod, CEO and Kevin Mitchell, Executive Director of Scrutiny & Assurance. This webinar will take place on Friday 24 April 2020 at 11:00am.

Please join this session to ask us and The Care Inspectorate any questions you may have.

Please note that this webinar will be hosted on Microsoft Teams instead of Zoom. Scottish Care members can find the link to join via the Members Area of this website. External partners should contact [email protected] to register interest, stating your name and organisation, if approved you will be sent the link to join.

For more information about joining Teams events without a Teams account please see: https://support.office.com/en-gb/article/attend-a-live-event-in-teams-a1c7b989-ebb1-4479-b750-c86c9bc98d84

Scottish Care comments on latest NRS figures on Covid-19

We are desperately sad to hear this week’s figures on COVID-19 related deaths, including the fact that three quarters of the deaths were of people aged over 75, and 33% of deaths took place in care homes.

Unfortunately, the particular impact of this virus on many individuals who are elderly, frail or have existing health conditions fits closely with the needs of our care home residents and makes this population particularly vulnerable.  It is why care homes continue to need all the support they can get in order to keep residents safe and well, including access to PPE, extra staff and other resources and we continue to work with national and local partners to ensure these supports are in place. 

It is important to note that in instances of COVID-19 in care homes and associated deaths, there should not be an immediate assumption that this reflects a failure of care homes to provide high quality support, to follow infection control guidance or to respond quickly to COVID-19 cases.  Unfortunately, we see that this virus does not discriminate in who it affects and it can get far and wide despite best efforts to limit it, including in settings such as care homes where a number of people with health vulnerabilities live in close proximity and are supported closely by a group of staff.  We welcome the wider health and clinical care support being given to care homes at this time, and we commend all staff who are doing their utmost to keep the environment safe and the  people they support well. We know they will be suffering the impact of resident losses too. 

We know that people, not least those with loved ones in care homes, will understandably be worried at this time and that is why we remain committed to ensuring that national and local supports for care homes, staff and residents are as robust as they can be.  Whilst it does not relieve the pain felt by those who have lost friends and relatives in care homes to this virus, it should also be noted that many residents with COVID-19 recover from it. 

These figures also highlight the need for dedicated mental health, bereavement and trauma support for all who are experiencing deaths as a result of COVID-19, including social care staff and the families of residents.  We are all being hit hard by the effects of this virus.

 

News Release: COVID-19 Homecare Issues

Understandably and correctly, the last few weeks have seen a significant focus on the challenges our care homes need support with whilst tackling the COVID-19 pandemic.

What has continued to be under-recognised publicly, however, are the challenges that our equally crucial homecare services are facing in supporting individuals in their own homes.

On Wednesday 15 April, the First Minister provided the first set of weekly figures from National Records of Scotland.  These showed that 129 people with confirmed or presumed Covid-19 died at home or in their communities – over 13% of the total deaths in Scotland up to 12 April. In the same way as individuals who die in our hospitals and care homes, we must not forget that these deaths at home represent individuals.  Given that the virus disproportionately impacts the mortality of elderly and frail individuals and those living with other health conditions, it is not unreasonable to assume that a significant proportion of the 129, and indeed those in hospitals, had been receiving support at home through homecare organisations.  More people are supported at home any day of the week than in hospitals and care homes combined.

We must therefore carefully consider what support these organisations require in order to continue to provide essential care and support and therefore preventing additional demand on health services, as well as how their workforce is protected.

The critical challenges facing homecare during the COVID-19 pandemic include:

Access to PPE

Whilst we welcome the move to deliver a direct supply of PPE to care homes this week, we are acutely aware of the ongoing challenges for homecare organisations in accessing PPE supplies.  We want to see a similar move to direct delivery of PPE to homecare providers and access to supplies beyond those required in emergencies for suspected or confirmed COVID-19 cases.  Homecare workers must be able to access the appropriate PPE in sufficient numbers to meet current PPE guidance.  It must be recognised in supply allocations that homecare staff support many individuals across the course of their shift, often visiting the same people on multiple occasions, which leads to an increased need to change PPE more regularly.  There is also an issue of equity here.  There is one Guidance document covering all community care provision yet homecare members are telling us that their staff are supporting individuals in their own homes alongside other colleagues who are wearing significantly different PPE.  This leaves staff feeling unfairly exposed.  We are also aware of some Health & Social Care Partnerships where PPE is being provided for in-house staff but not made available for organisations delivering care on behalf of the Partnership. 

Organisational sustainability

These issues are also compounded by the fact that, as for other providers, homecare organisations are struggling to obtain PPE through usual supply routes and available PPE is significantly more expensive.  So far, there has been no explanation of the commitment for reimbursement or financial support offered nationally or locally for costs associated with Covid-related PPE. This uncertainty is impacting the already minimal margins for homecare organisations.  Providers have been asked to submit data on additional spend as a result of Covid-19, but with no guarantee or details of back-payment. This is creating issues of cash flow, particularly in additional staffing costs relating to furlough and uplifted sick pay, as well as for PPE. Many providers await clarity on the Scottish Living Wage uplift to enable them to pass that funding on to staff. Whilst clarification of the rate has come directly from Scottish Government, providers await local rates and start dates from local HSCPs.

Whilst Scottish Care is currently seeking to collect additional data in this regard, several homecare members have informed us that they have seen a 10-15% drop in care hours they deliver.  One describes having 126 vacant hours for this week.  These figures are unheard of when demand for homecare usually significantly outstrips supply. This is as a result of cancelled visits both by Partnerships and individuals who fund their own care, often because family members are not currently working or are working from home and are therefore able to step in to provide care.  Additionally, social work assessments are not being carried out as planned therefore delaying or limiting the provision of new or additional support to individuals who require it. 

Not only does this place organisations in an extremely precarious position, in a sector where sustainability can balance on a knife edge of care hours at the best of times because of the commissioning and procurement climate, but it risks the jobs and financial sustainability of thousands of vital care workers where they are willing but unable to undertake their usual hours.

Almost 2 weeks ago, COSLA released updated Guidance for Commissioners of social care in an effort to outline supportive measures. That guidance has fallen short, underestimating the requirement for clear national direction in times of crisis on what standards of good practice would look like, it provides a more ambiguous picture by adopting uncertain language such as ‘could’ ‘perhaps’ and ‘may’.

Contract flexibility

Whilst some Health and Social Care Partnerships are working collaboratively with homecare providers to provide flexibility in managing the unprecedented impact of COVID-19, others are continuing with ‘business as usual’ approaches to contracting, monitoring and funding. 

Some areas are continuing to operate minute-by-minute billing for commissioned homecare visits through electronic call monitoring systems, with no tolerances allowed for late or extended visits.  This results in financial penalties for the homecare provider.  This rigid approach does not take into account the need for flexibility in supporting individuals who may have lost their wider support networks due to current restrictions and therefore need additional time for support, or for staff to ensure the safety, health and wellbeing of an individual thoroughly including monitoring for COVID-19 symptoms.  It also fails to recognise the additional time required to operate stricter hygiene and infection control protocols, or to put on and remove PPE. 

At a time when we truly are all in this together, there must be trust, flexibility and partnership in health and care provision in order that the whole system and workforce can operate safely and effectively. 

Testing

We welcome recent announcements regarding enhanced testing access for health and social care staff and for care home residents.  This must specifically include homecare staff and supported individuals too. Homecare staff are experiencing high levels of anxiety and distress associated with fears of carrying Coronavirus unknowingly between the homes of the vulnerable people they support.  Testing can support these fears to be at least partially reduced as well as to ensure critical workers are off work for shorter periods of time when they or a family member are suspected of having Coronavirus but testing proves they do not.  There must also be routes to accessing testing which do not require significant travel, which is proving to be a barrier for homecare workers who do not drive.

Individuals supported at home may not see anyone else in a day, particularly at the current time.  Knowing if they have Coronavirus can therefore help to direct their care accordingly.  The homecare they receive, from individuals they know and have built relationships with who can spot early signs of health deterioration, is absolutely essential to their health and wellbeing.

Karen Hedge

National Director

Care home admissions during Covid-19

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

Grieving in the time of a pandemic

Grieving in the time of a pandemic

Professionally I have been involved in the work of death, dying and bereavement for most of my adult life, both teaching and writing about the subject. In some senses then I am at ease talking about death and dying, about the pain of loss and the emptiness which the absence of another leaves.

At a personal level, like so many, I have had times when I have lost those very close to me. In those moments I have been forced to do the hard work of grief. In all honesty it has been in those personal times despite my so called ‘head knowledge’ that I have struggled to find a path through and a sense of balance when the waves of emotion overwhelm.

Bereavement is the sense of feeling robbed and bereft. For no matter how expected or anticipated a death or loss is, its ache is still sore, its pain still raw, its touch a cold beyond description. The pain of grief is like no other. It is a total emptiness, feeling abandoned and bereft and a searching which never seems to end.

This sense of lost-ness is beautifully conveyed in the original word for ‘bereavement’ from the Old English- ‘bereafian’ which denotes a sense of deprivation, of being robbed by someone, of being seized or grabbed out of living and life.

It is this feeling of being robbed that has been described to me in the last few days in my conversations with people who have had to endure the death of a loved one, someone they knew or who they cared for to Coronavirus.

This pandemic robs you. It robs you of time. It robs you of the moments when you would have been with another to say goodbye. It robs you of the touch, of the assuring smile, of the ability simply to wipe away a tear, of the chance just to be there. For to be with another at such times is to be still, to be in a touching place between life and death, between presence and absence.

This pandemic has robbed us of our traditions of saying goodbye. This is true of those who have died whether of Covid or for any other reason. It has robbed us of those moments when we find ourselves comforted by others; family have literally to be two metres apart unable to hug and console. It has robbed us of times when a song, a piece of music or hymn has sparked a memory and given familiar reassurance. It has robbed us of the rituals and rhythms of funeral and wake, of tradition and association. It has robbed us of the conversations which have sparked laughter even from the depths of sadness. It has robbed us of our ability to be with others, to reminiscence and remember.

This is in no way to deny or forget that undertakers and funeral directors, clergy and officiants are doing amazing jobs to keep things as ‘normal’ as possible not least through ‘Zoom funerals’ and video links. But strangely that very ‘connection’ has for many of us felt artificial serving only to confirm the sense of bereftness.

But out of such a sense of futility there are those who have been working hard to ensure that we can grieve despite the pandemic.

I wrote last week bout how important it was that we all made efforts to ensure that even if far from perfect there is a chance for people to say goodbye. I was therefore very pleased that a few days ago the Academy of Medical Royal Colleges along with Marie Curie and Scottish Care was able to publish some guidance to help this process. Huge thanks to Professor Andrew Elder for championing this and getting this done. 

Then on Wednesday we saw the publication the first Bereavement Charter for Children and Adults in Scotland. Over the last eighteen months I have been honoured to chair the working group of practitioners from across a whole range of organisations who have come together because they believed that Scotland needed to get better at dealing with death and dying. They devised the Charter as part of a national movement to get us all reflecting more about the role that grieving and supporting those who grieve should play in our lives and in our communities. 

No one could have imagined that the Bereavement Charter would be launched in such strange and disturbing times. Its messages have never been more important or necessary.

The next few weeks we will be all of us be rightly focussed on beating this virus. We will also be concerned about those most impacted in families and as professionals in the NHS and in care homes and home care. But after we get through to the end even if it is just the beginning of the end we will still be robbed of so many who have died, still needing to do the work of grieving.

We will need to do a lot to support those who are formal carers especially those who have faced grief at its most acute. For no matter how skilled and experienced you are we all need to be supported and upheld through our grieving, we all need to find a solace that comforts us in our weakness. When we have a sense of futility and despair, both personally and professionally, we need there to be space to open up and pour out our feelings; we need there to be people who have time and capacity simply to be present and there for us.

That will necessitate real change. There will be few of us who will be left untouched by this pandemic. Few of us will not know someone, however distant, who has been lost to the virus. We will all of us need to grieve both as a nation and as individuals. We need to be given space and time for that to happen.

We will, I hope, have a National Day of Mourning. I hope we will also as individuals and families have space for formal memorial services and events to recognise those who have died. But I also hope we will start to change the way we think about death and dying, the ways we need to begin again to restore the lives of those who are grieving and give solace to their hurt. Perhaps as a society in recent decades we have lost the capacity to share the grief of others and have individualised death, dying and loss. This surely has to change. We owe it to those who have died that their loss should mould us into a new tomorrow.

If Coronavirus leaves us with anything I hope it will be a determination not only to live better but also to be more comfortable and open in the face of dying as individuals and as a nation, for it is in that light, I am convinced, that we end up living our lives to the full.

Donald Macaskill

Letter from Cabinet Secretary & COSLA on Fair Work and the Living Wage in Adult Social Care

Scottish Care has received the following letter from the Cabinet Secretary and COSLA regarding the 3.3% uplift to contract hourly rates from April 2020.

The 3.3% uplift relates specifically to home care and those areas who are not applying a greater value of increase, essentially to set a minimum standard to enable the payment of SLW of £9:30 to social care staff.

Fair work in social care Letter from Cabinet Secretary and Councillor Currie - 10 04 03

Covid-19 Open Webinar – 16 April

The next Scottish Care Covid-19 webinar will take place on Thursday 16 April 2020 at 3:00 pm. This session will be hosted by Donald and Karen along with a guest host – Professor Graham Ellis, National Clinical Adviser for Ageing and Health, Scottish Government.

Professor Graham Ellis is a Geriatrician in Lanarkshire in Central Scotland and a clinician with the Hospital at Home service.  He has a research interest in the organisation of acute services for Older people.  He was recently appointed as National Clinical Lead for Older People and Frailty in NHS Scotland.  He was recently appointed as Honorary Professor at Glasgow Caledonian Universities department of Health and Life Sciences.

This is the perfect opportunity for you to ask us and Professor Ellis any questions you may have on Covid-19.

Please note that this webinar is open to both Scottish Care members and external colleagues, therefore those who are interested in attending will need to register to access the webinar (even Scottish Care members). You can register via the following link. After your registration gets approved, you will receive an email with a unique link to join the webinar.

Registration link: https://zoom.us/webinar/register/WN_1yyTi6HiTWmdS1meUpElqA

Tech Device Network keeping care home residents connected during Coronavirus

A generous Glasgow business has become the latest member of the newly established Tech Device Network and has immediately made a different to care home residents in Scotland.

DVI Technologies, a communications and IT business based in Stepps, donated four new tablet devices through the online initiative, which aims to connect donors with spare devices to local care services who need them in order to support vulnerable and older individuals to remain connected to loved ones during the COVID-19 pandemic.

The Tech Device Network, established by Scottish Care and Jennifer Nimmo-Smith from Electric Shores, encourages individuals and organisations to indicate through the website (www.scottishcare.org/techdevicenetwork) what they are able to donate whilst also asking care services to register, providing details of what they would like to use donated devices for in their support of care home residents.   The Network then connects these different groups up to arrange safe collection or delivery of the devices.

It is through this mechanism that DVI Technologies were connected to Nazareth House, a 70-bed care home and registered charity in Cardonald, Glasgow which has been supporting older people since 1902. Nazareth House requested tablets to help residents communicate with their families, which was providing challenging on the small phone screens of staff due to visual impairments.

Safe delivery of the devices took place on Monday 14 April, which gave staff from Nazareth House the opportunity to thank DVI Technologies and share more about how the devices will make a difference to residents.

Stephen Murney, Director of DVI Technologies, said:

 “DVI has always been delighted to support the work of Scottish Care, but more so in these recent weeks as Covid-19 has impacted their members. As a company, we remain open for business to provide essential support to those working in the Critical National Infrastructure sectors, and to help in whatever ways we can.

He added:

 “I have a deep and personal respect for the work of carers, and Coronavirus presents a hugely challenging time for them. With loved ones unable to visit, they’re carrying out their incredible jobs and taking the place of family. It’s been our privilege to help with the Tech Device Network, and I would urge other businesses to help where possible.”

A representative from Nazareth House said,

“As you can imagine, due to the present lockdown our residents are not able to have their loved ones visit them. Trying to explain to some residents who are living with dementia that their loved ones are thinking of them every day can be very emotional, not only for our residents but also for our staff. We are offering reassurance to the resident who is asking or looking for their loved one, as we staff feel their pain, anxiety and sense of abandonment.

“Modern technology is often criticised by us in what would be normally classed as a fast world, but in this present time each and every one of us are united in helping others in one way or another through their pain. By connecting our residents to their loved ones via Face Time we will offer reassurance to them that they are always near. Though not feeling their immediate touch, our residents can touch them virtually and seeing them will I’m sure bring tears but these will be overcome with joy as when in this sad world at present it also allows us to stop, think and thank how kind people can be. With this, we thank DVI Technologies and the Tech Device Network from deep within our hearts for their very kind gifts.

“Love, laughter and hope is being brought to all of us today and may this continue to be shared to all.”

Becca Young from Scottish Care, one of the co-founders of the Network, added:

“We’re very grateful for the generous donation by many kind-hearted individuals and businesses across Scotland such as DVI Technologies and are delighted that we are able to get these devices out into care services.

“The Tech Device Network is a positive opportunity in a difficult time for people to make a difference to the wellbeing of vulnerable citizens, and we’re really pleased that it is growing by the day. In order for us to support more people, we’d like to encourage organisations who could donate devices in unused or good condition to the Network to get in touch with us, as we have many more services in the Network who are desperate to receive devices for their residents.

“We have also established a JustGiving page for anyone who would like to contribute to the Network in another way, with these funds going directly towards the purchase of devices for care services. It can be found at https://www.justgiving.com/crowdfunding/techdevicenetwork”.

 

Ends

Full details of the Tech Device Network can be accessed at: www.scottishcare.org/techdevicenetwork

A JustGiving page has also been established for anyone who would like to contribute to the Network in another way, with these funds going directly towards the purchase of devices for care services. It can be found at https://www.justgiving.com/crowdfunding/techdevicenetwork

For media or Network enquiries, please contact:

Becca Young, Scottish Care – [email protected] / 07584 659995

Scotland launches its first human rights-based Charter for Bereavement

A Bereavement Charter for Children and Adults in Scotland

www.scottishcare.org/bereavement 

After eighteen months of development including consultation and engagement with individuals and groups across Scotland, on Wednesday (15th April) Scotland’s first Bereavement Charter for Children and Adults will be launched.

 

The Charter together with Guidance notes has been developed by a coalition of individuals and organisations. It contains 15 statements which describe what the best bereavement care and support should look like. It has been developed to support individuals and communities who struggle with the death of someone they know or someone in their community.

 

Today, the need for such a Charter has become even more important due to the unique circumstances we currently find ourselves in as a result of the COVID-19 pandemic. People who are bereaved may not have been able to be with a person as they approach the end of their life and may be isolated from their usual networks of support. It has also changed the traditional ways we are able to mark our grief. Traditional bereavement rituals and funerals have changed with many people now unable to attend funerals in the way that they might have in the past. Many deaths have become sudden with little or no time to prepare.

 

The Charter is designed to help us understand not only the importance of bereavement support, but what that support needs to look like.

 

Whilst accepting that every death is unique and that the way we each come to terms with a death is individual, this Charter and Guidance attempts to describe what good bereavement support can look like and what difference it can make.

 

The authors of the Charter hope that it will begin to appear in locations across Scotland and will be used by diverse groups and individuals. It is therefore hoped that the Charter will help us as a nation become more effective at supporting people to grieve.

 

Dr Donald Macaskill, Chair of the Bereavement Charter Group and CEO of Scottish Care, commented:

Bereavement support is an intrinsic part what it means to be a citizen in modern Scotland. Good bereavement support is not an optional extra, it is fundamental to a society basing its character on dignity and human rights. Good bereavement support renews and restores, it can give a sense of purpose and direction, for many it is what has literally saved their lives.

“I have been deeply honoured to lead the work on developing the first Charter on Bereavement for Children and Adults in Scotland. Dozens have given their time to create this unique document in the earnest hope that we will become better at talking about death and dying, and better at supporting the women and men who grieve in our communities.

“We are launching this Charter in very unusual times. The weeks and months ahead will require us all as a society to support one another to grieve for those who have died – our family, friends, neighbours and acquaintances. I hope that this Charter and its Guidance will help Scotland to be able to grieve.”

 

Dr Janice Turner, Principle Educator: Medical Education at NHS Education for Scotland commented:

‘’It has been an immense privilege to work with so many individuals and organisations in the development of Scotland’s first Bereavement Charter for Adults and Children. We collectively hope that it will make a real and positive impact on the quality of bereavement care in Scotland, both now, and for many years to come’’.

 

Notes:

The Charter has been developed by a wide coalition of individuals and organisations including the Care Inspectorate, Childhood Bereavement Network, CHAS, Cruse Bereavement Care Scotland, Healthcare Improvement Scotland, MND Scotland, National Bereavement Alliance, NHS Education for Scotland, NHS Fife, NHS Forth Valley, NHS Greater Glasgow and Clyde, Northumbria University, St Columba’s Hospice Care, Scottish Ambulance Service, Scottish Care, Sue Ryder, University of Glasgow and the University of the West of Scotland.

There is a short film further summarising the rationale for the development of the Charter available at: https://vimeo.com/395685686

The Charter, a FAQ Sheet and a Guidance document can all be found at www.scottishcare.org/bereavement