Health Protection Scotland has published Version 1.1 of ‘COVID-19 – guidance for stepdown of infection control precautions and discharging COVID-19 patients from hospital to residential settings‘.
This guidance provides advice on appropriate discontinuation of infection prevention and control (IPC) precautions for patients recovering or recovered from COVID-19 and either remaining in hospital, being discharged to their own home or to residential care.
Please see below for joint letter from the Cabinet Secretary for Health and Sport, Ms Jeane Freeman and the COSLA Spokesperson for Health and Social Care, Cllr Stuart Currie. The letter asks that wherever possible, for colleagues to participate in a minute’s silence at 11 am tomorrow (28 April), on International Workers’ Day in honour of our colleagues who have sadly lost their lives to Covid-19.
20 04 27 IWD - joint letter Cab Sec and Cllr Currie
Health Protection Scotland has published Version 1.0 of ‘Information and guidance for social or community care and residential settings’.
This guidance provides advice about COVID-19 for those working in residential settings.
1_covid-19-information-and-guidance-for-care-homes
Health Protection Scotland has published Version 1.0 of ‘Information and guidance for social or community care and residential settings’.
This guidance provides advice about COVID-19 for those working in residential settings.
1_covid-19-information-and-guidance-for-care-homes
NOTE TO MEMBERS: Due to much higher than anticipated demand, we no longer have any masks available. We are working as we speak to restock but it will be approx. 4 weeks before our new supplies will arrive (tentative date – June 1st). We hope to be up and running asap and will let you know when our new stock is ready to order. Thank you for your patience. Rainbow PPE
Need fluid resistant surgical masks -we have them available today. Click through for special Scottish Care offer.
To order please email us on [email protected]
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The next Scottish Care Covid-19 webinar will take place on Tuesday 28 April 2020 at 12:00 pm. This session will be hosted by our CEO, Dr Donald Macaskill and our National Director, Karen Hedge.
This webinar session will be split into two, 12:00-12:30pm will focus on Care at Home issues, 12:30-1:00pm will focus on Care Home issues.
This is the perfect opportunity for you to ask us any questions you may have on Covid-19.
Webinar link: https://us02web.zoom.us/j/81696241333
Webinar ID: 816-9624-1333
Everyone at Bandrum makes me feel so proud 23/4/20
We are now into week 4 of ‘full lockdown’ and the 6th week of restricted/no visits to Bandrum Nursing Home and my goodness how the world had changed! It is fascinating and uplifting how quickly most of society has adapted to the new normal or at least got used to a new routine and we must feel proud as a country for this.
However, in a care home life is quite different.
I am prouder than ever to be Managing Director at Bandrum. Our wonderful staff have the concerns of the world on their back when they come to work. Our residents and relatives are sorely missing each other, and their routine has completely changed. However, despite this our staff are being fantastic, they are dedicated to the home and their residents, being professional throughout and striving to keep our much-loved residents safe.
I have seen our team deal with this crisis with compassion and resilience. They work tirelessly. We are all anxious about what will happen next but continue doing everything possible to look after our resident’s health and wellbeing.
Another element to the crisis is the constant news updates sharing heart breaking and tragic stories. I know a harsh story gets more views however it is not all like that. It certainly is not like that at Bandrum.
With that in mind I took part in this morning’s BBC Radio Scotland News by means of a telephone interview. You can play it back on the following link:
https://www.bbc.co.uk/sounds/play/m000hdps (1hour 55mins into the program)
I wanted to get across how fantastic our staff have been and indeed raise the profile of all care workers who are working on the front line.
Here are the 10 main points I shared in my interview:
1. Our staff are dedicated and professional, striving to keep our residents safe
2. They are anxious about what will happen next at home and at work, as is to be expected but come to work and provide the absolute best of care
3. The negativity in the media is an added burden and not the full picture
4. Support – we have lots in place to support our staff, daily meetings, communication group, cake and sing, the clap/cheer on a Thursday. These have been well received. We also have a wall of gratitude to leave messages to help lift both staff and residents’ spirits.
5. PPE – I have worked tirelessly to get the PPE our team needs. Indeed, I pledged to the team at the start I would get them what they needed and am pleased to have managed this. Some have been bought at 10 x the usual cost and some suppliers have run out of the things we needed which has led to searching for different suppliers and swapping items with other providers. The demand is so much higher that stocks have run out and suppliers have been commandeered to central stores.
6. Fife partnership have been so incredibly supportive, the triage service has been good, we have worked closely with public heath who praised our team saying we have been fantastic and the care inspectorate as happy with our work. We also got a large delivery of PPE from central stores yesterday, so we are well prepared.
7. Our residents – watch the news and read the papers, they are up to date with what is happening outside the home and so it is so very worrying for them seeing people in suits and hearing the tragic stores. They are also missing their relatives and outings terribly. We help them through this by providing video calls to loved ones and doing what we can to raise spirits. However, like the rest of society, everyone looks forward to normality returning.
8. Our care – is different to hospitals. Residents move into us as they can no longer live at home and we look after their every need. Whether they have been with us for 1 week, a few months or years they become part of our family. It is an honour to provide end of life care which our team do exceptionally. When a resident dies it is like losing a member of the family which is sad for everyone at Bandrum.
9. In the current circumstances, with the restrictions we have, end of life care is different to usual. Relatives would normally come in for as long as they wanted. Although we still offer visits when we think our resident may be dying, it is not the same but we are learning to offer palliative care support in different ways.
10. My leaving thought for the interview is my ending note for you. I hope we as a nation will recognise the wonderful work our care workers are doing and give them the credit and respect they deserve now and moving forward. They are at the very heart of society.
Thank you for reading and please stay safe. We are all in this together – and will get through it.
Rachel Payne
Managing Director, Bandrum Nursing Home
‘Lock Down TV’ was developed by a professional entertainer who specialises in performances in care homes and sheltered housing. He aims to provide free entertainment to care homes during Covid-19.
Thus far, he has put on 3 shows, playing the guitar and singing. Each show lasts under an hour and includes Scottish songs and a 50-60-70 sing along.
These shows can be viewed for free with no advertising, however you may choose to donate if you want to.
You can access these shows here: http://www.hechwifie.com/open/
The new care normal
The First Minister published the Scottish Government’s strategy for coming out of lockdown on Thursday and encouraged a public debate on the issues which the document raised.
For the social care sector coming out of lockdown is likely to be very challenging. If as it is envisaged that there will be a phased and incremental removal of restrictions it is highly likely that this will mean that formal care settings will be amongst the last to be back to familiar patterns of behaviour and access. Even when this happens it is likely that social distancing will continue for some time and that staff will be required to continue to utilise a high level of PPE. It is likely that there will need to be increased staffing levels in a sector which has most recently been faced with acute staffing pressures and significant economic instability. But over all these very important and genuine concerns there should be a heightened awareness of the impact on those who are the recipients of social care and support.
Over the last two weeks in particular it has become clear that the levels of distress, of emotional and psychological harm, upon those living with dementia in our care homes and in our communities in Scotland are becoming more and more acute and worrying.
The ongoing focus in care homes in particular has been quite rightly the sustaining of life. This has led to the development of guidance which has meant that for 6 weeks our care homes have been in effective lockdown with only rare visits at the end of life and in the earliest couple of weeks for one named individual per family in situations of real distress. I fully understand and appreciate that concomitant to this have been clinical and infection control measures which have advocated self-isolation and social distancing; the end to the use of communal spaces and effectively the confinement of individuals who have been symptomatic.
Such ‘emergency’ measures have been justified as necessary and proportionate in order to achieve the legitimate aim of the maintaining of life. But I now believe that six weeks on we need to consider and actively debate both how long these restrictive measures can continue but also whether they are indeed the most proportionate and human rights-based interventions.
My personal concern is that we need to get a better balance between proportionate restriction of freedom of movement in order to attain infection control and a diminishing of normal life to the extent to which it is causing psychological and physiological damage e.g. through increased falls, impact on nutrition, effect on hydration, increases in delirium state etc. I am concerned that too many assumptions have been made in the adoption of infection control practices which fit an acute hospital-based environment without a full appreciation of the nature of care homes and of the population that is supported within them. I am fully aware that there is growing epidemiological evidence around the nature and rate of transmission of Covid-19 in care homes and that we are some distance from the peak of the challenge. However, we have to more fully recognise specifically that the levels of acuity in care homes are exceptionally high and in particular that the vast majority – probably about 90% – of residents have some form or another of dementia.
Lockdown from the perspective of someone living with dementia has been in many instances quite frankly, simply hellish. Staff have spent a lot of time reassuring, being present, reminding and reaffirming what individuals about what is happening. They have supported people to understand why family have not visited and have used technology to help people to remain in contact. But sadly, such measures have only worked for a minority. For many more this has been a maze of confusion, distress and very real emotional trauma. The familiarities of touch, eye contact, physicality and presence have been denied them. The rhythms of routine so fundamental to someone living with dementia have been replaced by strictures and detachment which is causing real harm. Despite all the best efforts of nursing and care staff, care homes even where there have not been cases have changed.
Outside in the communities we are hearing equally distressing stories of individuals without family support who are immensely confused and disturbed by the changes in the pattern of their encounters with homecare staff, with neighbours and with friends.
I am convinced that we need urgently, not just as a care sector but as a whole society, to think about how we are going to support the ‘new care normal’ in care homes and in communities.
If we are to continue with some form of restricted access for some time then we need to appreciate that a care home is not an institution or a unit – it is someone’s home – and we need to get back to that understanding as quickly as possible. We need to re-connect care homes to families and vice-versa taking appropriate precaution but balancing risk against the reality that for many individuals their lives are greatly diminished and risk being fore-shortened by current measures. We need to create a real army of volunteers and others prepared to support the added demands of staffing which will be necessary with new models of care which need to maintain their human touch and person-led focus. Critically we need to urgently move from self-isolation to safe social distancing within the confines of the physical environment of a care home supporting re-connection and re-membering.
Within the wider community I am also concerned that some of the narrative which we are hearing in the media is presumptively assuming that there will be the use of age restrictions in our exit from lockdown, so for instance those over-70 may be in lockdown for a longer period of time. Just as withdrawing treatment based upon age was unacceptable as an ethical choice so I would contend such restrictions would be equally unacceptable. Setting different rules based on age is a blatant form of discrimination. It is one thing to seek to shield those most at risk because of underlying health conditions it is quite another to use blanket catch-all prohibitions.
The ‘new care normal’ needs to be molded by families and residents, citizens and carers, clinicians and professionals, so that together we get the right balance between risk and life. We urgently need to have this care conversation as part of the national conversation the First Minister started on Thursday. Put simply there is a difference between existence and living and for many living with dementia at the present time that balance seems not quite right.
The last two months have been a tumultuous time due to the outbreak of COVID-19 which has sent shock waves through the world and has had devastating effects on families and services and restricted the lives of many . However, on a more positive note it has also been a time for deep reflection and re-connection of what is truly important and to look at how we can be more creative in our approach to meet our human rights and needs.
Moreover, for those who do not know, this is my final week before I go off on maternity leave and so it feels like the right time to reflect on the fantastic progress of the Rights Made Real project during phase one of the programme and take a look at what the future of the project holds. Lastly I felt that this was a prime opportunity to look at human rights in light of the current climate and how the projects have used what they have learned during this project to not only maintain the safety of themselves and residents but also how they have used their skills, learning and knowledge in a creative way and continue to make rights real in spite of the ongoing crisis.
The first phase of the Rights Made Real in Care Homes Programme was funded in 2018 for 2 years and is due to finish at the end of July 2020. Moving forward, I am delighted to announce that there will be a phase two extension to the innovative rights-based work that has been happening to improve the lives of those with dementia living in a care home setting. Further information will be released soon about what this will look like in the coming months – so keep your eyes peeled.
The aim of the project overall, has been to demonstrate and embed a rights-based approach to dementia care and each of the seven groups of care homes have taken unique and innovative approaches in how they have achieved this. You can find more information on what each of the projects were involved in here. https://scottishcare.org/about-rightsmadereal/
There has been an abundance of learning as a result of the project so far. Tamsin MacBride from UWS has been pivotal in the role of collecting, connecting and evaluating this learning from the different care home sites using My Home Life, appreciative inquiry and action learning approaches. This learning was compounded in the “Away Days” in October where we brought the projects together for two days of reflection and future forming workshops and key speakers involved in human rights in the health and social care sector. This time of reflection has been invaluable in maintaining the momentum, readjusting the focus of the projects and reinvigorating the motivation to look at human rights in new ways.
One of the key quotes from those Away Days was the realisation that,
“Many paths can lead to the same destination.”
Some of the other general learning from the Away Days was around:
Phase two of the project will seek to consolidate the learning from phase one and explore how this can be used to influence other care homes across Scotland. As the project comes to the end of phase one, there is a strong sense that the care homes have more they would like to learn. Phase two will go deeper than being rights aware to embed rights based approaches into practice.
So with that in mind, my role when working with the projects in 2020 has been to co-create a human rights resource with the projects to document the journey of discovery of the learning throughout the different organisations. There has been a clear transfer of learning throughout individual organisations, so we felt it was beneficial to share the journey in order to showcase how human rights are met through different tools and approaches. This resource will be available in the early Summer so please look out for more information on this.
From the beginning of 2020 as a result of the global pandemic, the world’s citizens have had their human rights inside and outside their home restricted and limited on many levels in order to protect public health and care homes are no exception. This project has highlighted how important and intrinsic the enjoyment of our human rights are in our everyday interactions and lives and this global pandemic is an example of how our fundamental human rights can be restricted in order to protect public health. It is useful to be able to understand what our human rights are and the principles of human rights so that decisions are being made proportionately, necessarily, and legally to protect people.
There have been many effects of restrictions specifically, with regards to social distancing for those with dementia in a care home. This has meant that a restriction to Article 5: The right to liberty has been applied. This can have a detrimental effect on someone with dementia who may not understand why they are not allowed to travel outside or to meet up with family or other residents and it is imperative that all decisions should be made to ensure the least restrictive option. Scottish Care CEO Donald has written a thorough and thought provoking article on the ethical choices that are having to be made as a result of COVID-19 – https://scottishcare.org/the-hardness-of-covid-ethical-choice/
All of Article 8 which is around the Right to private, family life and correspondence have been affected. This includes psychological integrity (mental and physical well-being), the development of ordinary family relationships and the enjoyment of current home all of which are affected through social distancing and the measures that the government have put into place. These restrictions have been especially difficult to navigate for those at the end of their life and those who have had to make the decision to attend hospital for life saving treatment.
However, as daunting as these measures sound, there are many examples of health and social care organisations taking steps to ensure the least restrictive option in a creative manner. This includes family visits from outside the care home and using Skype and FaceTime to connect with loved ones. Also, there has been an uptake of social activities electronically and connecting via technology. Scottish Care has also set up a technology device network where organisations and individuals can donate devices so that residents can maintain connection with their loved ones – https://scottishcare.org/techdevicenetwork/
It has been so encouraging to hear from the project leads that their time involved in the project has prepared them with the skills, knowledge and tools to be able to navigate this crisis using human rights, including buiding confidence in:
My time in this role has sadly temporarily come to an end and therefore I would like to take this opportunity to thank all of the projects for their ongoing dedication and commitment to improving the lives of those they support and for their incredible attitude even in the face of a global pandemic. Last but not least my colleagues at Scottish Care, who have been the continuous voice of the independent social care sector and have been very supportive throughout my time as policy and human rights worker in supporting the vision to make rights real for those in care homes.
Stay safe and stay tuned for more updates soon,
Verity Monaghan
Policy and Human Rights Project Worker
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