Article 14 – Prohibition of Discrimination
‘The enjoyment of the rights and freedoms set forth shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status’
With the most vulnerable individuals cloistered in care homes and allowed little opportunity for external contact, with the removal of homecare visits, individuals’ rights to not be discriminated against have been compromised and continue to be so.
In the past, social care has suffered by being perceived through the lens of its relationship with acute services, such as its impact on A&E waiting times and delayed discharge services. This pandemic has also exposed a certain bias towards the acute sector and a misreading of the nature of social care through a clinical response which has over-medicalised the approach to care homes in particular, There is an unconscious bias towards the sector as care homes are not healthcare settings in either registration or regulation and most certainly not in practice and custom. They are care environments where healthcare may be delivered but there is a very real distinction. The failure to understand care homes as non-clinical settings is evident in that report’s continual use of the word ‘patient’ and is regrettable in that a care home has residents not patients.
The initial guidance, on the 26th March to not admit care home residents to hospitals to protect the NHS was a clear indication of the primacy which health had in the dialogue and in the focus. Further, it implicitly suggests that all residents of such home are old and frail, a blanket presumption that shows a lack of understanding of the make-up of this sector and tangible discrimination. Although the guidance was reined in, the stigma survived and reluctance and fear accompanied any visit.
Vast quantities of PPE were requisitioned for NHS use, effectively cutting off supply routes for social care providers who then had to either pay exorbitant and unsustainable prices, or, in some cases, send staff in to shifts with inappropriate alternatives. The local Hub network that was set up to alleviate these issues was beset with initial administration issues, and this, aligned to confusing guidance as to what should be worn and when caused real concern. Compare this to the regimented discipline of acute settings and you can see some of the disparities.
The COVID19 pandemic has had devastating consequences globally, but has had a disproportionate effect on the vulnerable elderly in care homes, where 2/3 of residents live with dementia. The most recent statistics from the National Records of Scotland report that 47% of all Covid deaths noted a care home as a setting, slightly ahead of the 46% in a hospital (add footnote). Unpleasant commentaries around a ‘Boomer Harvest’, ‘just’ another flu, and the use of ‘underlying health conditions’ as an unedifying salve for the conscience of the nation, has relegated harrowing and in many instances critical experiences for people with dementia to the realms of acceptable collateral damage. Such societal ageism informed the response to the pandemic and was equally evident as the economic realities bit, and pressure increased to restart industry and commerce. Many opinion pieces led with the view that the working age population should be free to throw off the shackles of lockdown, but that the old and the vulnerable should not.