Are we about to see a repeat of discharging positive COVID-19 patients back into care homes?
It is incredible to believe, but recent reports suggest that we may see the return of the catastrophic strategy adopted at the height of the pandemic, where the transfer of residents who had tested positive were transferred from hospitals to care homes.
More than 1500 people died of the virus in care homes earlier this year when it was reported that care homes were being flooded with COVID-19 patients returning from hospital.
Despite the Health and Social Care guidance stipulating that care home providers would not be forced to accept people with the virus into their homes inline with policies and procedures for supported living. It also seems that Government pledge to place a protective ring around vulnerable residents is also at risk as we learn local authorities are now offering increased fees to homes prepared to take COVID-19 positive patients from hospital.
Local authority incentives
Cumbria has made it known to providers that they are willing to offer double the normal weekly fee to care homes who are prepared to take COVID-19 positive patients. Birmingham city Council has been offering £1000 incentives to providers for months, While Morecambe Bay wrote to providers only last month offering them extra cash.
Eileen Chub from the whistleblowing charity Compassion in Care says “it’s the same attitude to elderly people all over again-rushing people into care homes. They are sacrificing people needlessly.
Judy Downey of the Relatives and Residents Association says, ‘the incentives are perverse’. What are we saying about older people in care homes? They are collateral damage? ‘They are not humane’.
Winter plan
Nadra Ahmed of the National Care Homes Association is increasingly concerned about testing. She says the Governments winter plan describing how it would make discharges safe. But the association has received reports from providers who’ve taken patients from hospital with negative test results, but when tested on arrival were found to be positive.
Professor Adam Gordon of the British Geriatrics Society says, ‘what’s not clear in the winter plan is whether we have sufficient mechanisms to prevent the mistakes of the first wave being repeated again’. ‘In Scotland they do not send Covid-19 positive cases to care homes. In England that is still a possibility and the reliance is on care homes to get it right’.
The roles of hospitals and care homes during the pandemic
As the impact of the pandemic continues and the infection rate in care homes is on the increase. I think it is more important than ever to define the responsibilities of hospitals and care homes in dealing with positive cases of the virus. Hospitals should be responsible for positive cases as they are equipped to deal with the virus with access to medical staff, equipment and drugs. These are not available to staff in care homes, nor have many of the care staff received training in providing care to residents who have tested positive.
COVID-19 Fit for purpose assessment
Before we start rewinding the clock and find ourselves in a similar position with large number of fatalities in care homes, we should consider whether or not the care home is capable of meeting the requirements for treating positive cases. I would suggest that providers are asked by commissioners to carry out a clinical assessment into the facilities and services that can be offered by the home prior to any transfer of cases to a care home. The assessment could include:
Isolation facilities
The means of isolating positive cases from other residents
Care plans
Staffing levels required to meet positive cases
The training of staff to provide a service to positive cases
Availability of PPE and medication
Backup support from GPs and NHS
The assessment process would enable providers to state whether they were in a position to accommodate positive Covid-19 cases.
Summary
The incentive by some local authorities to encourage care homes to borders on incredulity. It seems that lessons have not been learned and the protection of the NHS at any cost is seen as sacrosanct.
We need to protect residents and care homes and adhere to the guidance that care homes will not be forced to take positive cases. It is not sufficient to expect care homes to get it right under their own volition, we need to confirm through clinical assessment that they are equipped to do so.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy