May 13, 2021
In recognition of Mental Health Awareness Week 2021 (10th-16th May), CMM’s editor Olivia Hubbard speaks to two registered care home managers about how working in social care impacted on their mental health during the pandemic. In the first of the series, Registered Manager Dawn Bunter shares her story.
Before the pandemic took over the world, Dawn Bunter, who works as a Registered Manager at Iceni House Care Home in Swaffham, Norfolk, felt confident in what she did. Dawn has worked in the social care sector since 1996.
‘I’ve worked my way up from a tea girl – earning £13.70 a week! And, since then, I have worked as a manager for the past six years,’ remembers Dawn. ‘When the pandemic hit, I had just started in my current role and had only been in the role for 14 days. I hadn’t met families and I didn’t know the residents or staff very well at all. Suddenly, the home was locking down and these poor residents ended up on a phone call with someone they hadn’t met before.’
Care workers took on new roles, too. Dawn felt that care workers were expected to become doctors, nurses, talk on the phone to share someone’s symptoms, be expressive, be someone’s family and ensure emotional wellbeing.
Powerless against the virus
The prevalence of COVID-19 was quite high in East Anglia at the time and the Director of Iceni House Care Home made the call to close the doors to the outside world. Dawn’s priority was to keep people safe and her determination to achieve this led to her first experience of anxiety.
‘I don’t think anyone would have thought that, a year ago, this would still be going on. I was then sending out formal letters of explanation because I was so worried that some families might travel – as we have some families who live far away. I wanted to be transparent and communicate properly to them. It really impacted on me – I had people saying, “Oh, who are you?” I felt like the gatekeeper at the time: “Please don’t visit because the home is going to close down.” It was heart-breaking because you had some relatives’ family members who said, “Oh, but it’s my dad’s birthday next week and we were coming with a Chinese” or “What about mum and dad’s wedding anniversary in two months’ time?” I felt like I was withholding family contact and this felt cruel.’
Like Dawn and so many other care workers, they believed that the world would get on top of this and ‘normal’ life would resume. In April 2020, the true extent of the mental health crisis that would take hold and consume the care worker workforce had not yet come to light. A survey conducted by the Care Workers’ Union of 1,200 workers has revealed that 75% of care workers say that their work during the COVID-19 pandemic has had a serious negative impact on their mental health. Care workers report anxiety levels are almost half as high (44% higher) than all employees in the wider economy.
Dawn’s care home experienced its first outbreak in April 2020. Care workers wrapped in PPE, goggles leaving their mark on exhausted faces and a united feeling of panic, confusion and fear. Dawn remembers the first outbreak and the trauma: ‘We had a gentleman go into hospital and then return. Within hours, we could tell that he was symptomatic. He hadn’t been tested in the hospital; we were told to take temperatures and monitor symptoms at the time. As a result, this gentleman did have COVID-19 and it spread. In the space of two and a half months, we lost nine residents. It was heart-breaking. I was very much walking around the building and not knowing who had COVID-19 and who didn’t because there was no testing unless someone was admitted to hospital. I wouldn’t sleep. I would go home and I would cry. I would think, “I can’t keep these people safe”.’
At Iceni House Care Home, residents’ temperatures were taken every hour and barrier nursing was in place as much as possible. Yet, the complexity of conditions within the care home made the approach to outbreak response challenging.
‘It’s very difficult to isolate residents with complex dementia in their rooms,’ says Dawn. ‘In April and May 2020, the temperatures outside soared and everyone was walking around with the gowns, goggles, PPE, masks, visors, trying to ensure people got medical care if they needed it, checking for deterioration. It was basically one-to-one care; it was so pressurised and so stressful for the staff. We didn’t have the resource, so we had to call 999.
‘I don’t think hospitals even knew who had COVID-19. There was a constant panic that was setting in. The hospital would call, telling us that they were going to be sending back residents. There was frustration because, as a care home, we learnt how quickly that virus could spread and we were saying, “No, not until they are negative”. Which was then creating animosity between the care home and the hospital because, clinically, we couldn’t give them the care they needed. We can’t give them oxygen. We aren’t clinically trained.’
Anxiety and panic
Dawn had never experienced mental ill health before the pandemic – it was an unknown and difficult for her to comprehend.
‘Pre-pandemic, I would have the odd wobble but, during the pandemic, there were so many wobbles. Forever wondering whether I had made the correct decisions. I’m really lucky that I have a second nominated individual and a director, so I can bounce off both and talk things through.’
I asked Dawn whether there was a moment that she wanted to walk away forever – did it ever get too much? ‘There were a couple of moments. We called an ambulance for one gentleman at 8.30am in the morning, then we called an ambulance for another gentleman at 9.15am and it was the same crew that came back. It was so hard, and I remember looking around and that’s when I thought, “I’m not keeping these people safe, and I can’t do this anymore.” That’s when I went home to my husband and said, “I’m going to quit in the morning.” I was worried I was going to develop panic attacks because I could feel tightness in my chest, and I was so worried I wasn’t keeping people safe. I went to the doctors and was offered diazepam and a six-week sick note and told to have a break. How could I have a break?
‘We had block-booked some agency carers. They gave up their lives and didn’t go anywhere for five and a half months to help us. For the care workers who slept in tents and stayed on site, I take my hat off to them because that was the ultimate sacrifice. I needed the outlet of driving away and not being there for a few hours. That was also a scary prospect – I would walk around the house in a mask because I wouldn’t want to pass the virus on to my family.’
Hope in the darkness
By August, testing arrived at Iceni House Care Home and Dawn was so happy that staff were no longer making assumptions about someone’s health. By October, the care home decided to allow visiting, going against the Government guidance and allowing people to meet. Dawn isn’t quiet about the fact that they did. ‘We were the only care home in East Anglia at the time who were saying to families, “You know what? Come and give your dad a hug.” We’ve never had a large-scale outbreak since. We had one gentleman who had lost so much weight – he is now back up to his normal weight, just from seeing his daughters once a week. And a lady who used to throw herself on the floor because she didn’t understand COVID-19 – she wanted the ambulance to come because the visiting times in the hospitals are in the afternoon “so I’ll see them”, she used to say. In her mindset, when you go to hospital, you get visiting times. Now, her family comes in three times a week and she’s not throwing herself on the floor anymore.’
Dawn says that if it wasn’t for her family and three other care managers who she met virtually and who have joined Dawn to run the chat show ‘Caring View’, she wouldn’t have been able to cope as well as she did. Dawn also engaged with private counselling, which has now been rolled out to all staff members at the care home. Sharing her story with all the staff has helped to break down stigma and invite open and supportive conversations.
‘We ensured that staff received mental health support and it was on a voluntary basis, so they could dip in and out as they wanted. They didn’t have to come one week but could come the next. The Director paid for it. At the time, there wasn’t anything open – other than them making telephone appointments with a doctor.
‘As a result of the counselling, I felt more confident in what I was dealing with. I could talk to people rationally. When you’re talking to yourself in your head like, “Oh, I swabbed 90 people today and the results are all going to come through at 2.00am via text message”, it causes great anxiety. I could hear my phone vibrate and I just had to check. The first set would come through, then the next lot. That was the cycle every week. I had to check and I needed to know. If a night-time care worker tested positive, I couldn’t wait until the morning because they had been on shift for six hours. I would lie there and go through them and go through them again, so I could sleep.’
Dawn’s advice for providers
- Find out what has affected staff. Because for me, I knew what had affected me and then I wrote a raw, open letter and the staff would come to me. It’s all relative to the individual. Finding out about the staff to the point that you know when something is wrong.
- Understand when staff need a mental health break and encourage staff to take their holiday – even when they can’t go abroad anywhere.
- We don’t need to work like trojans to be effective in our work.
- Consider rolling out mental health training – we have, and we have rolled out COVID-19 training for all staff.
Provider response – Rob Hammond, Nominated Individual, Iceni House Care Home and supporting consultant
‘At Iceni House, Dawn and I have often talked about the impact that the pandemic has had on her and the team at the home. It has been an unprecedented year for those who work in Care Homes and especially those who manage them. These people have made decisions and solved problems they never thought possible within their work. The consequences of making the wrong decision, (often in the absence of accurate information) on how to prevent transmission of Covid, as a country and a world, were unbelievably frightening and difficult.
‘As a consultant supporting care homes, I have seen the impact these circumstances have had on Registered Managers and it concerns me greatly that there is neither the support mechanisms nor the national desire in place to really understand what they have been through in the future. The role of a Registered Manager was already one of the most complex and responsible positions within the Health and Social Care sector prior to the pandemic. After March 2020, these challenges increased significantly. If we do not reflect on, or recognise, the emotional and draining impact that Covid has had on many managers running care homes then as we begin the debate about reform in social care, then we are likely to lose people from the care profession who have conducted themselves with integrity, resilience, value, and done amazing things in the pandemic to keep people safe.
Support mechanisms such as local authorities, social workers and CCGs, were all grounded and working remotely during this period of time and Care Home Managers, such as Dawn, often worked in isolation making significant decisions about unprecedented events and bearing the weight of this responsibility. A very tenuous and fragile structure around care settings crumbled and as the months have gone on, a blame culture has emerged that does not recognise their relentless and tireless efforts. With care homes often bearing the brunt of this, especially managers, and there hasn’t been recognition of their amazing achievements and the impact it has had on them personally and professionally. Prior to the pandemic, there was a need for more effective mechanisms to support, develop, and ensure the wellbeing of Care Home Managers. Now, more than ever, this needs to be part of the agenda and debate moving forwards…
In the next blog post, we will be speaking to Mark Topps, who worked as a Registered Manager at a care home supporting people with learning disabilities during the pandemic.
Share your comments and reaction to Dawn’s story. Visit the Care Workers’ Charity website for more information about the Care Workers’ Support programme.
Elsewhere on the CMM wellbeing website, you’ll find wellbeing downloads that can support you to recognise the importance of your mental health, make it a priority, and options to incorporate small changes into your life to make things feel easier. Skills for Care’s online toolkit gives examples of what a positive workplace culture looks like and explains how you can develop a positive culture in your workplace.