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Deciphering the key to safety during COVID-19

Sharing knowledge is a key part of running a care business, and even more so in recent months. Here, David Romero McGuire, Chief Executive of the Diagrama Foundation, shares how close ties and communication with colleagues in Spain helped their six care homes in England stay COVID-19-free.

It feels like an age since we took the decision to implement our own guidelines to keep both our residents and members of staff safe from COVID-19. As we have begun to ease restrictions – some residents were allowed home visits again from August 1st – we have started to reflect on lessons learned.

I hope the measures described here can help others prepare in future.

Locking down

Diagrama is an international non-profit organisation, with its roots in Spain. In March, as the pandemic took hold in Europe, I was in daily contact with our colleagues there. They warned us of what was to come. It was like a look into our own future, as the UK was two to three weeks behind what they were experiencing in Spain.

The first and most difficult decision we took was to lock down our homes at the same time as Spain and Italy – two weeks ahead of UK government guidance to do so here. This meant residents could not go to any community activities. Many have autism and this sudden change was difficult for them to adjust to. We also stopped non-essential visits, including from families, who were supportive of the move, themselves worried about the imminent threat.

Our Spanish colleagues reported how challenging it was just shopping for supplies – there, they were facing police fines if a non-key worker left their home. We quickly wrote two official letters on headed paper – one which we gave to our care homes, so that they would to be able to buy in bulk at the supermarket, and the other for all of our staff so that they could identify themselves as key workers in case they were stopped by the police here.

Avoiding transmission

As the pandemic started to grip the UK, I received another warning, this time from Spanish doctors sharing what they knew about the spread of the virus and how to minimise risks.

In the UK, while the government advised us to wash our hands, we could see much more was needed and took immediate action with a new raft of measures. These included:

  • Deep cleaning the homes twice a day – door handles, stair rails, keys, anything with frequent touch points.
  • Using diluted bleach (1%) upon the doctors’ advice to clean surfaces. (They told us it was more effective than supermarket products – which, by this point, were not available anyway.)
  • Staff changing in to clean clothes or scrubs upon arrival for work and disinfecting their shoes. As our residents had been in isolation for 14 days by now, we knew the only people who could spread the virus were staff, so we had to minimise risk as much as possible.
  • Socially distanced dining, with residents spaced out and staff eating separately.
  • Everyone in our homes – except residents – was told to wear a face mask at all times.

Wearing masks was our most challenging measure at this point. We’d heard from Spain that the virus could be spread by droplets from the mouth, but the advice from the UK Government did not reflect this risk. It took until late July for guidance around masks to emerge here.

Our challenge was not getting staff to wear them – they were more than willing – but getting hold of masks in the first place. All supplies had been diverted directly to the NHS. Hours upon hours were spent combing the internet for supplies. At the beginning, due to the extreme shortage, staff were asked to re-use them several times. It was not ideal, but not wearing a mask was not an option. The risk was too great. When news emerged on social media that staff were reusing masks, the community rallied by donating their own supplies and some staff also made washable masks.

But we knew more could be done to keep people safe. As a team, we devised a new shift system to halve the number of people entering the home daily. At a time of great stress, when everyone had their own family concerns to think about, our incredible staff embraced the changes and pulled together to think outside of the box and come up with additional measures we could take.

Alarming news was coming in from other countries. Care homes were struggling with infection outbreaks and swathes of deaths. The spread was increasing due to those infected with Covid-19 being discharged from hospitals and placed in care homes. I decided there and then this would not happen in our homes.

We immediately changed our admission assessment policy and informed the authorities that we would not accept any new admission without a negative COVID-19 test. They were not happy. Government guidance and our measures conflicted. Authorities were not prepared to test as it was not in government guidance. There were tensions, but, after a few weeks this was resolved and all new admissions are now tested.

Easing into normality

Managing the lifting of restrictions has been just as challenging. While the government eased lockdown, we needed to do the same, but at the right pace. We could not rush and put anybody at risk. We knew easing meant increased risk, but we had to balance that with residents’ wellbeing.

Our first trip out with our residents with learning disabilities was alarming. The park was packed and maintaining social distancing was difficult to manage. The risk was too high. We thought again. Different times? Locations? We approached a neighbouring school that had closed to children and the headteacher agreed to open up their fantastic grounds for our use. I owe him more than he will ever know.

Residents missed their families so it was time to have visits again, but we needed to manage expectations of families. Some residents didn’t understand what COVID-19 is. They didn’t understand why they couldn’t go to their usual activities. There was no way they would understand social distancing. Were we going to refuse these residents a hug with their family? Of course not. We need to manage risk, but there will always be risk.

Family visits were restricted to two relatives at a time, booked in advance to enable gaps between them to allow us to clean. They were also asked to disinfect shoes, use masks and to not drink or eat while with us. We asked them not to have close contact where possible. Everyone has been so supportive of the changes and the system has been running smoothly.

Now, we’re planning our residents’ visits back home again. This is the latest and the riskiest step to date. As I write this, we’re continually drawing up new protocols and speaking to people from other countries to learn from them – what has gone right or wrong? We’re reviewing all the options and calculating risks and how to minimise them. But, we accept, there will always be risks.

Thankfully, I know the incredible team around me will do their best to make sure these home visits happen as safely as possible. These past months have provided an opportunity for our staff to shine. The challenges have only served to strengthen our culture. When people were at times pushed to the limit, I’ve been amazed and exceptionally proud of the lengths they would go to ensure the best outcomes for the vulnerable people we care for. As a leader, I cannot ask for more.


David Romero McGuire is Chief Executive of the Diagrama Foundation. Email: diagrama@diagrama.org Twitter: @DiagramaUK

How did you come together with others to share learning during lockdown? What did you find effective? Tell us by commenting on this feedback on this feature below.

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