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Into Perspective: Covid restrictions and residential care

Can COVID-19 Restrictions be safely eased for people in residential care?

People living in residential care have been amongst those who have suffered most from COVID-19. Due to heightened vulnerability, residents have been subject to far tighter restrictions since the pandemic began than the rest of the public. Naturally, maintaining residents’ safety has been the motivation throughout and few would question their necessity in the darkest days of lockdown.

However, as society begins to return to normal life, free from almost all restrictions, people living in residential care are not currently being afforded the same opportunities. Whilst many limitations have been eased, a crucial few remain which some argue is placing unnecessary burden on residents, their families and carers. Protecting people living in residential care from COVID-19 continues to be a priority for all those concerned, that much is clear. Simultaneously interpreting guidance and keeping residents’ wellbeing in mind remains a challenge for care providers.

Rightful restrictions?

Since Government published its updated guidance on care home visiting in August, residents have been able to enjoy much-needed relief from certain restrictions, such as unlimited ‘named visitors’ who can now visit as many times as they would like to on a single day. Residents can also benefit from nominating an essential caregiver. These people can attend care homes to support residents practically, emotionally or mentally and may be known personally to residents, providing further reassurance. However, parity with the rest of the population is yet to be seen, as residents and their named visitors are advised to keep physical contact to a minimum and maintain strict infection control measures, such as wearing PPE.

Furthermore, non-named visitors will have to conduct social contact outdoors, in a pod or behind a screen.
Given that, as of July, 93.5% of residents in older adult care homes have received both doses of a COVID-19 vaccine, championed as the strongest form of protection against COVID-19, and that people over 50 will be offered a booster jab, it is difficult not to question why such limitations remain in place for residents in care homes seemingly uniquely.

Open to interpretation

The language of Government’s latest COVID-19 guidance for residential care homes encourages providers to take the initiative and form their own policies for visiting and other everyday activities. As a result, there is plenty of room for interpretation and residents and their families may have different experiences from home to home. Whilst we all wish for a swift return to life before lockdown for all care home residents, providers may, for example, consider the collective needs of their residents first and be wary of the possibility of further breakouts in the event of restrictions easing too much, too soon.

Despite this, it remains crucially important that care providers create individual risk assessments based on the rights and needs of individual residents. Residents, their families and friends must also be involved in decision-making, along with other relevant professionals if necessary. This balancing act places pressure on already stretched care providers to make decisions based on input from multiple fronts – that being the welfare of residents who may be growing tired of restrictions, the frustrations from friends and families who may argue that their loved ones are being left behind on the road out of lockdown and Government which, at this time, is not lifting the limits for residents.
There has also been questions raised about the fairness of the continued requirement for care home residents to isolate in their rooms for 14 days following an admission for emergency hospital care, regardless of vaccination status. As well as the detrimental impact on the individual’s wellbeing, it is recommended that all other residents in the home should also isolate under these circumstances. Campaigners argue that this blanket approach to isolation risks jeopardising the delivery of person-centered care.

Unique challenges call for a cautious approach

The happiness, health and wellbeing of our residents is our primary concern, so we will continue to follow guidance around keeping residents and colleagues safe.

Our colleagues have done and continue to do a fantastic job caring for some of society’s most vulnerable people, while supporting each other, residents’ families and their own families throughout the pandemic.
I’m proud to say that we’ve managed to keep life as normal as possible for residents, using innovative ways to enable people to stay connected to the people who are important to them, as well as using technology to keep families in touch with one another and our homes connected to each other with virtual competitions and events.

Last year, we launched our Summer of Sport campaign, where our residents took part in fun sporting activities, complete with medals and opening and closing ceremonies, in homage to the Olympic Games. This year, we launched Anchor’s Get Set, Cycle campaign, which saw residents in all of Anchor’s 114 care homes virtually travelling the length of Britain via Memoride machines, ensuring that our residents are physically and mentally active.

While restrictions have been lifted for the general public, the unique challenges faced by the care sector call for a more cautious approach and we continue to follow guidance around visiting, lateral flow tests for visitors on arrival and continued use of PPE to ensure the health, safety and wellbeing of our residents and colleagues.

In the short term, the current COVID-19 policies in care homes are prudent given the onset of winter, flu season and the need for our residents to have a COVID-19 booster jab to ensure they have maximum immunity against the virus. Even with these uncertainties, we shall continue to keep our residents safe and happy. We have plenty of fun activities planned with our upcoming Christmas celebrations. Watch this space for some more wonderful winter-themed activities from our residents!

We’re confident that restrictions can and should be safely eased in due course. In the meantime, we will continue to act swiftly to implement these welcome changes safely and effectively and maintain our drive to provide high-quality care for our residents.

Cath Holmes, Director of Care Quality, Anchor

It’s time to make life worth living again

Of course, care homes must now ease restrictions for people in residential care. The R&RA Helpline hears daily from families desperately worried about the deterioration of their parents, partners or siblings. They feel blocked at every turn trying to gain meaningful visits to support them.

According to Government guidance, each resident is supposed to have access to ‘one essential caregiver’. But even this concession can be denied to residents. A confusing barrage of differing advice from all sides bedevils care homes, including from public health departments, the Department of Health and Social Care (DHSC), the Care Quality Commission (CQC) and adult social care departments. As a result, overly restrictive and risk-averse practices ride roughshod over human rights and other legal protections. Closed cultures and institutional practices have taken root in many care homes. These inhumane restrictions ignore people’s basic needs for familial contact and relationships. Instead, relatives are perceived as potential sources of infection, which seemingly justifies seeing families and friends as superfluous, regardless of the resident’s wellbeing.

Consequently, many care home residents have become withdrawn, depressed, unresponsive or simply given up due to excessive controls. This can mean 20-minute supervised, fortnightly visits, with PPE but without touching and in a strange room.

In the last 18 months, relatives have witnessed new residents being placed in isolation, older residents deteriorating quickly, often unable to communicate or comprehend due to dementia and sensory disabilities. All taking place with minimal or no contact with their families.

At the same time, staff shortages and an over reliance on agency staff have taken their toll on the quality of care. We can and must protect our most vulnerable without imprisoning them, especially with access to tests, vaccinations and PPE – the very same that care workers use to protect them.

We need relatives to be seen as essential to the wellbeing of residents and staff and as intrinsic to residents’ lives, to prevent these closed cultures from becoming the norm. We need commissioners and regulators to put residents’ needs and wellbeing at the top of their agendas if we are to make life in care homes worth living again.

Judy Downey, Chair, The Relatives & Residents Association

About Cath Holmes

Cath Holmes joined Anchor in 2011, following a career in business development and has a proven track record of helping organisations to improve their performance. As Director of Care Quality, she cont…

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inues that focus and leads Anchor’s internal inspection, service improvement, dementia specialist and care quality teams to ensure residents receive the best possible support. Cath is a member of th e Development Board for My Home Life England, supporting the sharing of best practice and expertise across the care sector.

About Judy Downey

Judy Downey studied at LSE, has worked in social services and as a probation officer. She has worked in political and academic research. She then moved to the Civil Service, where she worked as an ins…

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pector and had policy responsibility on several topics. These topics included developing the first statutory complaints procedures for social services and the creation of the first national regulator. She is also the former governing body chair of a deaf children’s school.

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