The past year has been one of the most difficult in generations. The challenges that the care sector has faced have been unprecedented. The relentless pressures have taken their toll on staff and managers, many of whom have faced burn out, mental health issues and the distress of losing care users and colleagues.
For people relying on care services, their homes suddenly became very different places, particularly those living in care settings who have faced over a year of visiting restrictions.
The impact of the isolation on both mental and physical health has been stark. For the relatives and friends trying to connect from the outside, feelings of anxiety, frustration and helplessness increased as they witnessed the deterioration through the window or video screen.
Over the past year, the R&RA Helpline has been supporting older people at the sharp end of coronavirus and the measures taken to manage it. We have heard about older people who fear they have been abandoned, who are losing weight, losing speech and too many who have given up on life. This is why R&RA started our campaign to End Isolation In Care back in September, calling for people to be safely reconnected with their family/friends. We have seen some progress. Recent first steps to reopen care homes are very welcome and are having a beneficial impact on the wellbeing of older people. However, our helpline continues to hear that not all care homes are complying with the visiting guidance in full, or applying blanket approaches such as strict time limits on access. What is of particular concern is the limited availability of the essential caregiver role. For residents who need close contact with relatives/friends, including help with personal care or emotional wellbeing, it is vital that access to essential caregivers is rolled out across all care homes. We have published some FAQs to support care homes to facilitate this.
As we emerge from lockdown it is crucial that older people needing care don’t get left behind and that we end isolation for all. This means not only reconnecting people with their family and friends inside and outside their home, but also ensuring face-to-face contact with GPs, social workers, district nurses, dentists, mental health teams, CQC inspectors and the whole host of professionals who help ensure older people’s rights are protected. It means access to other types of visitors who help create an engaging, stimulating environment, particularly important for older people without any family or friends to visit. It means ensuring open cultures where care users and the relatives/friends they want to support them are encouraged to participate in discussions and decisions about their care.
All too often the issues and problems with care we hear via our helpline have been caused by poor communication or a closed culture. When relatives call care staff for an update on their loved one and are just told ‘they’re fine’, it offers little reassurance when older people often have complex care needs. When family advocates – even those with Power of Attorney – are denied access to care meetings or care plans, it increases anxiety and concern, particularly at a time when they haven’t been able to be on hand to support with everyday wellbeing. Sadly, our helpline hears that relationships between many families and care homes have broken down during the pandemic. Where there are bridges that need rebuilding, good communication is the crucial place to start.
Conversely, the care providers that have communicated well and operated with an open, transparent culture have maintained good relationships with families. The providers that have welcomed back family carers not only report increases in care users’ wellbeing but also improvements in staff morale.
With occupancy levels in care homes down, the sector as a whole also faces the wider task of rebuilding trust in services. Homes promoting their policy and practice on visiting is a key starting point. When families come to our helpline for support getting access to care services, questions about a care home’s visiting practice are often top of their list. Families are looking for homes to demonstrate that they are supporting residents’ wellbeing by fully complying with the Government guidance on visiting. They are seeking reassurance that the home has an open, inclusive culture where support from family/friends will be seen as a central part of the residents’ care.
A very real worry coming through our helpline is that a lasting legacy of the past year will not be the virus itself but the continuation of closed cultures in some care settings, at the expense of the needs and rights of care users. Yet, this is a change that doesn’t need to wait for new guidance or roll-out of a roadmap. An open, inclusive culture is completely in the hands of the manager and staff.