The aim of the Re-COV research project is to better understand the experiences of retirement villages and extra care housing during the pandemic, including the effectiveness of measures taken to protect the health and well-being of residents and staff.
History and narratives are often rewritten by politicians, and we’ve already seen this happening in terms of the conversation around care homes. It was important for us to put a red flag in the sand to say: ‘this was the reality faced by the sector’, `this is how we reacted’ and `this is how we compared to the general population’. We had to move away from subjective case studies to quantitative data, which was essential for us in order to share information, learn lessons and help plan for future pandemics.
Evidence of safety
The main findings of the Re-COV study, which was funded by the Dunhill Medical Trust and supported by the Housing LIN, showed that 0.97% of retirement village and housing scheme residents died from confirmed COVID-19 from March to December 2020. This was less than the 1.09% of people with the same age profiles who died from COVID-19 living in the general population in England and residents of retirement village-only operators also had the lowest COVID-19 death rate of 0.51%.
The evidence from the research points to what we knew all along: that older people are safer and age better living within a retirement village than they do in the wider community. The Trust has seen an unprecedented level of demand for its accommodation following the second wave of coronavirus. Our sales team have heard lots of anecdotal evidence from people living within the general population, who have realised how isolated they were and how little support they could draw on when compared with friends who were living in retirement villages.
Older people living among the general population didn’t have the level of support that we were able to deliver for our residents living within our environments. The control measures that we put in place meant that there were fewer infections and our residents were able to isolate safely within our communities, due to the services we could provide for them.
Designing a lifestyle
In terms of the future design of retirement villages, there’s a real danger that this and future pandemics may cause the sector to revert to designs that lock the community out. Our most recent development, The Chocolate Quarter in Keynsham, combines retirement living with a range of facilities which are open to the public and, uniquely, office space for local businesses, such as Pukka Herbs and IVC, plus a GP surgery. The Chocolate Quarter was designed by the people who use our services and its success lies in encouraging all the different generations to interact together and promoting mutually beneficial relationships with the wider community. Yet in our response to the pandemic, we still found that we were able to lock down The Chocolate Quarter and protect its residents and staff as successfully as we were our more traditional, ‘gated’ communities.
Our customers and residents have told us that they don’t want to live in gated communities. We need to ensure that new developments are designed around the principle of living well with COVID-19 and the best way to do that is through open and integrated communities.
Moving forward, we need to have more retirement villages being built in this country. We’ve shown that in extreme circumstances, retirement villages keep people healthier and there needs to be real investment in terms of providing retirement villages and Housing with Care schemes.
A change in planning regulations is required and retirement villages need to be seen as fundamental to any new housing developments being built. A positive step would be to make developing retirement villages VAT exempt, particularly for not-for-profit organisations. We’re not funding our retirement villages through grants – we’re doing it through bank loans and VAT exemption for retirement village developers would aid us to do much more and help meet increasing demand.
I would also call on the Government to resolve the disparity between health and social care services and the NHS. We need to treat people in health and social care the same as NHS staff, in terms of being paid appropriately, having the same career opportunities and recognition for work they do. It can’t stop at clapping outside of front doors and the Health and Social Care Act is where we hope to see positive action from Government in resolving this. We’re now more than 18 months into the pandemic, with no clear end in sight, and people are shattered. There’s a huge amount of investment needed to allow staff in our sector to recover.
In terms of the Trust’s response to the pandemic, we operated from the principle of putting anything we needed in place to keep our residents and colleagues safe and there were times when we went beyond Government guidelines. Whatever measures we took also needed to be understood by our residents and colleagues and clear, open and honest communication was vitally important to achieve that.
Considering there are 100,000 people living in retirement communities in England, we were disappointed at the absence of clear Government guidance aimed at the sector. This was in marked contrast to the guidance issued for care homes. It felt as if the Housing with Care Sector was only being addressed as an after-thought. We found ourselves in the position of having to take the guidance for care homes and interpret it ourselves for our supported living environments.
The Trust was fortunate in that we had our own Quality Team and a dedicated Communications Team. That meant that we were able to monitor all the information available from trusted sources, implement them as part of our coronavirus response plan and communicate the details quickly and clearly to our residents, their families, St Monica Trust colleagues and customers.
We were also quick in terms of working in partnership with other providers and organisations at a local level to share information and resources. The National Care Forum (NCF) and The Associated Retirement Community Operators (ARCO) were also a great source of help in terms of giving us advanced warning of what guidelines were being released by the Government, so that the necessary preparatory work could be undertaken.
Working with our residents we took an early decision to lock down our retirement villages. We also went early with regards to making the wearing of face masks mandatory and put air sterilisation units in communal spaces. Our Catering Development Manager was quick to realise that pubs and restaurants closing meant that their suppliers would have excess food. Through his contacts, we were able to negotiate and source boxes of fresh food and meat for our residents at a time when there were shortages in supermarkets and people couldn’t get home deliveries. Free tablets and IT support were provided for residents to ensure that they were able to stay in contact with their friends and families. We also negotiated delivery slots with local supermarkets and placed orders for our residents, plus arranging pharmacy collections.
In the space of three weeks, we recruited and trained more than 150 temporary members of staff to undertake non-care duties that freed up our front-line staff and helped us cover staffing shortages caused by the pandemic. We provided our residents with PPE and when there was an outbreak, our executive team would go from door-to-door, advising them on the situation, reassuring them and seeing what assistance they required.
The Trust was in a privileged position with regards to the resources we were able to deploy against COVID-19. However, there are certain things that all providers can do to prepare for future emergency situations, no matter what their size or resources.
I would recommend ensuring that crisis planning is included in your organisation’s business continuity plan. Spending time on your pre-planning is vitally important and it should cover all eventualities, including locking down services and dealing with large-scale outbreaks. Establishing the correct communications structure to enable you to get out communications from your executive team to managers, to front-line colleagues and to residents and relatives quickly, is also vital in keeping people informed and on board with the decisions you take.
From a personal perspective, this has been the most challenging experience I’ve faced in my entire career in health and social care and, at the same time, also the most rewarding. I’ve always believed that the best of human nature will see us through the most difficult of times and, despite all the heartache and hardships, it’s been so heartening to see our sector unite behind the common goal of keeping one another safe.
The very real sense of community that has come out of our sector’s response to the pandemic – how people have worked so effectively in partnership and regularly gone above and beyond what is expected of them – has been a true privilege to witness and be a part of.
A full version and summary of the St Monica Trust’s Re-COV research study is available for download on the St Monica Trust website.