LionRed
The author is based in the UK at the moment (ex-pat Kiwi) and travels the world as a consultant in developing countries working on business development. As a result, he is totally cynical about NGOs, the UN and WHO etc. He is regularly exposed to contact with governments and diplomatic agencies. He has regularly commuted to Myanmar and South East Asia over the past three years so is able to understand what China is up to in the world.
Mary was 84 years old and slipping in-between awareness and semi consciousness. She was suffering from long term dementia, gradually losing her ability to reason and understand. On a good day, she had fond memories of her long-ago times and would hum songs that meant something precious to her. On a bad day she was less than sentient and spent hours staring into the distance. The regional hospital that had taken her in after a tumble had been caring for her, but it was now in dire need of beds in the middle of the COVID–19 pandemic.
The ambulance came the next day to take Mary to a care home, which was 30 miles away. She didn’t understand what was happening and became more distressed and frightened as they tried to put her on a gurney for her transportation. Despite the best attempts of the nursing staff to comfort her, she became more disturbed and a sense of anxiety began to overwhelm her fragile mind.
On arrival at the home she was greeted by the nursing staff who began to go through the admittance procedures. In their eagerness to remove Mary from their beds the hospital had forgotten to load her paperwork onto the ambulance. Without her notes the home could not admit her. The hospital had also forgotten to send her medication with her, and the care home could not administer any drugs without reference to the current medication regime. Being aware of Mary’s distressed state the home agreed to admit her on condition that the notes and medication arrived the same day. This was done out of a sense of compassion for an elderly woman who was already in a distressed state.
The missing documentation and notes duly arrived – by taxi. A 60-mile round trip just adding unnecessary costs to the transfer. Thankfully, after the administration of her medication Mary became less anxious and settled down into a state of relative comfort, although she had no awareness of her location. Her relatives arrived that evening, but she was still bewildered. Thankfully she is as far as I know settling in as well as her condition will allow her.
On examining the notes, the home was grateful to see that there were no ominous acronyms – DNR was absent. This is being used by more hospitals now to ensure that their beds are freed up for Covid patients. They use DNR to mean Do Not Resuscitate and Do Not Return. As far as many hospitals are concerned Mary and others like her are now out of their hands and left to the best devices of the care homes to care for her until the end of life. Will this have been accelerated by her treatment? Who knows?
What is worrying is that she had not been tested for COVID-19, neither antigen nor antibody so that the care home did not know what isolation protocol to use. As far as the hospital was concerned, she was no longer their responsibility and the fact that she may infect a whole home was of no concern to them.
I do not use this illustration to blame staff, but to highlight the pressures under which they operate. With the best will in the world, when people are working 12-hour shifts under stressful conditions, accidents will happen. Add to that management who are gradually losing sight of the humanitarian needs and are focusing on numbers, bed availability and a recovery assessment for each patient then decisions will be made in haste. They are making decisions but are under all kinds of pressure when making them. They are prioritising COVID-19 cases over the aged.
I have used the case of Mary (not her real name) to show the human face of what is happening, and not to blame the hard-working staff in hospitals and care homes who are doing their best under trying conditions. I am rather trying to put a human face on what I am going to narrate.
The situation in care homes is a desperate one and has been under reported, but facts are gradually coming to light.
Until last week, deaths in care homes from COVID-19 weren’t included in the national total and went unreported. The national total was only reporting deaths in hospitals. Today, the National Care Forum released the results of a survey which showed in the week ending April 7th 299 residents from 47 care homes died as a result of COVID-19. Extrapolating this throughout the care home population of 400,000 it suggests that about 2,500 residents died from COVID-19 during that week. In Scotland, 25% of all deaths from COVID-19 took place in care homes.
These figures are thought to have been affected by a lack of PPE. There is a national shortage and a delivery of 400,000 gowns due today from Turkey has been delayed. This is destined for the NHS. Care homes are generally operated by people in the private sector and they cannot take advantage of the NHS purchasing system for PPE so are having to compete on the open market. This results in higher prices and means they could be competing with the NHS for the same goods.
Earlier this week Health Secretary Matt Hancock announced vital tests for anyone in the social care sector who needed one ‘immediately’. Elderly residents can get tested in the care homes in which they live, but staff members must travel to a regional testing centre. In one case staff have to make a 250-mile round trip to get tested whilst the residents in their care can get tested in the care home. To add insult to injury, NHS employees can get tested locally by the relevant NHS trust for which they work. Care home workers are amongst the lowest-paid workers in the country. How can they afford to travel 250 miles return for a test when many do not own cars?
The email confirming the test centre came from the Care Quality Commission and said that as per government guidelines staff were not permitted to go by public transport to the test centre but must drive or be driven by a member of the same household. They were not allowed to travel in a minibus provided by the care homes as that would not comply with the social distancing regulations.
And Public Health England said there were 3,084 care homes with Covid-19 outbreaks in England, as of April 15.
In a poll of 2,800 care home owners, managers and staff, 28 per cent said they were looking after residents who had tested positive for the disease.
Matt Hancock, Health Secretary said that he was instructing the CQC to report on deaths in care homes, and in typical government, fashion said that the data would be available shortly. What a wonderful display of urgency.
The care home situation is developing into a national scandal with poor supplies of PPE, inadequate testing and dumping of patients on them from the hospitals. Expect to see an explosion in the numbers of deaths in care homes from COVID-19 in the next few weeks. This will happen if there is a change of policy in the providing of death certificates. At the moment if a person dies in a care home from an illness eg pneumonia, brought on by COVID-19 then that, not COVID-19 is recorded as the cause of death. The treatment of the elderly by the “system” is tantamount to an informal cull, or if you prefer triage brought on by economic allocation of scarce resources.
If I was to make a prediction, it is that the care home situation will get worse and the appropriate bodies and agencies will be buck passing and ducking for cover. I dread to see what will happen. And Mary? Hopefully she is being lovingly cared for until she experiences a normal, peaceful death from old age.
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