Laing & Buisson’s seminars have been illuminating in explaining some of the many care home challenges they are facing during the pandemic.
Keeping up with the advice changes, feeling unprotected without equipment and living with high levels of risk has made care homes vulnerable and exposed. Being without the NHS ‘ring of immunity’ with promised funding bound by complexity has added to stress. Money furred up in arteries of bureaucracy in local government created delays or not reaching care homes at all in some cases when speed was of the essence for infection control.
Many staff are sick or isolating, destabilising, and reducing the team affecting the resident’s experience of continuity and familiarity. Some have had little GP support. The ethical challenges around decision-making has taken its toll. So many homes have done so well despite this, for example some larger Groups set up call centres for staff with regular updates, helping with difficult ethical decisions, bereavement support and so many other extraordinary examples.
The NCF highlighted the need to raise early ‘data flags’ and share earlier. Commissioners, regulators, and providers need to share information faster to understand what is going on.
CQC is requiring same standards and quality although there are no planned . Shock waves of CQC decisions would be very unwelcome with vulnerable providers. Trust is needed between regulator and providers with transparency needed for learning across all parties. The importance of regulators taking a supportive role in these times was stressed, as they can make and break organisations . ADASS data shows only 4% of providers can meet regulatory requirements due to Covid-19 additional costs and loss of planned income.
Concern over finances and worry down the line about legal challenges as the system is not designed to deal with pandemics. Furthermore, there is a lack of insurance market consistency, increased costs , PPI and PPE claims and liabilities for employees. These include staff working with symptoms as carriers , reduced staffing , fatigue errors , missing health needs and missing triggers, agency staff who do not know residents all compound and together have created huge vulnerability.
Blanket policies have had detrimental impact on making all citizens feel they count . The balance of Embedding rights, visiting and connection has been challenging as the medical overshadows other human needs for continuity, relationship, and meaningful connection. Challenging situations for distressed residents and families, increased deaths and under reporting of these has made care homes feel like second class citizens.
The CEO of Four Seasons, Jeremy Richardson challenged Local authorities, health, and safety regulation and how all of this needs to simplify -bureaucracy builds itself to show impact the more involved. There is a need to simplify the management of the sector as everyone needs to be aligned. Too much risk aversion focusing on the risk of getting it wrong outweighs benefit of innovation.
People must feel inspired to make change in a safe way. They are unable to do this now. This would allow more time with the resident which is what is fundamental to a good resident and staff experience, and surely pivotal to sustainable business. If this happens again normal rules of engagement must be suspended. Let’s hope learning from mistakes and as stated in a recent ADASS budget survey care market reform, investment and closer alignment of primary community integrated services and society is needed to build the sector up again for 30 years. Older people are at most risk at the end of their lives and doing nothing is not an option for sector viability.