The staff in Scotland's care homes understand that looking after people during their last days is an important part of their role. But coronavirus means they will have to do this on a scale unlike anything ever before.

Concerns are growing that care homes are being left without the funding or equipment they need to deliver the care that residents deserve and the protection their staff require.  

Guidance published by the Scottish Government near the end of last month states residents with suspected or confirmed covid-19 in long term care settings should not be admitted to hospital.

Although a revision of this guidance is underway to make clear that if it is clinically appropriate, residents with suspected or confirmed covid-19 should be admitted, instances have already emerged of care home residents being turned away from A&E and out of hours services.

While the NHS looks to increase covid-19 bed capacity, care homes have also been told by government they must continue to take new residents from hospital – a move that might be understandable but one that shifts the burden of care of many elderly people to an already stretched social care sector dogged by problems with recruitment and retention, and low pay.

The first death of a care worker in Scotland after contracting coronavirus was announced earlier this week, and while more staff deaths in the coming weeks would be tragic, they are not unexpected.

Scottish Care has been among the organisations fighting to ensure that older people in care homes are not discriminated against as health service resources are stretched and consumed by the pandemic.

While fighting to ensure those who need it do get more acute care, Scottish Care chief Dr Donald Macaskill acknowledges that for the vast majority of very elderly people in care homes, the existence of co-morbidities means that for most the distress of physically having to be taken to hospital would potentially kill them.

Remaining in a care home will be the best option for many who contract coronavirus. But the question remains over whether the social care sector is equipped to deal with this.

“Routinely many care homes deliver excellent palliative care – that is in essence their business,” Dr Macaskill says. “…What makes this situation distinctive and unique is the sheer volume that people may have to – and many already are – deal with.

“We are facing a shortage of staff and even though staff might be supplemented by hours from volunteers and returnees, palliative care is a particular skill set.

“That is why we are pushing for testing to be really ramped up so that we can get workers back to work and get those skilled individuals on the front line as quickly as possible.”

On the provision of personal protective equipment, he adds: “Absolutely there is a disparity between the experience on the ground and what government has promised, and I have been very clear that what we are hearing from those on the ground is something that alarms me.”

Scottish Care has urged government to make use of the armed forces logistical expertise to ensure PPE supplies get to where it is needed throughout social care settings.

Derek Barron, director of care of Erskine care homes and veterans’ village, told healthandcare.scot that the current policy of care homes having to wait until they have a suspected or confirmed case before getting PPE was “completely nuts”.

Similarly, a Moray care home manager reported to healthandcare.scot they have spent thousands on protective kit for staff after calling the triage hotline and only receiving basic face masks four days later, and no additional visors, aprons or gloves.

A Highland GP has also spoken about a colleague who had resorted to using a bra as a face mask as he and his colleagues have had to make do with home-made PPE.

The National Records of Scotland is still catching up with the number of coronavirus deaths happening outside of hospitals. As the organisation comes to the end of a consolidation of virus deaths in the community, a significant rise in the number of fatalities that government reports is expected today – many are predicted to come from Scotland’s care homes.

Highly infectious and more dangerous among older and frailer populations, coronavirus is likely to hit our care homes especially hard. Combined with confusion over non-admittance to hospital, staff and residents are left with an incredibly stark situation.

The need for palliative care is and will continue to rise in the coming weeks and months, and it seems those on the front line may not be have all that they need to protect themselves and those in their care.

 

 

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