A major charity has questioned the ‘logic and rationale’ of larger care homes after analysis revealed the impact of covid-19 on people with dementia. 

Alzheimer Scotland said it would be “folly” to stick with increasing numbers of homes with more than 30 residents, which it said had developed due to “perceived cost effectiveness”.

A Scottish government report found dementia was the main pre-existing condition in deaths involving covid-19 with more than 2,000 excess deaths among people with dementia during 2020 ‘almost wholly attributed’ to the virus. Three quarters (73%) occurred in care homes.

The charity said: ‘These figures clearly indicate that large group living environments present the greatest risk of virus transmission for people with dementia.

‘If the only way for care homes to mitigate these risks is to lockdown and isolate people in their rooms, deny them access to their loved ones and any form of normal living, leaving their families in complete distress, then we must question whether this is in fact the right model as part of the debate moving forward.’

The main spike of deaths with covid-19 and dementia both listed on the death certificate was seen at the beginning of the initial wave of the pandemic in April 2020.

Responding to the report, Scottish Care said: ‘It states a reality which we have known about for some time, namely that the population most at risk from covid-19 are individuals with pre-existing and multiple comorbidities and those who are in the older age population.’

The care providers’ organisation said ‘the lack of prioritisation of care homes in the early stages of the pandemics’ contributed to the reported deaths but questions remain over the impact of hospital transfer to care homes, clinical guidance and lengthy isolation periods.

It added: “It is regretful that despite numerous requests from Scottish Care that bespoke and targeted independent academic work be undertaken to explore the experience of those with direct knowledge of what was happening in our care homes, especially, staff, residents, and their families, that such work has not to date been forthcoming or prioritised.

‘The raw scientific data offers a partial picture, listening to the stories of those who matter the most would tell us a whole lot more.’

Last year an internal assessment of the first part of the pandemic said there was a ‘lack of subject matter expertise on social care (in particular for care homes) among key decision-makers’.

A judge-led inquiry into the Scottish government’s response to the virus was announced in August last year.

The suitability of larger care homes has come under increasing scrutiny over the last two years, including being questioned by a former deputy chief nurse. A government report found care home size, rather than discharges from hospital, were a more accurate predictor of a home having an outbreak.

Critics say the existing funding model incentivises the development of larger care homes.

Alzheimer Scotland said: ‘The fact that so many people living in care homes were impacted must make us question the logic and rationale of this form of care for those most vulnerable people in our society. The large care home model with, in many cases, some thirty people or more living together and being cared for with a small team of committed care staff is borne out of delivering the best quality of care within an economy of scale.

‘In our view, now is the time to start discussions about a new approach. In a world where there might be further variants, new pandemics and the need for new methods of preventing transmission, it would be folly to maintain a model of large group living…We need to begin designing and building smaller personalised units, with built in facilities to maintain family contact and avoid complete lockdown during any further outbreaks.

‘We must have care environments which are not built on economies of scale but designed to tackle the rigours of a world learning to live with covid-19 in as safe, humane and caring way as possible.’

Read More: Insight: Social care seen as “lapdog” of NHS; Scots covid enquiry to examine care home deaths; Survey: unprecedented anxiety of older Scots;

 

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