A new study from the University of Glasgow is revealing some of the “horrendous” impact felt by those working in care homes throughout the COVID-19 pandemic – with researchers and Scottish Care urging decisionmakers to learn from its findings.

The study has revealed a sense of abandonment and hopelessness for some staff, living in fear that “we are all going to die here”, while feeling unable to take a day off.

Dr Jenni Burton, Clinical Lecturer and Specialist Registrar in Geriatric Medicine, who led the research, says the study reveals fundamental changes to care homes amidst the national pandemic response.

She says the research sought to learn directly from those at the forefront of caring for Scotland’s care home residents and address a gap in the wider understanding of pandemic experiences in care homes.

While care home staff responded to the uncertainty with adaptation, the study also details increased pressure and external approaches to regulation and oversight created tension.

Dr Burton says that, despite challenges, care home staff talked of compassion shown by teams:

“There are many unheard stories from the COVID-19 pandemic in Scotland, particularly from those working and living in care homes.

“Care homes are complex and diverse care environments, and professionals working in the sector have expertise which was under-valued and under-utilised during the pandemic.”

Dr Burton adds that listening to individual care home workers’ experiences, whose insights are “vital”, can improve future practice and enhance care and support, in the care home and the wider health and social care system.

Some participants shared positive experiences of connecting services, but others explained that a lack of communication around changes expected ahead of inspection visits was unhelpful.

All this change, the study found, led to psychological impacts on staff.

Staff saw a detrimental impact on mood, behaviour and cognition from prolonged isolation for residents, which combined with working significantly more hours, impacted their own mental health.

Participants highlighted the challenges of working to new and changing rules, including increased responsibilities and reporting.

One manager and nurse reflected on working from the “minute we got up in the morning till the minute we went to bed”, with no days off for six weeks: “… it was pretty horrendous.”

While there was no singular experience of COVID outbreaks within care homes, the study identified common themes through interviews with staff.

Care home staff spoke of loss, sadness and a sense of abandonment from the personal and physical demands of working in a care home throughout COVID.

The sense of abandonment was especially heightened among those working in homes experiencing significant COVID outbreaks.

“We were just really let down at the time. The way I feel is like I felt everybody’s life was in my hands”, said one deputy manager and nurse in an older adult home.

Another shared the mental health impact of the risk for staff of becoming ill with COVID-19 combined with the powerlessness of being unable to prevent residents’ deterioration and the impact of loss:

“…one of my nurses thought she was going to die. She was, you know, standing in front of a very poorly man and her words to me were, I was standing here thinking, we’re all going to die here.

“It still upsets me to this day because it’s, like, how frightened must she have been and never took a day off. Never…you know, came in, they came in on days off, everything.”

Undervalued and overlooked

Deputy CEO of the independent provider’s body Scottish Care, Karen Hedge, told healthandcare.scot that she hopes to see the study’s insights incorporated into future practice:

“The impact of the COVID pandemic has lasting consequences for all of us which will require critical reflection in how we move forward and learn lessons for the future.

“This research by Dr Jenni Burton is a welcome spotlight on the experience and dedication of those working in care homes which has been a missing yet critical part of that story.

“This feeling of absence of voice is clearly echoed in the research; that for too long, care workers have felt undervalued and overlooked by our decisionmakers.

“Scottish Care hopes that the findings in this report will be taken on board by policymakers and politicians, for them to recognise, and respect the unique and complex skillset of social care workers and include their expertise in future transformation and preparedness programmes such as the NCS and winter planning.”

 Hostility and emerging inequalities

Several staff reported that their efforts to access specialist care were ‘met with hostility and refusal to attend’ from a range of practitioners.

Staff said they expended time and emotional energy advocating for residents’ health, with one saying:

“But I just feel as if I was advocating for the residents, and I was fighting with the GP surgery probably on a daily basis to get people to come and see the residents. And you just think, do you know what, we’re all in this boat together but it was very much…it became them and us very, very quickly.”

However, this contrasted with those who shared experiences of continuous support form their primary or community care times, including care for residents in an outbreak.

Investigating deaths

Some participants described the difficulties brought from visits by professionals or inspection teams. One recounted:

“And one point the consultant…we were talking about infection control, and I said, well, you know, we absolutely did our best with infection control measures, and he went yeah, but your residents died.”

Care home workers described the ‘profound emotional impacts’ of being judged as being at fault for residents’ deaths, with the ongoing Crown Office (COPFS) Investigation being raised as a particular source of psychological distress.

Scottish Care’s Deputy CEO told us that the sense of blame brought about by this investigation only adds to staff distress:

“It is worthy of note that there is little closure for those working in care homes whilst the COPFS investigation into COVID-19 deaths in care homes prior to December 2020 is still underway.

“Over 3 years since this work was initiated, care staff are being interviewed for hours on end with no end date to this process.

“For many, this lack of closure is adding to distress, compounded by a sense of blame that an investigation process exploring response to the virus conveys, despite sitting in contrast to the unwavering commitment to providing quality care under unprecedented circumstances that this study showcases.”

Ms Hedge says implementing the learnings from this work will require a collaborative approach, working with those in the sector, adding:

“There must also be key consideration of ongoing support for those staff affected which goes beyond the listening service offered as part of the public inquiry, to a more longer-term integrated and preventative wellbeing approach. 

“The tireless efforts displayed by staff throughout the COVID-19 pandemic is commendable and deserves recognition.”

Read more: Carers at a health and poverty tipping point; Third sector services ‘stretched to the limit'; Doctors ‘deeply concerned' for care homes over winter; Pain assessments meet AI in Scotland's care homes

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