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What happened in care?

Monday 16 November 2020


An overwhelmed care sector wasn’t able to protect the most elderly and vulnerable people in society. The UN has called the number of covid care home deaths across Europe “an unimaginable tragedy”.

In the UK, care home residents accounted for more than half of all Covid-related deaths in the first wave of the pandemic. Why? What happened?


What we know


Ethnicity as a risk factor

People from Black and minority ethnic backgrounds in residential care were at even higher risk of dying from the virus than non-BME residents.

On 17 June, the Care Quality Commission found that 54 per cent of deaths among Black people and 49 per cent of deaths among Asian people were related to Covid in residential care homes, compared with 44 per cent of deaths of White people and 41 per cent for mixed or multi-ethnic groups.

“It is clear that urgent action is needed to fully understand the impact of COVID-19 on people from BME backgrounds in adult social care settings.”

Kate Terroni, Chief Inspector of Adult Social Care at the Care Quality Commission (CQC)


Outbreaks by region

Risk of death in a care home was also dependent on locality. On 4 June the CQC reported that the North East and other northern areas had some of the highest number infection rates in care homes, a trend that would continue through the summer.

“There is an epidemic going on in care homes, which is something I bitterly regret.”

Boris Johnson, House of Commons, May 6th 2020


What went wrong?

Hospital discharges

  • The Department for Health and Social Care (DHSC) authorised mass discharges from hospital into care homes of patients infected or possibly infected with Covid, according to an Amnesty International report released on 4 October. The department also advised that “negative tests are not required prior to transfers / admissions into the care home”.
  • Between 17 March and 15 April around 25,000 people were discharged from hospitals into care homes, 10,000 fewer than for the same period in 2019, according to a National Audit Office report issued on 12 June. It is not known how many had Covid at the point of discharge, but a factor behind the lower number may have been fewer hospital admissions.

PPE

  • Official advice to care homes was that “no personal protective equipment (PPE) is required if the worker and the resident are not symptomatic,” according to the Amnesty International report
  • The report also accused the government of “a failure to ensure adequate provisions of PPE to care homes”; imposing blanket Do Not Attempt Resuscitation (DNAR) orders on residents of many care homes; and restricting residents’ access to hospital.
  • Between 20 March and 9 May, central PPE stocks distributed to social care settings accounted for 15 per cent or less of the overall modelled requirement for any item of PPE, apart from face masks.
  • DHSC guidance on 13 March advised that when caring for “residents with symptoms”, staff should use PPE for activities with “close personal contact” including “washing and bathing, personal hygiene and contact with bodily fluids”. However, the guidance did not urge the use of PPE where residents were not showing symptoms.
  • A study by the University of Kent in partnership with the Wellcome Trust found an overwhelming majority of survey respondents reported a lack of PPE. One care worker stated: “No communication, no PPE, no respect”
  • Personal Protective Equipment Regulations 1992, Regulation 4, state that “All workers have a right to suitable PPE because every employer must ensure PPE is provided to employees who may be exposed to a risk to their health and safety while at work, unless the risk is adequately controlled by other means which are equally or more effective.”

Testing

  • The DHSC failed to ensure regular testing of care home workers or residents, according to the Amnesty International report.
  • On 11 May, the DHSC announced that more than 45,000 residents had been tested by Health Protection Teams and 140,000 test kits had been sent to 4,387 care homes, but there are around 411,000 residents in care homes in England alone.

The Amnesty report also said the DHSC imposed blanket Do Not Attempt Resuscitation (DNAR) orders on residents of many care homes, and restricted residents’ access to hospital.


Dementia and Alzheimers

The impact of coronavirus on those who suffer with dementia and alzheimers was also felt across the country.

Research from Alzheimer’s Society found that:

  • At the peak of the pandemic the number of people who died from dementia was double the five year average.
  • 77 per cent of people with dementia also have at least one other specific health condition like hypertension, diabetes and depression.
  • There is evidence to suggest that dementia itself may itself be a risk factor for Covid and death when age and other conditions are taken into account, but further research is needed to fully establish this.
  • Nearly eight in 10 of the 128 care home managers contacted for the research said lack of social contact was causing a deterioration in the health and wellbeing of residents with dementia.

“Tragically, the effects of the pandemic go beyond this terrible death toll. I have seen and heard the devastating impact of social isolation for people with dementia”

Kate Lee Chief Executive, Alzheimer’s Society


Not just the residents 

One in ten care workers said they were aware of colleagues who continued working despite having Covid-19 symptoms, according to Unison. This increased residents’ risk of infection. A Vivaldi Care Home study of the impact of coronavirus on care homes in England found that for each additional member of infected staff working at a care home, the odds of infection for residents increased by 11 per cent.


Carol Jamabo

On 6 April the first two deaths of care workers in England from Covid were reported: Carol Jamabo and an unnamed care worker, both employed in the northwest of England.

Jamabo worked as a carer in the community for Cherish Elderly Care in Bury but fell ill with COVID-19 a week before her death. Her condition deteriorated rapidly and she was transferred to an intensive care unit and put on a ventilator at Salford Royal Hospital but could not be saved.

“Words cannot describe the damaging and destructive impact her passing will have to her work colleagues, friends, family and most painfully, her two children,” her nephew, Dakuro Fiberesima, said on a GoFundMe page to fund Carol’s funeral.


Government messaging 

“Earlier this year, and until 12 March, the government’s own official advice was, and I’m quoting from it, ‘it remains very unlikely that people receiving care in a care home will become infected.’”

Keir Starmer, 13 May 2020

“It wasn’t true that the advice said that.”

Boris Johnson, 13 May 2020

Government guidance published on 25 February twice stated that it was “very unlikely” people receiving care in care homes or the community would be infected with the new coronavirus. This advice was withdrawn on 13 March, and replaced with new guidance about what to do in the event of an outbreak at a care home or other supported living. FullFact