FEW PEOPLE have reason to linger in care homes. Fewer still have the energy or will to think about them in the round after dealing with the guilt-ridden and traumatic experience of visiting a relative who no longer recognises you. The exorbitant cost of staying in a care home devours expected inheritances, and adds to the secret wish of many that Gran would slip away sooner rather than later.
About ten years ago I spent some time in a couple of care homes as a PR consultant and friend of the owner, where I was undistracted by any personal relationship to a resident. Previously I had barely registered the existence of the expanded Victorian villas on the edges of towns where, I assumed, old people without families whiled away their time as if in faded seaside hotels.
The care homes I visited, were, I am sure, above average; their owner was genuinely concerned to make them nice, not just to deliver a tidy profit, and some of the staff were outstandingly caring, although necessarily very efficient. But the best efforts of staff and owner could not make up for the fact that many of the residents had no one, or at least no one who visited regularly, and had ended up in the home to wait out the end of their life.
Most residents in care homes are not merely old but suffering from advanced dementia, so they cannot safely live at home even with multiple daily visits from carers and family members. They are in varying states of mental and physical decay, and in varying states of awareness about their inexorable decline. Their routine consists of getting up, taking medicines, eating meals, and going to bed, punctuated by the odd organised activity. The rest of the time is passed by sitting around staring at television screens. Occasionally staff sing and light candles on a cake if it’s a resident’s birthday.
In response to the growing numbers with advanced dementia, many care homes have segued into partial or full nursing homes. There, residents may never leave their beds. As I was leaving one of my friend’s care homes one evening, I glimpsed a woman in a medical bed, a still tall figure prostrate beneath the covers like the carving on a medieval tomb. She was clutching a stuffed toy cat to her chest, quietly stroking it, otherwise impervious. Most care home residents are women; she had been a wife and mother. Her husband had predeceased her, and her children didn’t visit. They were elsewhere, wrapped up in their own lives. The image has stayed with me, recalling both an infant who comforts herself with a fluffy toy and a prone Pietà. It encapsulated the lonely end which awaits many women who have given their lives to caring for others.
I am not surprised that we are now facing a situation where we have allowed Covid to rage in our care homes, effectively turning them into death traps. For decades, many of us have used care homes to dispose of our decrepit elderly. Out of sight is out of mind. Despite railing about its cost, we have done it on the cheap; it’s no coincidence that just as the majority of residents are female, so too are the majority of carers on poverty-level wages. Decent, properly funded social care is a hot potato which every party has been able to avoid.
Yet I am surprised that there is still so little outrage at the reaction of our leaders.
Politicians obfuscate. They claim there is “appropriate” PPE. They change the definition of “appropriate” according to political expediency - i.e. the type and amount of PPE they have a hope of supplying.
They refuse to give out information. We are still not being given timely statistics about deaths, infections, PPE availability and stocks, infection control procedures and testing in local care homes. This is why individual homes have made the headlines when unhappy owners, disgruntled staff or relatives have blown the whistle.
They make excuses for not putting out this information. They hide behind data protection, or blame problems with data collection and reporting because there are thousands of care homes. But the authorities must know much more than they are letting on publicly about deaths, infections, PPE stocks and tests carried out in care homes, because what else are they basing their policies on? They certainly have direct access to all this information about local authority care homes.
They blame others. The Scottish First Minister Nicola Sturgeon has stressed that many care homes are the responsibility of private providers, as if to suggest they are not subject to regulators or the government’s emergency coronavirus legislation, or the vagaries of the market for PPE, or government organisation for testing. Yet all care homes are supposedly stringently regulated, and almost all depend on local authorities for fees, so it is absurd that in a national health emergency private care homes are not being required to submit information on all these matters. Sturgeon has also reminded people at her daily briefing that care homes are filled with elderly people with pre-existing health conditions, whom we can expect to die anyway.
They play with science. On 15 April Nicola Sturgeon defended not following suit after England said it would test all new care residents, on the grounds that false negative results could offer “false reassurance”. Eventually, a week later on 21 April, the Health Secretary Jeane Freeman said all new residents would be tested; they make U-turns, but never admit they were wrong.
They present intentions and ambitions as faits accomplis.
The real error was to empty our hospitals of the elderly, without any testing or isolation procedures. At the beginning of the lockdown 300 were discharged willy-nilly to care homes, and still more were sent home with carers even less well-equipped with PPE than care home staff. The journalist Chris Musson has reported that people testing positive “were also placed in care homes with knowledge of authorities, according to industry body Scottish Care and unions”. This arguably criminal action has yet to be addressed by any politician.
In the week ending Sunday, 26 April, the total number of care home fatalities in Scotland jumped from 537 to 886, accounting for 52 per cent of the total Covid-19 deaths.
Last week Professor Hugh Pennington told a Holyrood committee that based on the number of cases in care homes, the reproduction rate for Covid-19 “even in the best run care homes” will be “probably higher than 10”. He added: “The virus is really going on the rampage in care homes … It’s out of control. These are people who are absolutely at the top of the pyramid who need protection. Residents in care homes are the most vulnerable in the population by definition.”
On May 1st the First Minister acknowledged that “around 40 per cent” of care homes have coronavirus cases and announced “enhanced outbreak investigation in all care homes where there are any cases of COVID - this will involve testing, subject to individuals’ consent, all residents and staff, whether or not they have symptoms” as well as testing in linked homes and sampling testing in care homes where there are no cases. She warned “it was a significant expansion and we do not underestimate the logistical and workforce requirements, but promised “now we have the increasing testing capacity, we will make it happen as swiftly as practicable”.
Ever since care home deaths have become a public issue, the First Minister has been full of assurances that those in care homes are not “second-class citizens”, that “every life matters”. The most amazing thing is the number of people who have taken her at her word.
Linda Holt is an independent Councillor for East Neuk & Landward