Discharged into a care or nursing home? If your relative is about to be discharged from hospital to a care or nursing home or other care facility or is already residing in such a care setting then read on…
Front page headline, Daily Telegraph 18/09/20: “Hospitals told to clear beds for Covid spike in two weeks” included the following:
“Hospitals and councils have been told to find extra beds for coronavirus patients within two weeks at the NHS braces for a second spike in cases. With a steep rise in infections, isolation units are being set up where Covid patients can recover, with ward space freed up for those who need more care.”
“At the start of lockdown they were having to send people back to care homes or back to other facilities, with dire consequence, so they booked places in respite care or empty care homes, so people will go out of hospital, but won’t return to their normal place of living.”
“Everyone has learned that you cannot discharge people into care homes if there is any danger whatsoever they might be Covid-positive, so there is a big effort to find extra beds. Brent [Council] rented an entire care home… I think other places will be doing that as part of their efforts to get ready for a second spike”.
“Channel 4 News said last night that care-home providers in Greater Manchester were being told they must accept Covid-positive patients from hospitals. A leaked contract from Trafford Council outlines how eligible care homes will receive Covid-positive patients within just hours of the patient being identified by the hospital as ready for discharge. It states that: “Some of these patients may have Covid-19.”
These are worrying times indeed and the next few weeks are crucial if care homes are required to accept Covid-positive patients.
Although this article was written just over two weeks ago, we have now reached this anticipated timeframe. The number of reported Covid cases is on an upward trajectory, as expected. The cause could be multi-factorial – perhaps indicative of more people being tested, or the increase coinciding with the return of schools and now universities, or else people generally becoming more cavalier in their attitude and disobeying the government’s social distancing guidelines.
Whatever the combination of likely possible causes, there is a notable increase in the number of reported cases – hence the predicted second spike. Regardless, hospitals are still expected to discharge less needy patients quickly in order to free up beds to make way for Covid-positive patients. It is expected that those coronavirus patients with less acute symptoms, and who no longer need hospital treatment, will be placed into special isolation units or “step down” beds upon discharge. However, others might be discharged straight back to their care home, even though Covid-positive.
Anyone with a relative already in a care home will naturally be very concerned that such known Covid-19 patients are being discharged into an environment where there are already a large number of elderly, frail and vulnerable residents who are at high risk of contracting coronavirus. Sadly, care homes across the UK still remain the largest source of deaths from this pandemic. Initially, some care homes were too slow to react and isolate Covid-patients who were discharged into their care from NHS hospitals with such alarming alacrity under government guidance. Others perhaps suffered from a lack of knowledge surrounding the risk of infection, lacked sufficient personal protective equipment (PPE), or else took inadequate protective measures to keep staff and residents safe and stop the rapid spread of infection.
Conversely, for those whose relative is about to be discharged from hospital back to their care home (or go into care for the first time) this is an enormously stressful time, too. Families want to be sure that their relative is going to be in a safe environment and be well cared for.
The government’s guidance changes so frequently that it is often hard to keep abreast of developments. Inconsistencies and gaffes by policymakers add to the confusion and make it perplexing to understand what the current regulations are. It must be an impossible task for care homes to try and juggle the welfare of the patient and emotional needs of the family (who crave for hand holding and a hug) with the safety of all others working or living in the care home.
The latest set of guidance, current at the time of publishing this article, includes the following:
- To reduce the risk of infection, new residents entering a care home are required to isolate for 14 days.
- Care homes in England are only permitted to allow visiting rights if they are deemed ‘outbreak free’ or in the ‘recovery period’ – meaning, it has been 28 days since the onset of symptoms of the last case in the home.
- “To limit risk, where visits do go ahead, the government has mandated that they should be limited to a single constant visitor, per resident, wherever possible. This, for example, means the same family member visiting each time to limit the number of different individuals coming into contact. This is in order to limit the overall number of visitors to the care home and/or to the individual, and the consequent risk of a balance of the benefits to the residents, against the risk of visitors introducing infection into the care home, or spreading infection from the care home to the community.”
As care homes have discretion whether or not to allow visitors, and in what circumstances, some care homes may take a tougher line by denying access to any visitors altogether, in an effort to contain the virus from spreading. However, it cannot be ruled out that it is care home staff coming and going, rather than family visitors, who are importing the virus into care homes.
All these fears and constant media debate and analysis can only add to the anxiety and worry that your relative is being cared for as you would wish and expect, and given basic professional care – including food and drink to maintain weight and a healthy body; being fully medicated as needed and in a timely manner; being washed/dressed and having good daily hygiene; being stimulated and not being left for hours in isolation or in soiled clothes.
What if the care home refuses to accept your relative if they are Covid-positive?
We would expect private care homes to accept Covid-positive patients back, not only as it might be construed as a breach of contract, but for financial reasons, too. They need private funds to run the care home and keep it open. A private care home is still a business like any other and needs positive cash flow to keep it going. Patients returning from hospital would be expected to be isolated for 14 days. However, depending on the size of the care home and resources available, that might not be as logistically easy as it sounds!
Care homes run by local authorities have similar financial needs, too, otherwise they couldn’t survive. Again, it is expected that these care homes will also be required to isolate patients for 14 days in a secure environment.
James Bullion, President of the Association of Directors of Adult Social Services (ADASS) suggested on the radio recently that care homes can’t be forced to accept Covid patients back. If a care home doesn’t have the right space or facilities to look after a Covid patient, then the local authority should find an alternative placement for them in the meantime. Alternatively, the care home should be incentivised to accept Covid patients and get the correct PPE to stop infection spreading to other residents.
ADASS estimates that one-third of care home providers are currently making a loss because of the additional costs from Covid-19 – including personal protective equipment and covering staff sickness – and reduced income as a result of service reductions. Mr Bullion recently issued a warning to the House of Commons Health and Social Care Select Committee reportedly saying that, “Social care faces a dangerous scenario of most care providers going into the red this winter [sic making a loss] unless the government gives councils more funding to support them manage the impact of Covid-19.”
Unquestionably, proper PPE is critical for all care home staff so that they can do their job safely – whether they are responsible for providing essential treatment and care for those who are either confirmed to have Covid-19, are symptomatic or are highly vulnerable to infection. That comes at a huge cost which has to be sustained for the foreseeable future if care homes are going to remain in business. Care homes must have access to government funding and incentives in order to provide long-term care for the vulnerable in our society and maintain necessary staffing levels who can be assured of working in a safe environment.
Even more critical is the need to test staff and residents regularly, something promised early on at the outset of the pandemic, but yet to be rolled out consistently throughout care homes nationwide.
Whether privately or local authority funded care, all care facilities will need extra staff and resources to look after their patients, perhaps even recruiting additional specialist carers to provide 2:1 or 1:1 care for Covid patients. The cost of extra staffing and long-term requirements for PPE, coupled with the cost of creating a safe environment for staff and patients alike, will undoubtedly have a huge financial impact on care home budgets. The risk is that this cost will be too much for some to withstand, and will ultimately lead to their rapid demise, endangering the lives of their residents.
The alternative, of course, is for care homes to pass the increasing costs directly on to the resident. The latter is not going to be popular for most private paying (ie self-funding) residents who may already be spending £1000 to £2000 a week for their care. Some families will take issue at this extra cost being foisted on them, but care homes may simply say that is now the cost of looking after a patient with Covid symptoms. This outcome may cause some families to interrogate the contract with the care home to see if they can be legally charged this increase in fees; others will simply accept it as the new norm and pay the increase costs for peace of mind, not wanting to rock the boat whilst their relative is in the care of a third party.
Placing a relative into care is an emotional and traumatic time for most families. How much more so now in the current Covid environment with limited access to visitors.
Read our blog: Placing a relative into care…
What if you think your relative’s care home is going to go bust?
If your relative is considering making a claim for NHS Continuing Healthcare Funding (CHC) – free care that is funded by the NHS for all their healthcare needs (including their social care needs and accommodation) or have already been awarded CHC, then take note.
In the current climate with increasing staff costs, staff shortages and balancing the need for extra safety measures and cost of PPE to protect staff and residents, there is a fear that many care facilities will be forced to close. The matter was highlighted again in this short article, entitled: “Empty beds push care homes to the brink” published in the Daily Telegraph recently on 2nd October 2020. It simply read:
“Care homes are on the brink of closure because of a dramatic rise in empty beds during the pandemic. The number of vacancies in homes across England, Wales and Scotland has almost doubled in a year, according to ITV News. Statistics from 61 councils show that the number of empty beds is increasing every area, with an average rise of 88 per cent on last year. The National Care Association said: “The statistics provide a stark warning as we anticipate a second wave. Social care provision has been fragile and ignored for too long.”
Regardless of whether you have any concerns about the financial stability of your relative’s care home, try and get a copy of your relative’s notes and records whilst you can and remember to keep them safe! These records will become critical evidence in any assessment (current or retrospective) of their healthcare needs and eligibility for CHC Funding.
You also need to check the records frequently to ensure that they are up to date and accurately reflect your relative’s daily care needs.
Remember, your chance of securing CHC Funding may depend on these records and good record keeping will improve your chances of success.
For more information read as to the necessity for good records keeping and the need to get hold of your relative’s records, read some of our previous blogs on the subject:
Learning lessons as “Four Seasons Healthcare goes into administration”
Problems with care home records? Mind your language…
Why is it important to check your relative’s care home records?
June’s feature on flawed CHC assessments and the importance of good record keeping
Applying for Healthcare Records. Dealing with delays
For more general reading about safety measures in care homes and frequently asked questions related to COVID-19, click on these links:
https://www.local.gov.uk/our-support/coronavirus-information-councils/covid-19-faqs
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My father-in-law was discharged from hospital to an out of area care home. He wasn’t isolated for 14 days.
Within 24 hours of admission he was assaulted. Punched in the face by another resident in a communal area. The Care Home failed to follow protocols for a head injury. No doctor or ambulance was called. The assault was deemed abuse by safeguarding after Dad’s death. The home hadn’t followed Covid 19 protocols too. Dad died of COVID 19 which he caught at the home. They had a number of staff self isolating and another resident passed away too of COVID 19. Family could not go into the home but tradesmen who were still working could. Dad was sent to live on a building site.
My wife has had Alzheimer’s/dementia for 7+ years,I have never been given a definitive diagnosis.On 30th August she went into respite for 2 weeks.She entered respite fully mobile,but came out in a wheelchair,no adequate explanation has ever been given,the care home insisted that,had she fallen,there would be a note in the record book.
I kept her at home for 4 days where I had to lift and carry her, eventually calling the doctor.He thought she might have a fractured knee,it turned out she hadn’t.They kept her in hospital where no progress on her mobility was made.So for 2 weeks she lay in hospital bedbound,just sleeping most of the time.The hospital contacted me to say that there was nothing more they could do,and that they were going to discharge her into a nursing home.Originally I was told that funding would be paid for under the fast track CHC scheme and then reviewed and a decision taken whether the NHS would continue to fund her,or placed back with the local authority.I queried whether they had completed an assessment and was then told that the review would be after 4 weeks,and that I was mistakenly told that it would be 12 weeks.Obviously at this stage I was concerned that they would withdraw funding.They then contacted me to say that they had found a nursing home for her but would need a negative Covid test before she could be moved.So,on 2/10 she was moved into care home.I received a letter from CCG dated 7/10.It starts Fast track referral- Assessment outcome.
It goes on to say,It was determined that you are eligible for Continuing Healthcare.In accordance with the national framework a review will be scheduled at 3 months and annually thereafter.
I don’t envisage her lasting too much longer,she appears to have shut down.
Because of Covid restrictions I haven’t been able to see her since she went in,which is nearly 3 weeks ago.There is no way I could look after her in her current physical or mental state,in addition I am about to start treatment for prostate cancer,all in all an annus horribilus Hope my experience may be of some use to others.
Hello Charles,
Thank you for sharing your experience at what is certainly the most stressful and sad time in your lives. Your wife’s admission & discharge from hospital mirrored my late father’s experience back in 2016. Dad left hospital with Fast Track funding place, only to have it removed 3 months later because he hadn’t died as the nursing home had kept him alive! My CCG were ruthless at the 3 month review and disregarded the National Framework for CHC in respect of “managed needs”.
So, I urge you to be prepared for the 3 month review as it is generally known that this is when CCG’s unilaterally withdraw funding.
It’s a horrible situation to be in, when you fear your loved one is slipping away & you also have your own health issues and Covid to deal with, so I do hope you have family/friends around who can help share the situation you find yourself in.
Best Wishes!
Dear CTBD readers,
Just a reminder that if you are able to PLEASE, PLEASE, PLEASE make a pledge to Rear Admiral Mathias’s crowd funding, for a judicial review in to the scandal that is CHC. To have any chance of holding the Government to account for the misery it has caused thousands of old, vulnerable and ill people the fund needs to raise 250 thousand pounds. The contributions so far amount to 32 thousand pounds. Please tell all your family and friends about this important matter…….that will eventually affect everyone of us in an ageing population with increasing health and care needs.
I had never heard of CHC until 2016 when my dear dad was admitted to hospital with complications arising from advanced Parkinson’s disease and dementia. I fought a horrendous appeal process to secure CHC for my dad, after my own CCG removed funding following the Fast Track Funding he was awarded on discharge from hospital to nursing home. My dear dad died during the process. My father’s nursing home fees were finally restored to my mum, after I successfully appealed at IRP. A bittersweet victory!
My anger,stress and frustration was undoubtedly, responsible for my own ill health & cardiac arrest.
To this day, I am still angry about the process and why I continue to contribute my experiences and help on this forum.
I don’t want anyone to ever have to go through what I did for the best part of three years. My waking hours were spent researching and appealing the process, with absolutely no help from my local CHC.
Retired Rear Admiral Mathias needs our full support, SO PLEASE GIVE AS MUCH AS YOU CAN!
There are plenty of links here, but if you just google Admiral Mathias crowdjustice you will land on the right page.
Hi everyone, hope we are all keeping safe and not stressing out over the care of our loved ones at this time. We completed a checklist just before the lockdown came at the end of February 2020. We have now been contacted and have been told we need to start the process all over again as the NHS are not even considering conducting a DST meeting based on that checklist because of Covid 19. I thought the process was on hold not abandoned altogether, has anyone else had this problem? Or is it as usual a postcode lottery system where the interpretation of the rules appear to be so different?