Shropshire care homes' duty of care in a battle to protect lives
It has been a torrid time for care homes, where the human cost of coronavirus is being played out.
The grim reality of this disease is that it targets the vulnerable. That means homes across the country fighting an often losing battle to protect those who are the most susceptible.
Care homes have seen the biggest increase in deaths over time compared to deaths that have occurred in other settings. Deaths in care homes from all causes are starting to stabilise but remain 159 per cent higher than at the start of the Covid-19 outbreak. At one point, at the end of April, they were more than 200 per cent higher.
Today we focus on two homes in the West Midlands, where life still goes on and staff work tirelessly to ensure those in their care are both safe and happy.
The Uplands is a nursing home on the edge of Shrewsbury that specialises in caring for older adults and those with dementia.
With approximately 80 beds, 110 care staff and a further 30 or so ancillary staff, all operating under one roof in purpose-built premises in Bicton Heath, it is one of the largest single-site care homes in the town. It goes over and above to stimulate those who live there, even bringing a pony into the home last autumn to meet the residents.
Lapal House in Halesowen is an impressive building. It two well-appointed lounges as well as an orangery and a library together with beautifully decorated, spacious en-suite bedrooms, some with spectacular garden views. The home, which has just received a Good rating from the Quality Care Commission, sits in a region badly hit and has seen eight infections among those it cares for and 13 in staff.
Like all care homes, they have sat firmly in the firing line of the bombardment of challenges the coronavirus crisis has thrown at it.
The Uplands is operated by the family-owned Marches Care and its managing director is Carey Bloomer. When the situation regarding the pandemic was starting to unfold, Carey and her team responded as quickly as possible, but with significant hurdles to overcome.
“When the severity of the situation was starting to become apparent, there was absolutely no governmental guidance whatsoever so we were having to make decisions on our own,” says Carey.
“Care homes were certainly at the back of the queue when it came to advice and it was only about four weeks into the pandemic that we started to get support. We should have had access to testing far earlier. If we had had it the situation would have been a lot easier as we could have isolated individuals effectively and basically known what we were dealing with.”
Carey – backed by Marches Care chair and co-owner, Mandy Thorn – went flat out to get as much PPE as quickly as possible, and was able to source adequate protective equipment. And as the guidance started to come through, the task was about interpreting the guidance for each situation.
“The biggest cultural change was asking relatives not to come in when we had to impose the lockdown,” continues Carey.
“This was asking them to change the pattern of their lives and many of the families and the residents themselves found it very difficult. The families have been very understanding, though many are, quite understandably, very concerned. They appreciate that everything we do is for the right reasons.
“The residents themselves have been remarkably stoical and seem to take the attitude that they have been through a lot already in their lives and this is just another hurdle to overcome.”
Earlier this month Marches Care arranged for personalised goody bags filled with carefully selected Shropshire food and drink to be given to every member of the care staff. The message was ‘not all heroes wear capes’. The way they have conducted themselves has been “brilliant”, according to Carey.
“At first they were very concerned but after lots of reassurance and listening they have focused on their jobs in a really dedicated and professional way,” Carey says. “There has been very little sickness and almost everyone has done extra shifts here and there, and offering to do more. The lockdown also put extra stress on the administration staff as they have been taking phone calls from families all day, every day. They should be applauded for their professionalism and compassion, constantly answering the phone to concerned families.”
The story at Lapal House, in Halesowen, is similar. It is run by Tony and Pamela Billingham, specialising in people who require nursing or personal care or have dementia and physical disabilities.
Pamela was ahead of the curve and saw storm clouds gathering as the Government failed to act quickly enough.
“We were one of the first that were notified about the virus because we had a couple that came in. They were fairly new to us but the gentleman had to go into hospital as an emergency because he’d got stomach pains. He had an operation, as a result of the operation he died. He’d only been with us for a few days. On the death certificate, they put coronavirus. We investigated and found he’d picked it up in hospital. Neither he nor his wife had it here. However, because of that, we closed our doors. We had to make sure everything was closed down.
“All the residents were kept in their rooms. Because of the closure, we closed our other two homes straight away, in Oldbury and Halesowen. So because of our quick decisions, we managed to avoid some of the problems others faced.”
Pamela says that in general the Government was not quick enough to act, though local social services teams in Dudley stepped up: “They were particularly helpful on the issue of PPE. We were already stocked up because at this time of the year we have people who die from the normal flu. The problem now is the fact that we need supplies on a regular basis. Gloves, masks and all the rest of it are in short supply. All the prices have escalated like mad. We don’t have any support for that at the moment but the local authority has agreed a figure for us because of that. We’ll get financial support for that.”
Back at The Uplands, in Shrewsbury, a familiar face is Jill Wellings whose husband, Dick, has been a resident in one of the dementia units for five years. Jill has been visiting Dick on a daily basis ever since he took up residence at the home so you would expect this enforced separation from her husband hard to take.
“My feelings are really of gratitude, knowing that Dick will be well looked after,” says Jill, herself a former health worker who recently held her 80th birthday party at the Uplands. “Your first thought is, how are you going to manage? Then you look at the bigger picture and see so many people dying. I feel care homes missed out with PPE and tests but that’s the failing of the government. I know that Carey did everything in her power to get these sorted as quickly as possible. Her immediate thought is to protect the residents and that has to be the main thing. That give me more confidence that Dick will be well looked after.”
What communication does Jill have with the Uplands for updates with Dick?
“I phone in every other day and do face time twice a week which is know is available for all the relatives. I don’t want to do more than that because it’s more work for the staff. The other thing I want to say is that it’s not just Dick that I miss, it’s the carers themselves. It’s a very ‘homely’ home and I miss going there.”
But what about those on the front line, those who go into work day in, day out to fulfil their jobs of providing residents with the best possible care even when the circumstances are as demanding as they have been?
Meet Abi Hewer has worked at the Uplands for six years, starting off as a carer and qualifying as a nurse last year.
The last two months have of course been challenging but, she says, the atmosphere has been “very upbeat”.
She adds: “Everyone has had their low points but teamwork has kept us together. The girls have been dancing, making each other cakes and things like that.”
Abi, 43, lives in Shrewsbury with her husband and three children – another factor for frontline workers to conjure with.
This, according to Abi, hasn’t caused as many problems as it would for many because “my husband and daughter are key workers as well so everyone understands the situation – it’s a case of stripping off as soon as we get home and immediately having a shower.”
Abi, like her colleagues, has adapted to the situation but it hasn’t always been easy, especially as these are the workers in closest proximity to residents. The worry of passing on the virus has been at the forefront of the carers’ minds and that is why testing is such an important issue for them to resolve.
It has been a difficult and worrying journey for care home staff but remembering why they do what they do has been key to remaining level headed, according to Abi.
“When we heard about the pandemic, it was quite worrying at first,” she says. “We just didn’t know what to expect but the management have kept us up to date with things and we got the PPE quite quickly.
“Our main priority has been to come in and care for residents and keep them safe.
“A lot of our residents couldn’t understand why they couldn’t see their loved ones so it’s been really important to remind them and also give them that extra bit of care and attention.
“Being able to help like this makes the difficulties we face worth it.”
Across in Halesowen, Tony Billingham says staff have been magnificent, saying “The pressures on staff have been tremendous.
“We had a closure and tests and some of the staff had got the virus. They may have picked it up elsewhere, in the community, but that was a tremendous problem because you still have to look after the existing people.
“We had to pay a lot of overtime to come in at weekends. They all really put themselves out and gave us tremendous support. We don’t know when this is going to end. It’s going to be a slow process.”
“The biggest problem is that because of the thought of people coming into care, the normal vacancies are not filling. Relatives are afraid to send people into homes in case they catch the virus. Generally, there are vacancies throughout the country. We can’t go into hospitals to assess anybody to come into care because we don’t know what we’ll find. We have to look at these people and agree to offer proper care. It’s very difficult now. The problem is, because of the media, people are keeping their relatives at home at the moment. There is a tremendous financial strain caused by low occupancy. It doesn’t affect us too much because we’re private and we can work our way through it, but that’s a bigger issue.”
Residents remain buoyant and they have been entertained by musicians playing outside on lawns, while speakers present music inside.
“We have had to do different things. We can’t allow people to come in for entertainment, for example.
“You have to be very, very careful. We are very, very strict. The manager has worked so well – all my managers have been superb, they are so dedicated. They’ve been working as a team – and the situation is slowly getting better.”
