Care homes in the UK are still struggling to get enough PPE despite the deaths of nearly 6,000 residents from coronavirus – as workers say the lack of protection is causing ‘really high’ levels of stress.
Bosses say the requirement to wear PPE at all times while working in care homes, coupled with increased costs, mean that supplies often run out extremely quickly.
A shortage of PPE has been a consistent issue from staff in care homes since the pandemic began, with Unison yesterday revealing it has received almost 3,600 reports about access to PPE from workers through its PPE alert web form.
The government has also been lambasted for its attempts to deliver the protective equipment to frontline staff and also for the lack of routine testing available.
It comes as the the ONS bulletin today showed that one in five of all people who have died so far in the crisis have been care home residents. Some 5,890 people in homes succumbed to the disease by April 24.
Colin Angel, policy director for the UK Homecare Association (UKHCA), said sourcing equipment for workers is a main concern for care providers.
A worker at Newfield Nursing Home in Sheffield tenderly holding hands with an elderly resident Jack Dodsley
He told BBC Breakfast: ‘I think every homecare provider in the country is really struggling to get a sure supply of PPE, and having enough to be confident that they can continue providing care services across, sometimes even days, if not just a few weeks.
‘And it’s a real stress. I have a provider who was telling me he was spending 90% of his time trying to phone round and get PPE delivered.
‘That means he’s looking for PPE rather than being able to run the rest of his service.
‘That’s a huge problem, and the levels of stress it’s creating both for providers delivering care and their frontline care workers is really high.’
By April 24, a total of 5,890 people had died in care homes with confirmed or suspected COVID-19, out of a total of 27,356 people (21.5 per cent). The 27,356 is lower than the 29,710 total for that date because of a recording cut-off.
The scale of care home deaths is expected to continue rising as the National Records of Scotland last week revealed that 39 per cent of victims there have been in nursing homes.
Elderly people and those with long-term health issues are known to be the most at risk of the virus and close proximity living makes outbreaks difficult to stop.
Deaths in care homes also appeared to keep accelerating after the virus deaths peaked in England’s hospitals, ONS data shows.
Mr Angel said the response from Government has been slow, and that more support is needed as additional cost pressures mount.
When the number of COVID-19 patients dying was at its highest in hospitals, around April 8, it was still relatively low in care homes, which then surged in the days and weeks following
‘We’re seeing homecare providers having to use personal protective equipment that they’ve never needed before, and face masks and visors aren’t usually necessary in home care,’ he said.
‘And now we’re using them for virtually every contact that we have with somebody.
‘The prices are increasing, the amount of PPE needed to deliver care services safely has shot up in a month or so.
‘So, all of these additional cost pressures need to be funded, and that’s either funded by the local authorities in the NHS who are buying care, or potentially by private individuals who are buying their own care.
‘We don’t think that’s a cost which should be borne by private individuals.
‘We think we need some real support from Government which has been very slow in appearing.’
It comes as more than 130 frontline NHS and care workers have died during the coronavirus pandemic.
Health Secretary Matt Hancock acknowledged that there would be further competition for PPE from businesses seeking to reopen as the lockdown eases, but said that the NHS and care homes must remain a priority.
‘The first call on PPE must go to the NHS and social care and those other essential services who need it to keep the people delivering those services safe,’ he said on Monday.
Care home resident Pat, who appeared on the BBC with Mr Angel and her carer, Emily, said she is worried about the safety of her carers, without whom she would be ‘totally lost’, and echoed calls for more PPE.
‘It’s very important because I had a stroke so I can do very little for myself – so I totally depend on them … I would be totally lost, I don’t know what I would do without them,’ she said.
‘It can be very depressing sitting here on your own all the time and I look forward to them coming in for the company as well.’
Mr Angel continued: ‘We need to get money coming to the frontline care providers, we need to recognise the huge increase in costs, and sort out the supply of PPE so that Pat and Emily can carry on working together and receiving support.’
It comes as growing numbers of families are seeking legal advice to remove their relatives from care homes, it has been revealed today.
Legal firms have reporter a spike in the number of people looking to overturn safeguards which prevent them removing elderly residents from care facilities.
The law firm Leigh Day told The Guardian it is receiving, ‘at least 10 calls a week from families attempting to persuade local authority social workers to let them remove residents from care homes.’
Deprivation of Liberty Safeguards (DoLS) are strict processes which apply to people in care homes and hospitals, stopping them from leaving the facility without permission from a social worker.
A graphic that shows the different levels of PPE protection required by medical professionals and care workers
Helen Wildbore, the director of the Relatives and Residents’ Association, also told The Guardian its helpline had seen an increase in calls about the issue.
More than 5,000 care home residents have died from COVID-19. Official data shows care home deaths account for more than a third of all fatalities.
By April 24, a total of 5,890 people had died in care homes with confirmed or suspected COVID-19, out of a total of 27,356 people (21.5 per cent).
The 27,356 is lower than the 29,710 total for that date because of a recording cut-off.
Office for National Statistics data today revealed that 29,710 people in England and Wales had COVID-19 mentioned on their death certificate by April 24.
The Department of Health had, by that time, counted only 22,173 fatalities linked to the virus.
More than 4,000 care home residents in England and Wales have died during the pandemic up until April 17, official data shows, 19 per cent of the total on that date. This compares to Germany’s 2,401. A third of its total deaths have been in care homes, but that includes prisons and other community settings
Delays in death reports, uncounted victims who died at home or in care homes, and a refusal to count anyone who hasn’t been tested mean the daily death counts are not the most accurate measure of how many people are being killed by the illness.
Yesterday the Health Secretary announced that a total of 28,734 people had died after testing positive for the disease. This suggests the true total – if 34 per cent higher – could be 38,506.
The ONS bulletin today showed that one in five of all people who have died so far in the crisis have been care home residents. Some 5,890 people in homes succumbed to the disease by April 24.
And fatalities in care homes appear to have peaked on April 17, when 415 people died – this was nine days after the daily peak in NHS hospitals, on April 8, with 867 deaths.
ONS data is the most accurate picture of how many people have died with COVID-19, but the statistics are backdated so only relate to a period two weeks earlier.
It comes after a report from the LSE that said deaths in care homes are not inevitable.
Researchers at the London School of Economics have highlighted exactly where the UK has fallen short of protecting some 400,000 care home residents and staff.
More than 5,000 care home residents have died from COVID-19. Official data shows care home deaths account for more than a third of all fatalities.
The LSE report highlights how the UK Government’s response has been different to other countries, taking a reactive approach rather than precautionary measures to prevent an outbreak.
In contrast, Hong Kong – which took action to prevent a crisis early on – has recorded no official deaths in care homes.
In some cases, swab tests have been limited to six residents with symptoms per care home, forcing staff to make assumptions on who may have the killer infection.
Carers are allowed to continue working even if they have had contact with a positive case, while in Germany a 14-day self isolation period is compulsory.
In South Korea, where total and care home deaths have been relatively low, regular temperature checks are taken of residents. A fever is one of the tell-tale symptoms.
Similarly in Hong Kong, residents are self-isolating even if there is no outbreak and must wear a face mask if they leave their room.
Adelina Comas-Herrera, an author of the report, said she expects the UK number of deaths of care home residents to amount to half of all deaths, as is happening in France, Belgium and Canada.
The pattern has been reported in Spain and Italy – where governments were slow to act and were underprepared for the pandemic with low levels of PPE – but the data is not as reliable.
Ms Comas-Herrera, an assistant professorial research fellow in the Department of Health Policy at the London School of Economics and Political Science, has been gathering resources worldwide to create LTCcovid.
LTCcovid (Long-Term Care responses to COVID-19) will document the impact of COVID-19 in care settings over the course of the pandemic.
Its most recent report said: ‘While it is early to come to firm conclusions and there are many difficulties with data, these differences suggest that having large numbers of deaths as result of COVID-19 is not inevitable and that appropriate measures to prevent and control infections in care homes can save lives.’
LTCcovid collection of information finds that countries that appear to have had relative success in preventing COVID-19 entering care homes have very strict processes to isolate and test all care home residents and staff.
They don’t just focus on those who have symptoms, but anyone who may have had contact with people who have tested positive for COVID-19.
At least in the UK, timely and systematic testing of care home residents and staff has been lacking.
It has come to light that testing was initially done on the first five symptomatic residents, meaning potentially several more would have gone untested.
Testing capacity has been and is still very limited since the start, so priorities lie with people in hospitals and NHS workers.
Care homes have to decide who to isolate based on assumptions of who has the illness, leaving others to mingle with each other while following social distancing rules.
But ‘there is also growing evidence of asymptomatic transmission in care homes, which highlights the importance of regular testing in care homes instead of relying on symptoms to identify people with potential COVID-19 infections’, Ms Comas-Herreras writes.
‘Geriatricians are also raising concerns that, among care home residents, the symptoms of COVID-19 may not be the typical cough and fever that is covered in the guidance documents for care homes in many countries, but that a range of other symptoms (such as delirium, diarrhoea, lethargy, falls and reduced appetite) are more frequent among care home residents with COVID-19.’
Current guidelines in the UK only require the isolation of residents and staff who are symptomatic. Similar guidelines were in place in Spain until the 24th of March.
But the World Health Organization’s guidelines insist on isolation of residents and staff who are suspected to have COVID-19.
The Government has been slated for its lack of support to nursing homes, with no routine testing available, no up-to-date records of the number of people infected or dead, and ‘paltry’ attempts to deliver adequate protective clothing for staff.
The South Korean approach has been robust, albeit potentially distressing for care home residents.