Covid-19 – ‘Bubbling’ care homes

Care homes have undoubtedly been significantly affected by Covid-19 and the manner in which cases have both spread and been controlled has been criticised across national media outlets. The Office for National Statistics, reported on 3 July that for deaths registered up to 9 May 2020, 12,536 involved Covid-19. The number may of course be significantly higher as testing has not been undertaken in every death.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/deathsinvolvingcovid19inthecaresectorenglandandwales/deathsoccurringupto1may2020andregisteredupto9may2020provisional#deaths-involving-covid-19-among-care-home-residents

A recent study by NHS Lothian and Edinburgh University , looking at care-home outbreaks in a large Scottish health board has been undertaken. The study considered 189 care homes in the Lothian area where more than 400 people died from Corona.

The study identified that 37% of care homes considered within the sample group had experienced an outbreak of Covid-19 and significantly the larger the care home, the larger the associated outbreaks. NHS Lothian and Edinburgh University found the likelihood of the infection spreading increased three fold with every increase of around 20 beds. Homes with less than 20 residents had a 5% chance of outbreak, compared with a figure between 83% and 100% for homes with 60 to 80 residents.

The concerns with how the virus was controlled in care homes is still relevant considering the potential for a second wave. Lessons can and should be learned to prevent such significant numbers of deaths occurring again and actions taken to lessen the impact of a second wave. The study found that many of the deaths were due to outbreaks in only a few locations. This essentially means there is a wide pool of care homes that Covid-19 has not broken into, and thus a wide pool of potentially vulnerable residents that will need further protection ahead of any second wave.

The possibility of creating ‘bubbles’ within care homes has been suggested. These ‘bubbles’ in a care home setting could be created from sectioning larger Homes into smaller units.  Residents would be assigned to a small sub-unit and particular staff would also be assigned to those units. This way interactions between residents, staff, and the general footfall through the home could be limited, reducing the potential spread. Staff could be assigned to certain areas, and more scheduling of bubbled staff could be introduced for the running of the care home, such as cooking, cleaning and maintenance.

This in theory sounds like a possible way to reduce the outbreaks within care homes, however this will of course take considerable planning, resources, and staffing which will in turn increase the funding required to support the care homes.  Consideration will need to be given to individual set ups of care homes, and the possibility to  create small units within them, especially for homes with residents who may be prone to wandering, such as those suffering with dementia.

Pressure will likely continue to mount on the government, requiring clearer advice, and forward planning for a potential second wave and to ensure steps are in place to prevent the impact of any second wave.


Written by Holly Paterson at BLM

holly.paterson@blmlaw.com

COVID-19 and Scottish care homes

On 6 May it was announced that five residents had died at a care home on the Scottish island of Skye at the centre of a COVID-19 (C-19) outbreak on the island. 57 residents and staff at this care home have tested positive for C-19. Ten deaths have also recently been reported at a care home in East Dunbartonshire.

Statistics from the National Records of Scotland show that by Sunday 3 May there had been 2,795 deaths in Scotland where C-19 is mentioned on a death certificate. More than four in ten of those deaths (42.8%) have been in care homes. The proportion of deaths in care homes has also been growing, accounting for almost 60% of C-19 deaths between 27 April and 3 May.

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Significant rise in figures for care home deaths as a result of COVID-19

We have recently written several blogs regarding various COVID-19 related problems the care sector is facing.  In particular the supply of PPE and the effect of COVID-19 generally on staffing levels and management of service users are critical issues.

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Care providers urged to ensure they are ready for Brexit

The Government and other bodies such as the Care Providers Alliance are urging health and social care providers to ensure they have done everything they can to prepare for a potential No Deal Brexit on 31 October.

The National Audit Office published a report at the end of September noting that whilst the Department of Health and Social Care had undertaken a lot of work since June 2016 to prepare the sector for leaving the EU, there was still a lot of work to be done before 31 October in respect of the social care sector. For example the report notes that whilst the NHS has taken steps to stockpile medication for immediate use across the healthcare sector,  care homes often rely upon non NHS suppliers for supplies of items such as rubber gloves. The Department did not originally advise the social care sector to stockpile such items, but rather advised that care providers should be simply “ready to deal with any disruption”.

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CQC report highlights failings in dental care across the care sector

The CQC has today released a review of oral health and dental care provided to those in care homes. The report concludes that this is poorly implemented in care homes.  The review is based on 100 visits to different care homes by dental inspectors and oral health specialists.

There are specific NICE (National Institute for Health and Care Excellence) guidelines to cover dental care for persons living in residential care but in the majority of cases these were not being followed.  Residents generally had their oral health assessed upon admission, but often care home staff were not aware of the NICE guidelines and had not had specific training on oral health.  More worryingly, over half of the care homes surveyed had no policy to promote oral health, and nearly three quarters of the care plans reviews did not cover oral health or only partly covered it.

The CQC comment in the foreword to the report highlights the fact that the elderly of today generally are more likely to retain their teeth than earlier generations.  Good oral care is essential for those in care homes to reduce pain and reduce the risk of malnutrition.  Oral care was also often not joined up meaning that when emergency dental treatment was required, the homes would call a GP, or 111, or send the person to A&E – thereby placing a strain on already overworked services.

The care sector should carefully consider this report with a view to future policies and management of residents’ oral health otherwise this may be an area that residents and families focus upon in terms of claiming for damages.

The CQC’s report can be found here:  https://www.cqc.org.uk/publications/major-report/smiling-matters-oral-health-care-care-homes


Written by Jennifer Johnston at BLM

NHS launches digital capacity tracker for care home places to cut ‘bed blocking’

The NHS has this week launched an online portal to assist NHS hospitals in identifying care home places for patients upon discharge. 

Elderly and infirm patients are often delayed in being discharged from hospital due to the lack of availability of a suitable care home for them to be discharged to.  Often, their care needs will have changed since their admission to hospital.  The fact that patients remain in hospital after they are medically fit for discharge – but cannot return to their previous home – places a strain on the NHS.  In 2018, the NHS estimated around 250,000 hospital beds days were taken up by patients well enough to be discharged but with no care home to go to. 

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