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Some care homes may not survive the pandemic

COVID-19 has pushed me to the brink, the care home sector I am so passionate about to the edge, and my nursing home ever faster towards bankruptcy, says nurse manager Anita Astle

Picture shows a resident of Wren Hall nursing home talking to a medic who is wearing personal protective equipment
A medic talks to a resident at Wren Hall nursing home Picture: Shuttercock

I am the nurse manager and managing director of Wren Hall, a nursing home in Nottinghamshire.

I am proud that we are rated outstanding by the Care Quality Commission (CQC) for the ‘committed and compassionate’ care we give the home’s residents – who we call our family members.

Weeks into the COVID-19 crisis care homes are finally in the spotlight. Any government support is welcome but after such delay it must be swift. While it is positive that staff and residents will now be tested, this does not go far enough.

‘Care staff are being told to verify death in residential homes… They have had no training and been given no guidance’

The government’s strategy, focused on protecting the NHS, gives me a feeling that care outside hospital doesn’t matter. It doesn’t even recognise the difference between a residential home and a nursing home.

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Care staff are being told to verify death in residential homes. This has been done by nurses in nursing homes for some time, but care staff are not registered. They have had no training and been given no guidance.

The strategy moves people out of hospital into care homes to free up beds irrespective of whether the homes have the expertise to look after them.

‘Even if a care home has no cases of COVID-19, hospitals can discharge people with the disease to that home’

And even if a care home has no cases of COVID-19, hospitals can discharge people with the disease to that home. Yet the CQC has suspended routine inspections because of the outbreak.

Like all care providers, I am paying for personal protective equipment. It costs £8,860 for an eight-day supply of masks only. That’s £1,107 a day. I sent the invoice to several people explaining I was at risk of terminating our contracts. The relationship director at the bank replied, followed by the local MP. Later, the CQC got in touch but only to ask what I was going to do. I’ve not heard from the local authority.

Most of our family members have complex needs and are funded through NHS continuing healthcare. Over the years, clinical commissioning groups have not raised the fee they pay in line with inflation. They have only lifted the local authority element of our fee, to 63%. The remaining 37% has been frozen since 2015, despite huge hikes in our costs.

‘We are running at a loss and will be bankrupt soon…we cannot accept new admissions’

We are running at a loss and will be bankrupt soon. We are usually full, with people waiting for a bed. But because we have family members with symptoms, we cannot accept new admissions.

Government guidance and communication have been poor and inconsistent. The initial guidance had no information about what to expect or how to tackle COVID-19. We hope the latest guidance does better.

Our nurses are following best practice, treating our residents with oxygen and subcutaneous fluids as they deteriorate and become unable to eat and drink.

‘I am getting dragged down by the relentless nature of this crisis and the lack of support’

The respiratory nurse specialist contacted me to ask about our oxygen use as there is not enough supply to go round. My residents need and are responding to this treatment. I am not going to let this go easily. But I am getting dragged down by the relentless nature of this crisis and the lack of support.

I am usually at my desk by 5.30am reading emails before the 7.10am handover. One day, at 7.05am, I realised I’d been sitting with my head in my hands, psyching myself up to let the team know I am there for them and in control. The truth is I have never felt so alone or out of control.

Care home nursing can be isolating. Along with colleagues, we’ve developed an app to support people to express their fears and anxieties.

‘The biggest challenge is that we’re all so down… Staff are being infected and worry about taking COVID-19 home to their families’

The Foundation of Nursing Studies has been amazing, supporting us to focus on what we can do and achieve. For us that is training and development. Most care homes struggle to release nurses for training due to the lack of backfill, yet no funding is available to address this. It means care homes are now less able to do what the government is telling them. This is important learning for the future.

The biggest challenge is that we’re all so down. Residents have died. Staff are being infected and worry about taking COVID-19 home to their families. Many also care for older parents.­­

All we can do is pace ourselves. My nurses have been brilliant, volunteering for extra carer shifts. I must make sure they don’t burn out. Because weeks in and we still don’t know what we’re looking at or for how long. Unless more government focus is put on care homes, and supporting the vital work they are doing, some might not be here when this pandemic is over.


Picture of Anita Astle, nurse manager and managing director of Wren Hall nursing home. She says the pandemic has pushed the care home sector to the edge.Anita Astle is the nurse manager and managing director of Wren Hall, a nursing home in Nottinghamshire

 

 

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