Transcriber: Eunice Tan Reviewer: Tanya Cushman
Over the past number of weeks,
all of us have had to adapt and change everything that we do:
limiting our contact with people,
being scrupulous about washing our hands,
standing patiently in line to enter a supermarket,
and staying at home.
The word 'home' has become loaded with meaning.
For many of us, home is a place of safety and sanctuary.
But this is not the case for everyone.
What has become very apparent over the past few weeks
is that care homes for older people have not been places of safety
either for staff or for residents.
The care home setting has been the forgotten front line in the UK.
Numbers of cases and deaths in UK care homes were not reported
in the early stages of the pandemic.
And it is only now
that we're beginning to understand the scale and the impact
that the coronavirus has had in this environment.
Many, who like me,
who've conducted research in care homes and are familiar with the sector
are, sadly, not surprised by what has happened.
So why has it happened?
And what lessons can be learned from this tragedy?
Care homes,
which is a term sometimes used to describe nursing or residential homes,
provide care,
usually to older people who are unable to continue to live in their own homes.
The average age of residents is around 80 years.
The population is largely women - about 70 percent.
And most will have two or three medical conditions, including dementia.
This means that they will be taking a number of medications,
and in some cases, more than 10.
Care home residents tend to be more prone to infection.
And research that we did in Northern Ireland in 2011
showed that there were higher levels of antibiotic prescribing
used to treat infections in Northern Ireland nursing homes
compared to homes in other European countries.
Another study, which we published in 2010,
found high levels of a bacteria called MRSA
in both residents and staff.
Further research showed
that controlling infection in care homes was difficult for staff
because of lack of time
and they didn't have the resources
to purchase the necessary equipment to prevent infection.
A survey conducted by Mather LifeWays,
which provides care services to older people in US nursing homes,
found that staff felt ill-prepared to deal with public health emergencies.
In the UK context,
care homes are not seen as part of the National Health Service.
Many of them are privately owned,
and this may affect access to personal protective equipment, PPE.
And, importantly, as the name suggests, care homes are homes.
They are the residents' homes,
albeit on a communal basis,
and staff will try to enhance that homely environment
rather than create a clinical environment,
which would be commonly seen in the hospital.
So all of this background
highlights how a perfect storm has been created in care homes
during this pandemic:
a vulnerable population,
a high-risk environment,
and lack of resources.
But, perhaps, there's also been an intangible factor at play
and something this society may not have been prepared to admit:
do we really care about what happens in care homes?
The residents are old and are probably going to die anyway.
So why bother to test?
And why bother to count the number of cases and deaths?
Prime minister Boris Johnson stated in the UK Parliament
on Wednesday, May the 6th:
'There is an epidemic going on in care homes,
which is something I bitterly regret.'
There's been growing recognition
that care homes were left behind and forgotten in the early stages.
and there's now a concerted effort to play catch-up with testing,
the provision of PPE,
and further support from the NHS,
with hospital nurses now working in care homes
and other staff providing advice on infection control.
Care home staff have worked under the most difficult of circumstances
to provide the best care to residents,
to the extent that many are now living on-site
to maintain lockdown conditions and minimise the risk of transmission.
As we move towards a possible lifting
of some of the more extreme elements of lockdown,
might the experience witnessed in care homes
lead to a more sustained and permanent change
in how society views older people
and particularly those who reside in care homes?
Might care homes be seen
as an important part of health and social care,
not sitting at the periphery of the NHS
and often viewed
as the care provider of last resort?
In 2007,
the British journalist Polly Toynbee
wrote in an opinion piece for The Guardian:
'Schools are hot politics;
old folks' homes aren't.'
13 years later, in 2020,
care homes have become hot politics, but for all the wrong reasons,
and society has been appalled at what has happened.
But perhaps this tragedy will be the catalyst for change in care homes.
On a Thursday night,
we stand on our doorsteps to applaud those working in the NHS
and other front-line workers.
Let us reflect, in particular, about care homes -
the staff, the residents -
and what they have faced over the course of this pandemic.
It is timely that we think about what we value
when it comes to the care and protection of some of the most vulnerable in society.
And we should think about what we would want for ourselves
if, in the future, we become care home residents.
Alan Bennett, the writer and playwright,
has been an advocate for improving care for older people.
He has written movingly about his own mother's time in a care home,
where she eventually died.
In his book 'Telling Tales',
he reminds us that old age will come to many of us despite what we think.
He writes the following:
'And one of the ways the young think they are safeguarded
against the fate and the future of their grandparents is by their names.
Sharons don't suffer from dementia or Damiens from incontinence.'
Alan Bennett goes on to warn us that our names are not enough to save us.
I quote:
'But coming up the road are the Danes and the Darrens and the Waynes,
and they too shall fail.
It won't be long before even Tiffany is a grandmother
and her cot got ready in the corner.
Her children, middle-aged and vaguely resentful,
come and sit with her on Sunday afternoons
while she tries to remember who they are and who she is.
"You're Tiffany, Mother,
and this is your little granddaughter."
And what will her name be?'