Why risk should continue to be assessed individually for people and places
Of course, it is completely understandable that policymakers want to take every precaution they can when it comes to care homes, given the catastrophic suffering and loss of life earlier in the pandemic and now with the emergence of a ‘second wave’. Declaring a ‘no visiting’ blanket ban, or near ban, may seem to them like the right thing to do against this context – but we seriously question whether it really is, and for a number of important reasons.
Firstly, care homes and residents are all different whereas a blanket ban inappropriately treats everywhere and everyone the same. Surely, with this as with everything the appropriate way to proceed is by assessing the risk for places and people on an individual basis.
Secondly, it seems perverse, to say the least, for official guidance to say that in certain circumstances a person can be discharged from hospital into a care home without a test showing they are COVID-19 negative, yet carefully managed visits by loved ones should cease. This makes no sense at all.
Thirdly, we are not aware of any evidence showing that ‘visits’, if carefully managed, have been a significant risk in spreading the infection so far. On the contrary, our understanding is that the evidence points more towards people who come in and out of a care home inevitably being rather more of an ongoing risk, whether they are staff or visiting GPs and District Nurses, or indeed CQC inspectors. Unless these incomers are housed on site they live in communities like the rest of us and so are as vulnerable to picking up the infection as we all are.
Finally, the risk of visiting contributing to spreading the infection is not the only risk that has to be managed here, though it’s the one we have the metrics to count. The other risk, which is very significant for many older people living in care homes, is that their physical and mental health significantly declines as a result of a prolonged lack of connection with those who mean most to them. It is this very delicate balancing act that homes, in partnership with relatives, have been negotiating in recent months.
It is a very human balancing act that centres around people and their needs, and the risks for those living and working within a care home and relatives and friends too. Everyone has their part to play in making this a success: homes need to communicate transparently and often, sharing their thinking and measures to minimise risk as the situation changes; relatives need to ensure they are working with the home to facilitate these mitigations; and everyone needs to keep the focus on what really matters here – the safety and the welfare of the person living in the home. A polarised debate helps no one.
The public conversation about this is not helped by the term ‘visiting, which somehow fails to capture what many relatives and friends often do for people in care homes to supplement the care available from staff. It is not unusual, for example, for the partner of a resident with dementia to spend many hours with them, helping them very slowly to eat and drink sufficiently. As the most familiar and cherished people in their lives relatives and friends also play a big part in giving residents reasons to stay cheerful. They are also often able to communicate effectively with a person who has dementia or another form of cognitive decline in a way which even the most highly skilled staff cannot manage – love makes all the difference.
Finally, for older people with dementia we understand there is clear evidence that connection helps to slow down the progress of the disease, whereas its absence helps to accelerate it. The very hard reality for all us to contemplate is that for many care home residents, they don’t have time for us to get this absolutely right and therefore it is about balance – like every decision we have to take with and for them. However, let us not let this be portrayed as a Faustian pact – it should be a shared endeavour amongst us all to support people to live the best possible life, one we undertake knowingly, and with the best intentions at heart.