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News ArticleA woman has been arrested after attempting to take her 97-year-old mother out of a care home for lockdown. Qualified nurse Ylenia Angeli, 73, wanted to care for her mother, who has dementia, at home. But when she told staff at the care home, they called the police who then briefly arrested Ms Angeli. The family have not been able to see their elderly relative for nine months, and decided to act ahead of the second national lockdown. Assistant Chief Constable Chris Noble, from Humberside Police, said: "These are incredibly difficult circumstances and we sympathise with all families who are in this position." "We responded to a report of an assault at the care home, who are legally responsible for the woman's care and were concerned for her wellbeing. We understand that this is an emotional and difficult situation for all those involved and will continue to provide whatever support we can to both parties." The incident came to light on the day the government announced new rules for families wishing to visit their loved ones in care homes. Under the guidance, issued hours before lockdown, families can meet relatives through a window or in a secure outdoor setting. Visits will need to be booked in advance, but the Department of Health and Social Care advice said care homes "will be encouraged and supported to provide safe visiting opportunities". All care home residents are allowed to receive visits from friends and family during the second national lockdown. Read full story Source: Sky News, 5 November 2020
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Content ArticleElderly people in care homes in Cornwall were abused and neglected while failings led to reports of concerns not being investigated, a new Safeguarding Adults Review has found. The Morleigh Group, which operated seven homes in Cornwall and has since shut down, was exposed in a BBC Panorama investigation in 2016. A new Safeguarding Adults Review which was commissioned as a result of the TV show has been published making a number of recommendations to all agencies which were involved in the case. The review was completed in April 2019 but has only just been made public - Rob Rotchell, Cornwall Council Cabinet member for adult social care said that this was due to the number of agencies being involved.
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News Article
Judge says care home residents in England are legally allowed visitors
Patient Safety Learning posted a news article in News
A senior judge has said friends and family can legally visit their loved ones in care homes, in an apparent challenge to recent government policy that has in effect banned routine visits in areas of high COVID-19 infection. Mr Justice Hayden, vice-president of the court of protection which makes decisions for people who lack mental capacity, said courts are concerned about the impact on elderly people of lockdowns. He has circulated a memo that sets out his analysis that regulations do “permit contact with relatives” and friends and visits are “lawful”. He was responding to guidance from the Department of Health and Social Care (DHSC) last month telling thousands of care homes in England that visiting should be stopped in areas with tier 2 and tier 3 lock down restrictions, apart from in exceptional circumstances such as the end of life. It triggered blanket prohibitions by some councils and sparked anguish from relatives who warn a lack of contact is leading to misery and early death in some cases. Within a week, Gloucestershire county council told care homes in its area to stop visits until next spring. With the England-wide lockdown starting on Thursday, care home providers, families and groups including Age UK and Alzheimer’s Society, have called on ministers to this time make clearer provisions for visiting. Hayden said exceptions in the existing regulations mean contact with residents staying in care homes is lawful for close family members and friends. He said the court of protection was concerned about “the impact the present arrangements may have on elderly people living in care homes,” citing their suffering. Read full story Source: The Guardian, 2 November 2020 -
Content ArticleThe Cornwall and Isles of Scilly Safeguarding Adults Review into The Morleigh Group has found elderly people in care homes in Cornwall were abused and neglected while failings led to reports of concerns not being investigated. The Morleigh Group operated seven homes in Cornwall and has since shut down. The review was completed in April 2019 but has only just been made public - Rob Rotchell, Cornwall Council Cabinet member for adult social care said that this was due to the number of agencies being involved.
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News ArticleA total of 338 patients with a diagnosis of COVID-19 were discharged from Scottish hospitals into care homes in the three months from March this year, says a report from Public Health Scotland. The discharges were necessary to free up space in hospitals for COVID-19 patients but some care home owners have claimed that it introduced the virus into their premises, causing almost 2000 deaths across Scotland.2 Public Health Scotland says that most of the 3599 discharges that took place in the busiest month of March were among people who had never been tested. Of the 650 who were tested, 78 were positive, but the discharges still went ahead. Scotland has been found to have the highest rate of COVID-19 related deaths in care homes of any part of the UK. Read full story Source: BMJ, 29 October 2020
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News ArticleThe government has been warned it is throwing “a lit match into a haystack” by discharging Covid-positive patients to care homes, with politicians demanding that the safety of residents and staff is guaranteed under the new policy. During the first wave of the pandemic, approximately 25,000 hospital patients were sent to care homes – many of whom were not tested – which helped spread the virus among residents. Around 16,000 care home deaths have been linked to COVID-19 since the start of the crisis. The strategy was one of the government’s “biggest and most devastating mistakes” of the crisis, says Amnesty International, and questions have been raised over the decision to introduce a similar policy as the UK’s second wave intensifies. As part of the 2020 adult social care winter plan, the government has called on local authorities and care providers to establish “stand-alone units” – so-called “hot homes” – that would be able to receive and treat Covid hospital patients while they recover from the disease. There is also an expectation that, due to housing pressures and a shortage of suitable facilities, some patients may be discharged to “zoned accommodation” within a home, before being allowed to return to normal living settings once they test negative for the virus. Councils have been told to start identifying and notifying the Care Quality Commission of appropriate accommodation, and to ensure high infection prevention standards are met. Under the requirements outlined by the government, discharged patients “must have a reported Covid test result". However, The Independent revealed on Monday that these rules have not been followed in some cases, with a recent British Red Cross survey finding that 26 per cent of respondents had not been tested before being discharged to a care home. There is also concern whether care homes possess enough adequate personal protective equipment to prevent outbreaks, with the CQC revealing last month that PPE was still not being worn in some sites. Read full story Source: The Independent, 27 0ctober 2020
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Content ArticleA rapid-learning report on the role of Patient Safety Collaboratives (PSCs) during the pandemic has been published by the AHSN Network. PSCs are just one part of the health and care system which responded quickly to the immediate crisis from COVID-19 in March. They reprioritised their day-to-day work and took on new programmes at speed, such as promoting safer tracheostomy care. The report has been published as part of the NHS Reset campaign and gives examples of how PSCs refocused their work ‘almost overnight’ to respond to the pandemic. It illustrates some of the creative ways AHSNs supported their local systems and how this experience will be built into future patient safety programmes.
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News ArticleMinisters have denied care home inspectors access to weekly testing for coronavirus – despite fears they could contribute to the spread of COVID-19 as cases rise across the country, The Independent can reveal. The Care Quality Commission (CQC) was told by the Department of Health and Social Care last month it could not have access to regular testing for inspection teams as the watchdog prepares for 500 inspections of care homes during the next six weeks. Officials said the teams, who are assessing care conditions for the vulnerable and elderly, did not get close enough to people to present a risk. During the first wave of the virus, after Public Health England initially said there was no risk to care homes, an estimated 16,000 residents died from the virus. At the height of the crisis up to 25,000 NHS patients were discharged to care homes by the NHS, with many not having been tested for the virus. Labour MP Barbara Keeley said: “The refusal of the Department of Health and Social Care to treat CQC inspectors in the same way as other staff going into care homes puts lives at risk.” Read full story Source: The Independent, 20 October 2020
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News Article
England's 'fragile' care sector needs immediate reform, says regulator
Patient Safety Learning posted a news article in News
The government must immediately deliver a new deal for social care with major investment and better terms for workers, the Care Quality Commission (CQC) has said, as it warned that the sector is “fragile” heading into a second wave of coronavirus infections. In a challenge to ministers, the regulator’s chief executive, Ian Trenholm, said overdue reform of the care sector “needs to happen now – not at some point in the future”. Boris Johnson said in his first speech as prime minister, in July 2019: “We will fix the crisis in social care once and for all.” But no reform has yet been proposed, and more than 15,000 people have died from COVID-19 in England’s care homes. Trenholm said Covid risked turning inequalities in England’s health services from “faultlines into chasms” as the CQC published its annual State of Care report on hospitals, GPs and care services. The report reveals serious problems with mental health, maternity services and emergency care before the pandemic, and says these areas must not be allowed to fall further behind. The regulator argued that the health system’s response to the pandemic needs to change. After focusing on protecting NHS services from being overwhelmed, health leaders must now adapt to prevent people who need help for non-Covid reasons from being left behind, it said. These include people whose operations were cancelled and people from black and minority ethnic backgrounds, people with disabilities, and people living in deprived areas who have suffered more severely from the impact of Covid. “Covid is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others,” said Trenholm. Read full story Source: The Guardian, 16 October 2020 -
News Article
Infection control experts issue open letter on care home visiting
Patient Safety Learning posted a news article in News
A group of experts in nursing and infection prevention and control (IPC) is today warning against the use of IPC measures as a “rationale” for stopping safe and compassionate visits in care homes during the Covid-19 pandemic. In a new open letter published in Nursing Times, the specialists say that preventing people from visiting loved ones in social care settings in the name of IPC is a “misinterpretation and at times even abuse” of IPC principles. The letter is the brainchild of independent global health consultant and former Infection Prevention Society (IPS) president, Jules Storr. Among the signatories are five former IPC presidents, current president Pat Cattini as well as incoming president Jennie Wilson. Dr Ron Daniels, chief executive of the UK Sepsis Trust, is also on the list, Helen Hughes, chief executive of Patient Safety Learning, as well as leading IPC nurse specialists, nurse academics, a GP and carers. Ms Storr, a nurse by background, and the hub topic lead, said she was motivated to take action after hearing “the most heart-breaking” stories from health professionals and relatives of residents about restricted visits in the UK in the wake of COVID-19. Some had not seen relatives for weeks or months, whilst others were only allowed to see their loved one once a week for 20 minutes at a distance, she said. One individual had told her how when their father had died only one family member was permitted in the home and they were not allowed to sit close enough to hold his hand. Ms Storr said these practices were “absolutely outrageous and wrong from an infection prevention point of view”. Read full story Source: Nursing Times, 16 October 2020 -
Content ArticleAn open letter has been published in the Nursing Times from infection prevention and control experts, together with interested and concerned individuals and organisations, about the restrictions enforced in nursing, care and residential homes. Restrictions are being imposed in relation to COVID-19 across too many nursing, care and residential homes in the UK and beyond, in the name of infection prevention and control. A number of experts in this field, led by Jules Storr, independent global health consultant and former Infection Prevention Society (IPS) president, summarise in an open letter why infection prevention and control should be an enabler not a barrier to safe, compassionate human interaction in nursing, care and residential homes. By adding their voice their intention is to accelerate action to end this uncompassionate treatment of people in homes as well as for their families and other loved ones.
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Content ArticleOn the 12 October 2020, the Care Quality Commission (CQC) announced the launch of a review into the imposition of blanket ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) notices for patients in care homes, primary care and hospitals. This follows revelations earlier in the year that potentially thousands of patients were being placed in care homes with blanket ‘do not attempt resuscitation’ (DNAR) notices in place. This has led to widespread public criticism. This article explores whether a DNACPR notice is valid without the consultation of family members or other representatives of a patient receiving care and, if not, what should be done?
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News ArticleCare homes should refuse to take coronavirus patients from hospitals if they cannot prevent the spread of the disease, the care watchdog has told The Independent. Staff should admit these patients only if care homes are equipped with the right personal protective equipment (PPE) and infection prevention measures, the Care Quality Commission (CQC) said. During the first wave of the pandemic, care homes saw widespread outbreaks of the virus with 16,000 deaths. Homes struggled to access protective clothing for staff and were forced to take 25,000 untested patients discharged from hospitals. In an in-depth interview, Kate Terroni, the CQC’s chief inspector of social care, said care homes should not be put under pressure during a second wave to take infected patients they could not properly look after. She said any home that refused to admit patients would have her support. “Care home providers should only admit a resident when they are confident they can meet their care needs, so where they are confident they’ve got good infection prevention control, they’ve got the right PPE, they’ve got the right workforce." “We will absolutely support a provider to say they cannot admit someone if those ingredients aren’t in place.” Read full story Source: The Independent, 12 October 2020,
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News ArticleAn urgent investigation into blanket orders not to resuscitate care home residents has been launched amid fears some elderly people may still be affected by the “unacceptable” practice. After COVID-19 cases rose slightly in care homes in England in the last week, with 116 residences handling at least one infection, the Care Quality Commission (CQC) said it was developing the scope of its investigation “at pace” and it would cover care homes, primary care and hospitals. In March and April, there were reports that some GPs had applied “do not attempt resuscitation” (DNAR) notices to groups of care home residents that meant people would not be taken to hospital for potentially life-saving care. This was being done without their consent or with little information to allow them to make informed decisions, the CQC said. Cases emerged in care homes in Wales and East Sussex. Care homes said the blanket use of the orders did not appear to be as prevalent ahead of a possible second wave of infections and families were reporting fewer concerns, although that could be because visiting restrictions meant they had less access to the homes and were getting less information. There are also concerns that steps may not have been taken to review DNAR forms added to care home residents’ medical files, and so they could remain in place, without proper consent. The CQC review will examine the use of “do not attempt cardiopulmonary resuscitation” (DNACPR) notices, which only restrict chest compressions and shocks to the heart. Dr Rachel Clarke, a palliative care expert in Oxford, has described the CPR process as “muscular, aggressive, traumatic” and said it often resulted in broken ribs and intubation. The review will also investigate the use of broader do not resuscitate and other anticipatory care orders. “We heard from our members about some pretty horrific examples of [blanket notices] early in the pandemic, but it does not appear to be happening now,” said Vic Rayner, the executive director of the National Care Forum, which represents independent care homes. “DNAR notices should not be applied across settings and must be only used as part of individual care plans.” It will also investigate the use of broader do not resuscitate and other anticipatory care orders. Read full story Source: The Guardian, 12 October 2020
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Content ArticleFor months, Trevor has been unable to visit his wife, Yvonne, who lives in a care home. In this blog, published by the Alzheimer's Society, Trevor calls for assurance from Government that they will consider the needs of people living with dementia, like Yvonne.
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Content ArticlePublished by the Older People's Commissioner for Wales, Care Home Voices: A snapshot of life in care homes in Wales during Covid-19, gives a voice to people living and working in Welsh care homes and provides a snapshot of their experiences during the COVID-19 pandemic. The responses from older people and their families and friends highlight just how difficult lockdown has been for many people. Many older people had not seen their family and friends at all for prolonged periods and had concerns about the impact that lockdown could be having on their wellbeing.
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Content ArticleThe report, As if expendable: The UK Government's failure to protect older people in care homes during the COVID-19 pandemic, was published by Amnesty International in 2020. It argues that the UK government, national agencies, and local-level bodies have taken decisions and adopted policies during the COVID-19 pandemic that have directly violated the human rights of older residents of care homes in England – notably their right to life, their right to health, and their right to non-discrimination. The report states that decisions and policies have also impacted the rights of care home residents to private and family life, and may have violated their right not to be subjected to inhuman or degrading treatment.
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News ArticleSending thousands of older untested patients into care homes in England at the start of the coronavirus lockdown was a violation of their human rights, Amnesty International has said. A report says government decisions were "inexplicable" and "disastrous", affecting mental and physical health. More than 18,000 people living in care homes died with COVID-19 and Amnesty says the public inquiry promised by the government must begin immediately. According to Amnesty's report, a "number of poor decisions at both the national and local levels had serious negative consequences for the health and lives of older people in care homes and resulted in the infringement of their human rights" as enshrined in law. Researchers for the organisation interviewed relatives of older people who either died in care homes or are currently living in one; care home owners and staff, and legal and medical professionals. Amnesty said it received reports of residents being denied GP and hospital NHS services during the pandemic, "violating their right to health and potentially their right to life, as well as their right to non-discrimination". It adds that care home managers reported to its researchers that they were "pressured in different ways" to accept patients discharged from hospital who had not been tested or had COVID-19. Amnesty says the public inquiry into the pandemic should begin with an "interim phase". "The pandemic is not over," it added. "Lessons must be learned; remedial action must be taken without delay to ensure that mistakes are not repeated." Read full story Source: BBC News, 4 October 2020
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Content ArticleEverybody has a right to good care. Much attention is rightly focused on the occasions when people experience poor quality care, but it is also important to recognise where care is good and to celebrate the services that are getting it right. Some care providers do things well through innovative new ways of working, or by doing the basics well. Others can learn from them and solutions should be shared across the system. This publication from the Care Quality Commission (CQC) is purposely focused on celebrating good and outstanding care that CQC's inspectors have seen.
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News Article
Coronavirus: Delirium 'key symptom' in frail older people
Patient Safety Learning posted a news article in News
Doctors and carers should look out for signs of confusion or strange behaviour in frail older people because it could be an early warning sign of COVID-19, research suggests. Even if they have no cough or fever, delirium is more common in vulnerable over-65s than other, fitter people of the same age. But it's not yet clear why this extreme confusion or delirium happens. In this King's College London study, data from more than 800 people over the age of 65 was analysed. They included 322 patients in hospital with COVID-19, and 535 people using the Covid Symptom Study app to record their symptoms or log health reports on behalf of friends and family. All had received a positive test result. The researchers found that older adults admitted to hospital who were classified as frail were more likely to have had delirium as one of their symptoms, compared with people of the same age who weren't frail. For one in five patients in hospital with Covid, delirium was their only symptom. The study calls for more awareness of it in hospitals and care homes. Read full story Source: BBC News, 30 September 2020 -
Content ArticleIn the UK, people affected by dementia have been hit the hardest by the coronavirus (COVID-19) pandemic. From the high death rate in care homes, to the significant cognitive decline for people who live in the community, to the rising mental health challenges for unpaid carers, the pandemic has had a severe impact, while exposing our fragmented social care system for all to see. Alzheimer’s Society is the UK’s leading dementia charity, and in this report they bring together evidence from a wide range of sources to shine a light on the impact of COVID-19 on people who have dementia and those who care for them.
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News ArticleSweeping bans on visiting at thousands of care homes risk residents dying prematurely this winter as they give up hope in the absence of loved ones, experts in elderly care have warned. More than 2,700 care homes in England are either already shut or will be told to do so imminently by local public health officials, according to a Guardian analysis of new government rules announced to protect the most vulnerable from COVID-19. Care groups are calling for the government to make limited visiting possible, including by designating selected family members as key workers. Since Friday any care homes in local authority areas named by Public Health England for wider anti-Covid interventions must immediately move to stop visiting, except in exceptional circumstances such as end of life. It also halts visits to windows and gardens and follows seven months of restrictions in many care homes that closed their doors to routine visits in March. The blanket bans will result in the “raw reality of residents going downhill fast, giving up hope and ultimately dying sooner than would otherwise be the case”, warned the charity Age UK and the National Care Forum (NCF), which represents charitable care providers. Read full story Source: The Guardian, 23 September 2020
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News ArticleHealth inspectors have uncovered multiple problems with infection control and the use of personal protective equipment (PPE) in care homes in England ahead of a second spike in COVID-19, which is starting to be detected in care facilities across the country. The Care Quality Commission (CQC) found homes where PPE was not being worn and that had out-of-date infection prevention policies and were failing to take steps to protect black and minority ethnic residents and staff who have been identified as potentially more vulnerable to the virus. The checks took place last month in 59 English care homes and were triggered by concerns about safety and quality or complaints by residents, staff and relatives. The checks precede a government announcement within days of a winter infection control fund that is expected to broadly match the £600m already committed this year. The fund will pay additional staff costs stemming from using fewer highly mobile temporary workers, who have been shown to spread the virus. However, the CQC inspections found PPE being worn inconsistently by staff members, limited supplies of masks in some places, and a failure to store PPE safely away from infection risk. “We found examples of infection prevention and control policies that were out of date,” the inspectors said. “Some had been updated early on in the Covid-19 outbreak but had not been amended since and so contained out-of-date information. This posed a risk to the staff and people who live in the care home. Others had not been updated since 2019. One care home had completed a [contingency] plan, but it only covered the hot weather and did not include preparations for autumn and winter.” Read full story Source: The Guardian, 16 September 2020
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Content ArticleA fundamental shift is underway in care provision for older populations, with long-term care (LTC) increasingly taking on care provision that was traditionally delivered in hospitals. As OECD populations are rapidly aging, there has been increasing demand on the LTC sector to provide care for more, and older people, with complex conditions and heightened needs for expert care. Currently, 58% of adults aged 65 or over report living with two or more chronic diseases, with this figure rising over 70% in many OECD countries. Simultaneously, trends in LTC focus on substitution of care settings from nursing homes and residential care towards home care and supporting older persons to live on their own or with family as long as possible. The total cost of avoidable admissions to hospitals from LTC facilities in 2016 was almost USD 18 Billion, equivalent to 2.5% of all spending on hospital inpatient care or 4.4% of all spending on LTC. Research shows that over half of the harm that occurs in LTC is preventable, and over 40% of admissions to hospitals from LTC are avoidable. The root causes of these events can be addressed through improved prevention and safety practices and workforce development—including skill-mix and education. Targeted investments in a number of key areas can have a significant impact by mitigating the main cost drivers of adverse events in LTC.
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News ArticleThe government has written to care home providers in England to warn them of a rise in new coronavirus infections within the sector. A letter from the Department of Health urged care bosses to take "necessary action to prevent and limit outbreaks". Cases were mainly among staff but risked spreading to residents, it said. It comes as a further 3,330 positive cases were recorded in the UK - the third consecutive day in which cases have been over 3,000. It brings the total number of confirmed cases to 368,504. Friday's letter from the Department of Health and Social Care said testing data had revealed an increase in the number of positive results in care homes and called on the care sector to work with the government. "You will know already that we are experiencing a rise in confirmed Covid-19 cases across the UK population," wrote Stuart Miller, director of adult social care delivery. "I need to alert you to the first signs this rise is being reflected in care homes too." "I am writing at the earliest opportunity, so we can work in partnership to prevent further spread of the disease. The rapid flow of data and information, to and from care providers, is vital to this effort." Mr Miller said the infections had been detected chiefly among staff but had been transmitted to residents in some cases. He went on to stress "the importance of regular testing and consistent use of PPE". Read full story Source: BBC News, 14 September 2020
