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We must take care of the mental health of those in care homes


George Coxon, author.


Our duty of care is multifaceted. To ensure mental wellbeing in our care homes, we must be kind, curious and non-judgmental in how we recognise and respond to signs of stress, distress and upset.

Last month we observed two minutes silence in my two care homes to remember those who made the ultimate sacrifice in past conflicts.  As always, Remembrance Day felt emotional, with a combination of sadness and pride.   

It was especially poignant this year because we are living through another serious battle right now, with another similarly menacing enemy – this time an invisible one. Coronavirus is giving huge anxiety to us all particularly those living and working in care homes, as well as their loved ones. Between April and July 14,000 deaths occurred in UK nursing and care homes and as the pandemic continues there is fear this second wave will be more virulent.  The frontline is where we all find ourselves right now but perhaps with extra special stress for those most vulnerable and those with close emotional ties to them.  

Mental health is my long-standing clinical background so I am acutely aware of the impact this pressure will have on mental health. What we must remember is there are four cohorts of people who need careful and person-centred support for their wellbeing and resilience. These are our residents, their loved ones, our staff and their loved ones. 

There are nearly 22,000 care homes in the UK with around 16,000 in England with over 400,000 people living in them. Our determination to retain a robust, safe and positive day to day life has seen a mixture of great adapting and resilience at the same time as frustration based on negative headlines and late, often confusing, saturation of guidance where a one size-fits-all view is often witnessed. That’s a lot of people under huge mental strain.     

This is why the issue of visiting loved ones in care homes is so important. I have for years been a supporter of the advocacy group John’s Campaign, which was founded in 2014 and calls for extended visiting rights for family carers of patients with dementia in hospitals in the UK. They have recently raised concerns about the visiting rights in care homes during the coronavirus. As have a new campaigning body ‘Rights for Residents’. They have had a lot of media coverage recently arguing to retain visiting in care homes. They point out that care homes have witnessed devastating mental as well as physical deterioration during the pandemic.  

My care homes have been very vocal in supporting the reuniting of loved ones being ‘risk aware not risk averse’. This has meant speaking up in support of families maintaining real contact not just using virtual (often logistically challenging) methods of keeping in touch. We have dared to challenge simplistic blanket bans by exercising our own best practice and policy guidance, using the principles in the most recent guidance of ‘dynamic risk assessment’ on a very person-centred basis. We have said no window visits and no artificial walkie-talkies in separate rooms; just sensible adherence to distancing, PPE, use of basic hand washing and sanitising, and sensitively observed humane support with reassurance during the visits. Our duty of care is multifaceted. To ensure mental wellbeing in our care homes, we must be kind, curious and non-judgmental in how we recognise and respond to signs of stress, distress and upset.   

But things could be looking up. I write this fresh from a call having been selected to be amongst the few Devon care homes chosen to be part of a Department of Health and Social Care visitor testing national pilot. This is after taking delivery of an external camping pod to enable safe visits and possible accommodation for staff wishing to isolate away from their own families should this be needed now as we go full steam into winter. The Government has announced testing should be available for residents in care homes so they can have up to two visitors per week in the Christmas period.  And of course, we’ve had the big news the Medicines and Healthcare products Regulatory Agency (MHRA) have approved Pfizer/BioNTech’s COVID-19 vaccine for use. With the Oxford University/AstraZeneca vaccine hopefully not far behind. The term ‘game changer’ has been talked about, and this gives real possibility life might return to normal by the spring.

The frontline has moments like these; some prove false dawns but ultimately we are optimistic that the end will come soon. We want to survive this period with the least casualties possibly, with pride and resilience. But we must remember just how important it is to take care of the mental health of everyone in care homes to do that.