After 10 months of successfully resisting this vicious invisible enemy, our defences were finally breached early in the New Year. Soon (too soon) after we celebrated being one of the first care homes in the country to get all of our residents vaccinated.
We spent the first week of January testing residents and staff, and one by one all of our core staff tested positive despite every effort to increase our already hyper vigilance. Subsequently the staff were required to isolate for 10 days. We also saw residents testing positive too but they remained asymptomatic, though we were now isolating everyone in their bedrooms for the 14 days, in accordance with guidance. This, for people living with advanced frailty and dementia, was so hard and for most it felt like a misery and punitive step. So much effort was made by our borrowed staff seconded from our sister home and with support from agency (we have never used agency staff in 14 years owning the home).
In week two and three of January we had a combination of unfamiliar staff, the isolation of residents feeling increasingly hard, and some of our most frail, vulnerable and long-lived residents beginning to show signs of significant decline not typical of the virus. General lethargy, loss of appetite, some agitation – all of which could easily be regarded as consequences of the restrictions being imposed during isolation.
The end of week three from the vaccination saw our first loss of a resident who had been declining over several months. They had tested positive but again there were no classic coronavirus symptoms. We remained hopeful that after well over two weeks from vaccination we may still come through reasonably unscathed. In week three, however, we had a non-Covid unexpected loss at the point the resident was about to end her 14 day isolation. We also saw two further residents have very rapid declines and need palliative end-of-life care. Our final loss of our longest lived resident happened a few days later.
After this experience, I would say there are seven stages of response and recovery when Covid enters into a home. First there is shock and fear it has found its way in then there is hope you can withstand the assault. You make furious preparations in case it takes hold, you deal with the consequences of isolating staff and residents, come under fire as residents develop symptoms (which happened between day 11 and 14 for us). Then come the numbness and pain of loss, and finally you are trying to return to a normal life and atmosphere in the care home.
Week four for us was recovery week. We had all of our staff back, all feeling a mixture of enthusiasm to return tinged which much guilt at not having been able to support the home during their isolation. Our debriefings with staff have been and are still emotional. The relationships that staff in care homes have with those we care for are based in loving companionship, never more embedded in everyday life than during the pandemic, when family visits have been far from adequate.
In our care home, we were determined not to be beaten or silenced in our battle against this dreadful unforgiving enemy. Our honesty and shame-free approach has been endorsed by the support we have had from the families of all of our residents, even from those who have lost loved ones. We have said throughout the pandemic that kindness and tolerance with no blame and no shame are essential for us all in how we stay strong and confident. We know we are not alone as so many care homes suffer the similar awfulness as the virus strikes. The overwhelming support from our local community has been breathtaking and four schools have sent drawings, stories and lovely cards that have both warmed our hearts and given us morale boosting support. Working with our district nurse and primary care partners was also so important where the approach needed to be based on mutual respect and trust. There can often be a mismatch in terms of how health and care services work together but to sustain a positive approach to getting through the difficult times we must all remember we are in it together and want the same thing – great care and a focus on the wellbeing of those we look after.
I believe there are many learning points as we come out the other side of this desperate situation. As well as not allowing a blame culture, it’s important to document and communicate because these are the bedrocks of great care standards – communicate with families as well as residents – and for leaders, we must embed confidence, belief and trust in our homes. We must ensure residents’ physical (especially make sure they are hydrated) and mental wellbeing are a priorities. Most importantly, take time for residents during isolation. It is important tackling Covid in their home doesn’t feel like a punishment.