Why social workers should be aiming to get residents out of care homes during the pandemic

For many deprived of their liberty, coronavirus means that it is no longer in their best interests to stay in a care home, argues barrister Oliver Lewis

Human rights card
Photo: relif/Fotolia

By Oliver Lewis

In the distant past of 25 March 2020, Michelle Bachelet, the UN High Commissioner for Human Rights, warned that coronavirus “risks rampaging through [detention centres and residential care facilities’] extremely vulnerable populations.” She called on governments to address the situation of detained people in their crisis planning to protect them, staff, visitors and wider society.

Her prescient prediction has come true. Data from European countries suggests that half of all coronavirus deaths involve care home residents. While official figures from the Office for National Statistics record 1.043 deaths linked to coronavirus in care homes in England and Wales up to 10 April, not-for-profit providers umbrella body the National Care Forum has estimated that 4,040 people may have died in residential or nursing homes in the UK up to 13 April.

Over the weekend Public Health England announced there were 3,084 care homes in England with Covid-19 outbreaks, as of 15 April 2020. There are currently 15,492 homes registered by the Care Quality Commission in England, which means there had been, as of last week, outbreaks in 20% of homes. That proportion will rise and some larger providers have already reported cases in at least half of their homes.

Care homes increase residents’ risk of infection because of the physical proximity of and multiple contacts between residents and staff. Care home residents are more likely than the general population to have comorbidities relating to respiratory disease, heart disease, their immune systems, diabetes and obesity, which increases the risk that they will have a more severe form of the infection.

DoLS in the time of coronavirus

A significant number of those in care homes are deprived of their liberty. In the year to 31 March 2019, 116,940 Deprivation of Liberty Safeguards applications were granted in care homes or hospitals. There is no data as to how many residents are currently under a DoLS authorisation, but whatever the figure is, it is a very significant number of residents of care homes and hospitals who are not legally allowed to leave. Those people lack capacity to decide where to live. Unless they are under a short-term urgent authorisation, they are deprived of their liberty under a standard authorisation, under schedule A1 of the Mental Capacity Act 2005 (MCA).

A deprivation of liberty is lawful only if the “qualifying requirements” of schedule A1 are met. One of them is the best interests requirement, which is that it must be in the person’s best interests to be detained and the deprivation of liberty must be necessary to prevent harm and  a proportionate response to the likelihood and seriousness of that harm. In determining best interests, the best interests assessor (BIA), typically a social worker, “must consider all the relevant circumstances” – as per section 4(2) of the MCA.

The Coronavirus Act 2020 makes no changes to the MCA. The guidance on managing DoLS cases during the pandemic emphasises that “[c]are and treatment should continue to be provided in the person’s best interests.”

The legal framework may not have changed, but the relevant circumstances certainly have. The life and wellbeing of each care home resident is threatened by continuing be a detained resident, given the risk of contracting coronavirus.

Coronavirus changes the best interests calculation.”

For many residents, the best interests qualifying requirement will no longer be met, because continued detention will cause harm rather than prevent it. Coronavirus is not the only “relevant circumstance” and there will be a myriad of other considerations. But there is no doubt that coronavirus is now a major consideration which local authorities ignore at their peril.

In addition, responding to the coronavirus pandemic, the European Committee for the Prevention of Torture (CPT) has published a statement of principles relating to the treatment of people deprived of their liberty. The CPT calls on all relevant authorities to take concerted efforts to find alternatives to deprivation of liberty, including reassessing the need to continue involuntary placement of psychiatric patients and, wherever appropriate, discharging residents of care homes into community care. Similarly, the UN Committee on the Rights of Persons with Disabilities has called on states  to “accelerate measures of deinstitutionalization of persons with disabilities from all types of institutions.”

Furthermore, the state (which includes local authorities and all organs of the NHS such as clinical commissioning groups and NHS trusts) has an ongoing duty to protect each person’s right to life, under Article 2 of the European Convention on Human Rights. The state must not only refrain from taking life, but it must proactively take steps to protect people against threats to life. Given that coronavirus threatens the lives of everyone in long-term care facilities, the state has a duty to reduce that threat, and has a duty to take action now.

Where local authorities have failed to take sufficient or speedy action to protect life, they can expect legal claims against them for negligence and under the Human Rights Act 1998, by families of residents who have died in care homes.

What does this mean for social workers?

Social workers in local authorities are ‘the state’, whether in their roles in arranging people’s care and support under the Care Act, as part of DoLS teams responsible for the deprivation of liberty in hospitals and care homes or as BIAs working on behalf of those teams.

Practitioners should work with families and friends of the person deprived of liberty and make creative use of available resources including family, friends and community. They should use funding already at the disposal of local authorities as well as urgently accessing emergency funding by central government. Social workers should also explore home care, given one carer in a home setting is safer coronavirus-wise than multiple carers in congregated care.

Remember that around 80% of care homes in England reportedly do not yet have a coronavirus outbreak. That figure is going down every day, so take action today to save lives in these care homes. Here are some concrete steps that social workers should take:

  1. Gather a list of all residents deprived of their liberty in care homes and hospitals your area.
  2. Contact each resident and ask them how they are doing and whether they have any relatives they could live with while this virus persists. Explain that you will contact these relatives and friends. An inability to talk to you about relatives and friends should not prevent you from contacting them.
  3. Contact the relatives and friends and ask whether they can provide interim accommodation. This may be a life-saving measure. In ordinary times, people may not be willing to provide such accommodation, but the whole country is stepping up and people are volunteering to help others in so many ways. A “coronavirus planning check list” is provided below, to guide conversations you have with relatives. You can also direct them to the government guidance for those who provide unpaid care to friends or family.
  4. Contact homeshare and shared lives services in your area and ask for their support to help you move people out of care homes.
  5. It may not be possible for an occupational therapist to conduct an assessment in the relative or friend’s home, so this will have to be done via video conferencing. Much can be done in this way, asking questions about whether the home is barrier-free, has stairs and so on.
  6. Likewise, any training that the relative or friend requires to enhance their capabilities to meet their loved-one’s needs can be done via video conferencing.
  7. Telephone the registered manager of each care home in your area, and advise them to reach out to residents’ families and friends to make arrangements to get residents out on a temporary basis.
  8. Reach out to families and friends of care home residents directly. Put out public information to people who live in the area (for example through social media and local radio and television) advising families to contact their loved-ones in care homes and make arrangements wherever possible, to offer interim accommodation and care. Frame the message in a positive way: this is an opportunity to save a life and make a real difference.
  9. Speak to colleagues about how the local authority could provide funding for professional care staff to go into the home of the relative or friend to support their loved-one.
  10. Inform care home residents’ relevant person’s representatives (RPRs) and independent mental capacity advocates (IMCAs) of the steps that you and colleagues are taking and ask for their urgent assistance.
  11. Where there is any dispute (in other words, if there is some solution that could work but the local authority thinks it is not in the person’s best interests), it is incumbent on the local authority to make an application under section 21A of the Mental Capacity Act 2005 to the Court of Protection as a matter of urgency.
  12. When an application is made, involve the RPR and send them a copy of all of the documents and make sure they get in touch with a solicitor. In these times, it would be useful if the local advocacy service contracted by the local authority is able to perform the function of a litigation friend in the Court of Protection. This will be a much quicker process than the court inviting the Official Solicitor to act as litigation friend. If this is not part of the contractual arrangement, work with colleagues in other departments of the local authority to amend the contract and provide additional funding.

Coronavirus planning check list

Below are 25 prompt questions that social workers can use in discussions with relatives or friends of care home residents. The answers can be used to develop a plan for the resident to leave the care home.
Safety

  • Is the loved-one in danger of infecting other vulnerable members of the household?
  • During these stressful times, is the relative’s household able to provide a safe, abuse-free and conflict-free place for all, and conducive to the demands of care that the relative would be taking on?

Mobility (if relevant)

  • Is the home barrier-free?
  • Is the loved-one able to move around the home?
  • Do they need to be transferred (bed / toilet / shower) and how would this happen?
  • Do they need a lift?
  • Do they need bedrails or other protective devises?
  • Is the bathroom accessible?
  • Do they need assistive devices such as wheelchairs, walkers or canes?

Medication and home care

  • Can the relative provide any needed medication?
  • Is the relative able to monitor health conditions?
  • How will skin care be managed (if relevant)?
  • How will incontinence be managed (if relevant)?
  • Can the relative support physiotherapy or gentle exercise under tele-guidance?
  • Does the loved-one have trouble eating? Can the relative support their food needs?
  • Who will the relative call if the loved-one becomes sick (with Covid-19 or an underlying condition)?
  • Will the loved-one have access to their regular GP?

Finances

  • How will finances be arranged? Can social workers help the relative with benefits applications? Can local authority funding be redirected to home care?
  • Is the relative in employment

Dementia and memory (if relevant)

  • How will the relative support their loved-one if they have dementia?
  • Is the relative able to support a person with memory loss and other effects of dementia such as wandering or self-harming?
  • Is there a plan to keep the person safe at home? DoLS teams may need to apply for an order depriving the person of liberty in the community from the Court of Protection, but this should not slow down or prevent a transition to a relative’s home.
  • How will the relative support their loved-one’s social engagement – for example, through telephone, Zoom and so on?

Carer support

  • What are the main areas where the relative would need support (this can be done through a quick carer’s assessment under section 10 of the Care Act 2014)?
  • How can the local authority provide such support?

This list has been adapted from CanAge, an elder law NGO in Canada.

Perfection is the enemy of the good

It will not be possible for each resident to leave. Many people do not have families, so there will be no relatives to call on, shared lives or home care is unfeasible or needs are too significant to meet in a home environment. But many people do have families and friends who may be willing to step up and help out for a few months. And there are thousands of people in the country who may consider sharing their home to save a life.

During a human rights emergency, perfection is the enemy of the good. Social workers are used to rolling up their sleeves and getting on with it. Now more than ever, they should muster their creativity to come up with solutions that reduce the risk of older and disabled people living in congregated care facilities.

This is a public health emergency. It is also a human rights emergency for care home residents and staff. The best time to have taken this action was a month ago. The second best time to take action is today.

Oliver Lewis is a barrister at Doughty Street Chambers. His email is o.lewis@doughtystreet.co.uk and his Twitter handle @DrOliverLewis

26 Responses to Why social workers should be aiming to get residents out of care homes during the pandemic

  1. A Man Called Horse April 21, 2020 at 12:31 pm #

    Totally unrealistic bears no relationship to risk outside of a care home. If at home with families they will be at risk from their own families. Care workers are not being routinely tested in the community and many have the virus. Moving people out of the fire into the frying pan seems totally unrealistic and is a logistical nightmare to achieve. I think inevitably as the virus progresses many vulnerable people will die as a consequence of an absence of pandemic planning and fatal delays by Government in acting quickly enough. I see no prospect of any action at all by Local Authorities to do any of this.

    • Flint April 21, 2020 at 3:27 pm #

      Totally agree , I despair !!!

    • Kat April 21, 2020 at 7:29 pm #

      Absolutely agree… there are more problems with PPE in the community than in care homes… risks would be even higher.
      I feel there are some nasty surprises due to come from ONS statistics come out over the coming weeks… focus was slow to look at care home deaths and as usual community services to people at home lag behind.

      • Susanna Griffin April 29, 2020 at 8:25 pm #

        Agreed

    • Carina April 22, 2020 at 9:36 pm #

      I totally agree too. We need to consider all risks and at this moment in time it’s almost impossible to provide a risk free environment .

    • Tariro Jakaza April 26, 2020 at 9:49 pm #

      My thoughts exactly.

      Your comment is awaiting moderation.

    • Susanna Griffin April 29, 2020 at 8:24 pm #

      I agree as well. We have no media forum that is critical of this Government’s lack of concern about our care home residents. If we transfer people home there is a lack of carers and consequently we can’t meet their needs. Also they usually have a mish mash of carers who could transmit the virus. No figures about those dying in their own homes.

  2. June Andrews April 21, 2020 at 1:39 pm #

    It is a bit scary when a barrister says that there are likely to be legal challenges. Do you think that under normal circumstances before the COVID crisis that you would’ve issued similar advice to social workers about the many thousands of people who were medically fit but stuck in hospital because no suitable arrangements had been made for them to be discharged to a care home? Which at that time would have been in their best interest but was often not provided because of “budget” problems. Getting families to take those people home as an emergency measure? It’s sad that care homes are suddenly presented to SWs and families as an avoidable risk when it has been known for a long time that they are much less dangerous than hospitals. This line of thinking implies that we should have filial responsibility legislation that makes this the primary responsibility of families rather than local authorities. Would that be a good idea? Just asking.
    As a sort of post script it’s important to remember that however frightening it is that half of coronavirus deaths are happening in care homes, that number needs to be set against what fraction of all deaths usually happen in care homes. Every unnecessary death is a tragedy but when presenting raw data rounded up and guessed, this always has to be in context.

  3. Smitty April 21, 2020 at 3:43 pm #

    I’m not sure about this. Most of us here who work in local authorities only place residents in residential care when it’s practically impossible for them to remain in the community. We don’t offer or provide 24 hour or night time care for residents in the community, and the coronova virus (in my opinion) doesn’t make one bit of difference to the long term care arrangements for the resident. They may be some exceptional circumstances where this is possible, and the barrister rightly mentions this in the last paragraph of the article, and indeed we would honour that, where it is safe to do so.

    • N. Akhtar April 21, 2020 at 9:01 pm #

      I completely agree with your comments. Residents are only placed in care homes as a last resort and where no alternatives are available. There maybe safeguarding risks, issues around capacity impacting on oneself to manage in the community as well as carer relationship breakdown in the first place that may have led them entering care. The comment about one paid carer visiting the person in their own home- I would say in the majority of cases people have multiple carers coming to look after them in their own home. Therefore, risk of infection isn’t necessarily lower at home than in a care home. Who ever wrote this article is clearly not a frontline worker and is perhaps a little out of touch with reality?

  4. Sally Conteh April 21, 2020 at 4:00 pm #

    I am surprised at the inflammatory language used throughout this article by a member of the legal profession. Language which ‘would predispose the listener towards a subject in an unreasonable and prejudiced way’ No death is acceptable and 20% is a truly terrible amount. But surely 80% is worth more than cursory mention and acknowledgement that this is because many of the care homes actually acted decisively and ‘locked down’ long before some hospital or other institutions. And to add that it is care homes that people with care needs who have tested Covid 19 positive are being discharged to.
    Moreover, that people in care are usually there because everything else had been tried at home. So the writers theory that ‘1 carer in a home setting’ is safer than residential care, whilst I would agree in theory I would also argue, if that person can be supported by one loved one without multiple carers coming in to assist (surely a greater risk than carers employed by care homes) then that person would not be in care in the first place. Care is not an easy option for any loved ones it comes after everything else has been tried and at great personal sacrifice and personal suffering to both parties (particularly for people with cognitive impairments) . This article will add to carers anxiety and panic and possibly lead to bad decisions in my personal opinion.

  5. LW April 21, 2020 at 4:18 pm #

    This seems completely unrealistic – where are all of these additional carers going to come from to support people in the community when we can’t get enough carers to support people out of hospital as it is. Where would the accommodation come from? Many families would have people home with them anyway if they had the space/could meet their care needs. I think that the best way to support people in care homes to stay safe is to ensure that staff have access to testing, and adequate PPE.

  6. Gerald Hudson April 21, 2020 at 4:42 pm #

    Being a Barrister Oliver Lewis demonstrates very clearly what one can do to present a plausible case for any “ legal “ argument before him, this must have taken him considerable time and effort and I can see he is very proficient in his job.
    In a Court of Law it is normal to have both sides presented as this gives a more balanced picture , I must say I think that would be useful on this occasion.
    As most Social Workers are already aware Care Homes are necessary and are , in,general doing a an extremely difficult job, otherwise the general public would not support over 450 thousand residents living in them.
    Everyone has their own view point and expectations and freedom of choice ( this also includes residents of Care Homes} long may this continue.

  7. Joe Z Mairura April 21, 2020 at 5:22 pm #

    The only sensible section in all of this article is the very last paragraph; where Oliver Lewis acknowledges that SWs di have brains; and that they put this to very good use on a daily basis- COVID-19 pandemic or not.

    The rest I find astonishing and truthfully unhelpful. I’d have thought that Mr. Lewis is aware that placing a loved one in Residential care is the last resort after all options have been explored, and this is a consultation with family friends or people with the clients interest at heart.

    I’m amazed Mr Lewis seems to have completely overlooked the disruption, emotional turmoil, and distress this will all course the individuals’ concern and therefore exposing the parties concern to more risk.

    I would have preferred that he had addressed himself to how care homes might be assisted to ensure there’s no outbreak of COVID-19… PPEs etc. and community-based testing and clinical support

    Just my two pennies worth

  8. kenneth jones April 21, 2020 at 5:30 pm #

    Barrister. Human Rights. Really ?. Most clients are in care homes because the family are unable to manage them. Send them back to their family and they will be confined to a room and if lucky they may get a few daily visit from carers. Carers that have visited many other clients during that day, with the minimum of PPE. There are and never will be enough Support Workers in the community,

  9. Jules Mcfinn April 21, 2020 at 6:29 pm #

    Placing someon in care is the last resort and every option will have been explored. This article does not take into account people who have challenging behaviours and when you have family crying down the phone because their husband who they have been married to for 60 years is trying to leave the house and is physically violent due to their dementia diagnosis. I think people are at risk wherever they live and care packages in the community are difficult to get hold of. I can see the emotional harm to relationships and this is not manageable to contact e ery single person placed in residential care. What about people needing nursing care. Also we dont have the technology to do video conferences with families. I find this very extraordinary advice and surely we should be looking at reducing the spread of COVID19 by ensuring care homes have appropriate PPE.

  10. Dave Brown April 21, 2020 at 6:57 pm #

    I feel this article is flawed for a number of reasons and I would certainly not advise any social worker to follow what is suggested here, though it is clear the author shares the same concern many have about the risk to people in care homes and he wants to respect their rights.

    But there is more to it than just getting people out and into a family home. Aside from all else it contradicts what is provided in the Coronavirus Act 2020 and in the statutory guidance, which is a dangerous thing to advise.

    What would happen, for example, if a social worker was to move a person out of the care home and into the family home as suggested? Imagine if the person had picked up coronavirus but was not showing symptoms at the time of the move, and he or she then infected the family? If one of them died the social worker will have done something which brought about the death of a person!

    That would more likely work the other way; how would anyone know if the family members didn’t have the virus but they infected their older relative! All those in the household could pose a risk to the older person.

    I think this piece is well meaning but it has not been thought out. There would need to be infection control assessment and management of the new home and support from dom care agencies, which we know are also struggling.

    Also how would it be for a person with dementia – used to being in the care home and not understanding why their home and the people they know in it are no longer there? Sadly this article does not mention anywhere the person’s wishes or feelings, what they might want and what might make them happy.

    Another issue is what happens when restrictions are lifted? Will that happen at the same time across the country/ i doubt it. E.g. the family members return to work, but care homes remain in lockdown? Who will look after the older person then? And will there even be a place for him or her to return to?

    I also feel it is a bit disrespectful of the amazing work care home teams are doing just now, to isolate infected residents to minimise the risk of spreading the infection. These people, whom we clap for every Thursday night, are working with residents and relatives alike who are anxious and suffering and they are putting themselves right on the front line, exposing themselves to risk of infection. We should be supporting care homes and those working in them, not fueling fear and suspicion. Care home staff are coming up with ways to isolate people, to keep spirits up, to keep the environment spotless etc. Let’s get behind them and help them keep the people in their care safe.

  11. Mary Peck April 21, 2020 at 10:48 pm #

    The present emergency presents a terrible dilemma . Continuity of care is the first priority. Temporary care in a home based family setting carries the risk of what would happen if the home based carer becomes ill with the virus and cannot continue. ? What would happen to the loved one in such an event. ? Return to the usual care home might not be immediately possible . It is a situations which carries the most immense and troubling issues with no easy resolution.

  12. Xontheweb April 22, 2020 at 7:48 am #

    In a typical legal fashion, here a barrister is sharing his thoughts WHILE alerting us that there will be legal challenges, that we must think carefully before signing off to a care home placement. It will prompt some hopefully not to use C19 as an excuse for lame practice and to continue promoting what is in people’s best interests. Don’t be too critical, accept this article as a gentle prompt to gauge where we stand in terms of case analysis and evidence-based practice. We have to defend our decisions, even when working with medical teams to discharge people ASAP.

  13. Andy B April 22, 2020 at 12:16 pm #

    I agree with all of the comments here – including Xontheweb – we are in unusual circumstances and trying to find a safe place for people has become very difficult. It is always difficult enough to balance out best interests when the options available have their own historic (stable) positives and negatives.
    I work in a hospital and the range of people surviving and dying is great – meaning predicting the potential outcome is not so simple, and including that variable makes everything a bit of a gamble…and doing nothing is not a safe option either.
    Discharge processes have always been contentious – mainly due to the differences between LA and health ethics, processes, assumptions and expectations – which even in normal circumstances can lead to unsafe discharges (such as no nomad box for essential meds despite knowing the person cannot open childproof bottles). Disagreement on what levels of need and support really are is often reflected in CHC processes.
    I just wish everyone the best in doing what they can at this time

  14. Eddy McDowall April 22, 2020 at 2:59 pm #

    Reply on behalf of the Care Association Alliance:
    “There have been suggestions recently from pundits and politicians that during the Covid-19 pandemic, people should be kept out of care homes because they are not safe. Sadly, the people spouting these opinions appear to be totally misinformed about the care sector.
    “It is long established that care organisations deliver excellent end of life care to patients with complex needs and multiple comorbidities. (45% of people die in care homes and at home according to gov.uk each year) People do not receive care services because they are well and care homes are expert at supporting people during the end stages of their lives. It is part and parcel of our job and something we spend a lot of time on to ensure we get it right.
    “Staff in these services are trained, skilled, competent and knowledgeable, more over knowing the people they look after very well, their lives and loves intimately, and being able to deliver holistic, personalised care in the way people want and need during and at the end of their lives.
    “With Covid-19 hitting the elderly and those with long term conditions so hard, and the most vulnerable to these receiving care services, it is hardly surprising that we’ve witnessed a number of deaths. What is incredible, and not reported, is the number of organisations who have had this virus, but have not had many (or indeed any) people die, and/ or have not had it spread to other patients and staff.
    “There are dreadfully sad, heart-breaking scenarios of care homes where multiple deaths have occurred. Their staff, other patients and families will undoubtedly need emotional support on an ongoing basis, for some time, and our thoughts and deepest sympathies go to them all.
    “This virus has killed 90,000 across the world. There are approximately 400,000 people in care homes in UK. Given the vulnerability of people who care homes and domiciliary care agencies look after, it’s important to remember that many do much right – unfortunately, we only hear the negatives.”

    How people die lingers in the memories of those who are left behind (Dame Cicely Saunders).

    “Never truer words or more important than now. Dying with people you know understand you, in an environment where you have chosen to be, with your family if they wish to be there, has and will always be, the right thing for every one of us.
    “To suggest that people should be moved to hospital, or any other setting, unless THEY wish to be moved (or the environment cannot meet their needs) is inconsiderate, contrary to their rights to make decisions for themselves, and evidence of the lack of recognition of the immense skills of an already under-appreciated workforce. Our greatest privilege is to know and care for others, and to be with them ensuring a comfortable, dignified and good death in a place of their choice.
    “Please DO NOT allow politicians, finances or others’ perceptions to undermine any further our staff’s confidence in their outstanding contribution, allowing people to live and to die well in the place of their choice. This virus is here and we need to manage it as best we can, without blame, without pain, and in the comfort and dignity that every one of us deserve. It’s not easy, but it is possible. The suggestion that we move everyone out of care homes demonstrates a complete lack of understanding of the health and social care system and is totally unnecessary and harmful to our care workforce, care home residents and those who love them.”

  15. Terry McClatchey April 22, 2020 at 9:23 pm #

    This is a very difficult issue to which there are no easy answers. It’s clearly not realistic (or appropriate) to discharge all residents from care homes. The balance of argument has however changed with the Covid-19 crisis. The high risk of premature death was clearly not factored in when many placements were made. The other big factor is that in many homes (and especially those with active outbreaks of infection) residents are confined to their single rooms and not interacting with other residents. For those individuals with capacity to make such decisions, it may indeed seem wise that they lock themselves down in compliance with general government advice. For those however who are unable or unwilling to give consent to such high levels of confinement, the balance of “best interests” (or least worst interests) is very different to anything that we might previously have contemplated. As with the MCA in general, individual circumstances matter.

  16. Chris Hamilton April 23, 2020 at 2:14 pm #

    The article seems to me to be written from a theoretical legal position, without, as many have said, much recognition of practicalities. Of course we should continue to be alert to the possibility of alternative arrangements being in a person’s best interests and consider proposals accordingly. But we have to be realistic about a) the relative risks in different settings – it is not accurate to describe all residential settings as risky. Clearly the vast majority don’t have infections present and those which do are working tirelessly, often with local authority support, to control any spread; b) the availability of community care support when families and care agencies are over-stretched; c) the affordability and practicality of home based support – most people are in care homes because alternatives have been exhausted.

    And, for goodness sake, let’s not add any additional pressure to social care staff. I’m aware daily of the excellent and creative efforts made by all involved, – social care staff, families and care providers – to provide good quality care at a very difficult time, using their energy and creativity to support the most vulnerable. Enough said!

  17. Matt Johnston April 24, 2020 at 1:33 pm #

    I had a visceral reaction to the title of the piece: it reads as a direct instruction and implies a moral duty to take a specific course of action. It’s clear that Mr Lewis’s knowledge of the legislative framework and his experience of safeguarding human rights vastly outweighs my own and I broadly respect the perspective he presents here. It makes sense to review all placements to ensure each one meets the needs of the individual in a way that respects their wishes and provides most benefit with minimal/proportionate restrictions.

    However, his specific call to action is too much. Suggesting I phone family members to ask them to take ‘life saving’ action feels at odds with my personal and professional ethics. I don’t think the evidence-base exists for such certainty. The assertion that 50% of covid-related European deaths took place in care homes is inaccurate and a red herring: place of residence is a correlate to place of death – not necessarily a contributory factor. In Scotland, we know some information about the 33% (ONS) of covid-related deaths that have occurred in care homes but we know very little about the 160 (10%, ONS) people who died at home – we have no way of knowing if their human rights were upheld to a higher standard. I acknowledge there is an established level of risk associated with staying in a care home – but at least this is measurable, monitorable, and mitigatable. Moving out of a care home presents a whole new set of risks and I don’t think it would be possible to provide the aids, adaptations, home care, support, training, or other safeguards required to replace 24/7 care in order to make these moves viable or sustainable. A smaller point is that Mr Lewis suggests a move to familial care would be for a few months but we could be looking at more than 18 months before a vaccine or treatment allows us to relax shielding measures.

    There’s undoubtedly scope to consider how we restructure community care at a national and local level but placing the onus on the individual social worker to coerce the adult’s next of kin to assume a 24/7 caring role without an area-wide, multidisciplinary, service delivery plan in place would be untenable. Health and social care systems are complex, open, adaptive systems. A mass migration from residential care to the community in the middle of a public health crisis would place increased pressure on GPs, CPNs, District Nurses, care providers and so forth.

    Social work always happens in uncertain circumstances but I feel that we need support and leadership now more than ever – particularly from experts such as Mr Lewis and authoritative sources such as this website. I wonder if there’s scope to retitle and reframe this article in order to maximise its potential as a critically reflective, rights-based, decision-making tool rather than a dread-inducing diktat.

  18. Theresa Batchelor April 30, 2020 at 9:31 am #

    This would be just another paper exercise in reality. A complete waste of time and resources when the social workers and other Best Interests Assessors have a far more pressing role in protecting vulnerable people.