By Christian Kerr and Michelle Janas
In normal circumstances many people move from hospitals into care homes, either temporarily or permanently, with the support of social workers. Yet Covid-19 has proven, devastatingly, to be near impossible to contain in those settings.
Care homes are not by nature set up to provide appropriate care, support and treatment to Covid-positive patients. Throughout the pandemic, care home workers have shown incredible dedication and compassion toward those they care for. However, they don’t have the expertise or resources needed to effectively nurse Covid-positive or Covid-recovering chronically ill and disabled people who have been deemed fit for discharge by hospitals under immense strain. And nor should they be expected to, having long been undervalued by government and society, expressed in poor pay and few development opportunities.
At the height of pandemic, one of us volunteered in a care home and witnessed frantic, inexpert care of Covid-positive older people. The perennial issue of low staff-to-resident ratios – again driven by the need to make profit in the care market – meant that when some people needed more intensive attention just to meet their basic needs to eat and drink while suffering from Covid, others were simply left alone in their rooms for prolonged periods.
Those working in care homes have described scenes of isolated suffering and dying, of distress compounded by the challenges to comprehension presented by cognitive illness such as dementia. For a person in care, prolonged isolation and separation from the people they know and love can lead to near-absolute disintegration of the world they know, a world containing all the anchors and cues and routines and assurances that give shape and meaning to the day, and support their identities, even as those identities are under threat by medical conditions and by life in a group home.
These issues are not limited to older people. People with physical and learning disabilities, mental health issues and brain injuries also face these risks. It is an unjust society, indeed, that expects those who have already borne the brunt of the impact of pandemic to face further isolation, separation from family and friends, denial of daily activities and routines on the basis of resource allocation that favours one public service over another.
The Department of Health and Social Care’s (DHSC) winter plan, published last month, states “[n]o one should be discharged from hospital directly to a care home without the involvement of the local authority”. This again highlights social workers’ key role in supporting and coordinating discharges. One of us is a practising social worker and the other an experienced immunologist, student social worker and recent care home volunteer. We are concerned about the plan’s implications for older and disabled citizens, and the social workers who are responsible for their welfare.
The plan says the government is working with the Care Quality Commission (CQC) to designate “premises that are safe for people leaving hospital who have tested positive for Covid-19 or are awaiting a test result’. Any “safe premises” for Covid-positive people would, by definition, require separate facilities and a separate, live-in workforce with access to the same types and levels of PPE that hospital staff have access to.
The plan also calls for hospital discharges to be “safe and timely, ensuring that testing takes place before every discharge to a care home, and results are available and communicated before discharge, unless otherwise agreed” (emphasis added). Both the above statements could be interpreted a number of ways at a time when clarity and consistency are crucial.
Supporting people to go home after hospital should always be the primary consideration, if that’s what the person wishes. This has been given added impetus at a time when the risks associated with going into residential care are higher than ever before. However, the practicalities of delivering care at home – driven by the need to make profit in a care market – require workers to visit multiple homes in a day, providing close-quarters care to people who could, under the winter plan, conceivably be Covid-positive.
There are many practical and ethical issues to be considered when planning discharges from hospital back into the community. Social workers are key to this process and, as an exceptionally challenging winter approaches, will be under considerable pressure to source and arrange care and support for people who have been receiving hospital care, some of whom will have had, or even still have, Covid. Social workers have a duty to protect those whose welfare and wellbeing they are statutorily and professionally responsible for. They also have a duty to protect the general public. In pandemic the stakes are extremely high and the situation complicated by a number of factors.
‘Scrap the easements’
With all that in mind, we were dismayed to read in the plan that the joint interim chief social workers advised government to continue with the controversial Care Act ‘easements’, enacted by the Coronavirus Act 2020, through the winter, in anticipation of ‘triple whammy’ of the usual winter pressures on the NHS and a second wave of Covid at a time when the NHS is still recovering from the first. Following the plan’s publication, MPs voted to continue the Coronavirus Act, including these provisions.
The easements allow councils to temporarily suspend legal duties to assess needs, develop or review care and support plans, carry out financial assessments and meet eligible needs – other than where this would breah a person’s human rights – and are designed to enable councils to, where necessary, prioritise care and support in order to meet “urgent and acute needs”.
Again, social workers will be central in this process. In a time of politically chosen austerity, in a country that spent over £500m on encouraging people to eat out in a pandemic and which spends billions on management consultancies that time and again fail to deliver the results they promise, there is no valid moral argument for cutting or denying care and support to one person in order to provide for another.
We urge social workers at every level to stand in solidarity with the disabled and older citizens who are pressuring for the easements to be scrapped and in comradeship with the care workers facing the devastating impact of Covid every day, and send a strong message that the right way to address the looming pressures of the coming winter is to properly fund both social care and the NHS.
Christian Kerr is a social worker and Michelle Janas a social work student and former immunologist