A toolkit for supporting CHs with social distancing and isolation measures for older people
Authors
Joanne M. Fitzpatrick, Anne Marie Rafferty, Shereen Hussein, Sarah Sims, Amit Desai, Sally Brearley, Richard Adams, Lindsay Rees, Ruth Harris
For further information, email ku.ca.lck@kcirtapztif.ennaoj
Acknowledgements
To everyone who contributed to developing this toolkit, our sincere thanks.
Special thanks to the residents, family members and CH staff who shared their stories so openly and honestly, helping us to learn from the whole experience of COVID-19 to help reduce cases in the future, refine how care can be provided amid restrictions, and contribute to the well-being of residents, families and friends, and staff.
Our sincere thanks to the CH providers, managers, deputies, staff who took on the role of a project champion, and all the staff who supported our research.
We are grateful to the National Institute for Health Research for funding this research, and for the support and insightful contributions of members of the Steering Committee, Data Monitoring and Ethics Committee, PPI group and the co-design workshop participants.
Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132541) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 45. See the NIHR Funding and Awards website for further award information.
Contents
About this toolkit, who is it for, and how to use it.
Caring for residents
Caring for Families and Friends
Priority Area (C) Supporting residents, families and friends to communicate when visiting is not permitted.
Priority Area (D) Supporting visits from families and friends when visiting is allowed but with restrictions.
About the toolkit
To protect older people from coronavirus (COVID-19), CHs have used various measures that include social distancing and isolation of residents. Care homes have shared that it can be challenging to implement social distancing and isolation measures when caring for residents.
Our research aimed to explore and understand the real-life experiences of implementing social distancing and isolation for older people living in CHs. To help us do this, we interviewed residents, families and CH staff about their experiences of delivering or receiving care during the COVID-19 pandemic, analysed CH policy documents and conducted focus groups with senior health and care leaders.
We have used these findings to co-design guidance and resources (the toolkit). We have worked with a group of service users and public representatives, CH managers, nurses and carers and leaders working in health and social care services and research.
Who is the toolkit for?
This toolkit will support health and care delivery now and during any future coronavirus outbreaks (COVID-19). We hope that it will
contribute to person-centred care for residents, families and friends by providing evidence-informed guidance for social distancing and isolation of residents and related restrictions
support CHs to care for residents with diverse health and care needs (e.g. those living with dementia)
support CHs to communicate well with residents, families and friends, and health and care professionals
help direct focus on staff well-being
help make the job easier for CHs during a pandemic
help inform care for other infectious diseases.
How to use the toolkit?
The toolkit can be used flexibly with staff, residents, families and friends, for example as follows.
To inform discussions involving
CH staff and health and care professionals in the wider multidisciplinary team, to enhance understanding about the
CH sector, particularly about the challenges faced related to social distancing and isolation measures for residents and solutions implemented.
For conversations between CHs and policy-makers at a local level to inform the guidance provided to CHs.
Reflective sessions with
CH staff about learning from the unintended consequences of social distancing and isolation measures.
To inform facilitated discussions with residents, families and friends, for example, to instil confidence about measures that can be used by CHs to mitigate the negative consequences of social distancing and isolation of residents.
To guide conversations with residents, families and friends, for example, about refining approaches to communicating remotely and digitally with families and friends, and to co-design interventions to connect residents with nature and bringing the outside in.
Caring for residents
Priority Area (A) caring for residents when they are social distancing
What is the issue?
Care home residents are required to keep a physical distance between each other and with staff and visitors.
‘I think it [being able to participate in activities] has improved, I think that the home was learning a lot from the first lockdown and as things have improved, I mean they still did the activities, how on earth they managed to organise things by distancing people I do not know, it’s incredible. But I’ve got a feeling that things are not so much back to normal but a new normal and she’s participating again’.
(Family Member)
‘… there’s no way on earth that I’m going to stay … 6 feet away from a resident at any given time, you know, it’s just impossible. We’ve got people who may need assistance when they need to eat or when they need a drink, or people who might need personal care. You can’t keep away from people’.
(Senior Support Worker)
What we have learnt
(1) Communicating can be challenging for residents when being socially distanced from the person they are trying to communicate with, especially if a resident has a hearing and/or vision impairment. Mask-wearing can make communication even more complicated, hiding much of the face and making lip-reading impossible.
(2) Residents with cognitive impairment find social distancing challenging to understand.
(3) Residents not being permitted to visit other residents in their rooms due to social distancing rules can cause frustration and upset.
(4) Limited capacity in communal areas makes it harder to arrange social activities for residents and with reduced numbers of residents. The reduced social interaction and mental stimulation associated with this means that residents are not as mentally alert as usual.
(5) Limited capacity in dining rooms reduces the number of residents who can eat in designated dining areas, and some CHs must reconfigure other rooms into dining rooms, stagger mealtimes, or ask residents to eat in their bedrooms.
(6) Maintaining social distancing with residents when staff deliver personal care is a struggle – residents miss physical touch, for example hugs and holding hands.
You could try this
Communicating well with residents, their families and friends
Care home staff need to be clear about what is and is not allowed around social distancing rules and communicate this to residents, families and friends.
Explain to residents what social distancing is and why it is needed. Communication/cue cards may be helpful.
Care home staff can have a conversation with residents about what activities they might like to participate in, and communal rooms can be reconfigured to make these activities possible. This information should be recorded in residents’ care plans.
Approved transparent face coverings can be worn to make communication easier for those residents who communicate through lip-reading or facial expressions.
Maintaining connections and friendships
Activities and well-being co-ordinators can provide entertainment and activities for residents that adhere to social distancing guidance.
Examples that residents and families/friends liked included Christmas specials with a photograph of each resident sent to family, celebrations for pancake day, significant national memorial days, anniversaries, cultural and religious notable days/events, card-making, word games, small group cake-baking, yoga, karaoke, bingo, quizzes, letter writing to local school children, online sessions connecting residents with local churches and community groups, indoor gardening.
Senior leadership can consider investing further in well-being and activities co-ordinator positions that are not already in place.
Create resident support bubbles to help maintain communication and friendships, while adhering to social distancing guidance.
Discuss and make it possible for residents to go out of their
CH while adhering to restrictions, for example, for religious or cultural activities.
Addressing the needs of residents with cognitive impairment
Care home managers and senior leadership can decide if social distancing is possible for residents with cognitive impairment (e.g. for those who ‘walk with purpose’). Talk with other CHs to share experiences of what has worked well and what has not.
For tips on how to communicate well with a person living with dementia, visit
Supporting staff to care well for residents when social distancing
Encourage
CH staff to be vigilant about observing residents’ physical, emotional, mental and cognitive well-being.
Educate staff about signs to look out for regarding the well-being of residents to mitigate the negative impact on residents of social distancing, for example low mood, appearing anxious, physical discomfort.
Managers can discuss with staff how to put into practice apparent contradictions in guidance, for example, regarding physical touch with residents.
Managers can communicate to staff that their decisions/judgements about resident care are respected.
Thinking about care home space
Activities and communal dining arrangements can be reconfigured with smaller groups of residents.
Care home managers and senior leadership can consider how best to manage social distancing for residents and staff where spaces are not easy to reconfigure/repurpose.
Caring for residents
Priority Area (B) caring for residents when they are isolating
What is the issue?
Care home residents must isolate in their rooms for several days if they have suspected or confirmed COVID-19 infection, when they first move into the CH, or return to the CH following hospital discharge/attendance.
‘You know and like when I had any phone calls you know, people that normally phone me, I couldn’t take the calls, I wasn’t allowed to have any calls because that meant I would go out the room to take the calls and that I wasn’t allowed to do’.
(Resident)
‘… some have chosen not to go to hospital appointments if they don’t feel it’s necessary … so they won’t get isolated … they like to be downstairs in activities, so they’ve chosen not to go to hospital because of the risk of being isolated’.
(Manager)
What we have learnt
(1) Formal isolation can have a negative impact on residents’ physical, mental, emotional and cognitive well-being.
(2) Residents feel cut off from their usual
CH life and family and friends when asked to isolate in their bedroom.
(3) Residents with cognitive impairment may not understand that they cannot leave their room and why.
(4) Being in isolation may have a negative impact on the nutritional health/well-being of residents who eat better when supported by a companion or in social settings.
(5) Residents sometimes may be asked to isolate themselves in rooms that are not their own, leading to feelings of dislocation and discomfort.
(6) Some residents may be reluctant to seek hospital care for fear of having to isolate on their return.
(7) Families sometimes do not understand what isolation means for residents, leading to a lack of support for residents.
(8) Some people are deterred from moving into a
CH if they need to isolate upon their arrival.
You could try this
Fostering a sense of connection
When residents are required to isolate, make sure they can see the outside world from their bedroom, and have access to television and music (e.g. via a digital assistant such as Alexa or Google) if they wish.
Where possible, ensure that residents isolate in their own bedroom. If this is not possible, arrange for personal possessions to be moved to the resident’s isolation room and help residents to communicate with staff, fellow residents, families and friends.
Consider cohorting to care for residents for whom isolation would be detrimental to their well-being.
Ensure that a resident’s needs for companionship during essential activities (e.g. mealtimes) are supported by
CH staff.
A useful resource is ‘Supporting older people and people living with dementia during self-isolation’ (The British Psychological Society, UK):
www.bps.org.uk.
Support essential caregivers in their role. Helpful resources are as follows:
Supporting staff to care well for residents who are isolating
Managers and senior leadership can decide on interventions to manage the emotional and mental well-being of residents who are isolating.
Care home managers and care staff can work with physiotherapy and occupational therapy colleagues to plan how best to promote physical activity for individual residents during periods of isolation.
Care home staff can facilitate choice and control for residents – this can help residents adapt to isolation measures and restrictions (e.g. their thoughts about how they would like to keep connected with their families and friends, and friends in the CH).
Care home staff can carry out more frequent visits to check on the well-being of residents who are isolating (e.g. looking out for signs of residents appearing upset, down, tearful, anxious, frightened, lonely).
Activities and well-being co-ordinators can lead on providing entertainment, activities and exercise for residents in isolation.
Care homes can consider implementing activities for residents that previously would have only been considered in a face-to-face mode now being done remotely through digital means (e.g. yoga, music, arts and cultural interventions).
Care staff can provide supportive walks for residents (e.g. to a garden area within the
CH, to a balcony).
Senior leadership should invest further in the training and development of the care workforce to be able to care well for the emotional, mental and physical well-being of residents who are isolating. This should include a specific focus on the legal duties that staff have and how they relate to implementing isolation, social distancing and visiting restrictions in terms of the Mental Capacity Act, the Equality Act, and the Human Rights Act.
Communicating well with residents, their families and friends
Care home staff can prepare residents for the possibility of isolation by talking to them about what it entails and what facilities they would like if they were required to isolate. The outcome of these discussions should be included in the resident’s care plan.
Care homes can facilitate communication between an isolating resident and other residents in the
CH (e.g. by arranging phone or video calls, helping to write a postcard and popping it under the resident’s door/posting to family/friends).
Care homes can support communication between residents, their families and friends that meets their needs (e.g. arranging mobile devices for phone or video calls, supporting residents with letter writing/reading).
Care home staff can explain to residents’ families and friends what formal isolation means for residents and ask what support they can offer.
Thinking about care home space
Senior leadership can consider short- and longer-term
CH redesign opportunities to enable residents to connect socially with their families and friends and to connect with the outdoors and different sensory experiences.
Caring for families and friends
Priority Area (C) supporting residents and their families and friends to communicate when visiting is not permitted
What is the issue?
Care homes are required to stop visiting by family and friends of residents due to an infection outbreak in the CH or wider epidemic conditions in society.
‘… we have an iPad, and we have Skype for the home, so they’re able to Skype family … and we’re able to assist them so they can have those conversations, see their family face-to-face’.
(Manager)
‘The pictures on Facebook are invaluable to families, absolutely, seeing what they’re doing I mean you don’t always get a picture of your loved one on it, but you can see what they’re doing. So, and birthdays as well go in, so you can see they’re celebrating birthdays and everybody gets cake and stuff like that’.
(Family Member)
What we have learnt
(1) Residents may become depressed at the lack of physical visiting.
(2) Residents with cognitive impairment may not understand why they no longer receive visitors and may feel abandoned.
(3) Families and friends feel frustrated that they cannot visit their loved one and worry about residents’ mental and physical health.
(4) Not being able to visit residents in person can cause families and friends great emotional anguish:
that a resident might die before being able to see each other in person.
not being present to support residents’ care.
not being present to contribute to and participate in events and activities – missing being part of the
CH community.
extended family not being permitted for get-togethers with residents.
(5) Families of residents who are new to the
CH may feel powerless about having to ‘step away’ from their role as carer and experience emotions such as heartbreak, grief and anger that they cannot be present in person to support residents for such a significant life event.
(6) Families may feel powerless about how they can help prevent
COVID-19 from coming into the
CH community.
(7) Staff ‘doing the job’ of families brings comfort and reassurance to family members but can also be tinged with sadness that residents forget them.
(8) Virtual communication replaces physical visiting for some residents, their families and friends and is generally valued by all groups. However, some residents may struggle with the technology or may be confused by the virtual nature of the interaction; additionally, residents and families may be distracted by background noise or a lack of privacy.
You could try this
Supporting remote communication for residents, families, friends and essential caregivers
Encourage residents and families to plan by having a conversation about remote communication – are they interested in this, what device, arrangement for purchasing, set up, and support to use.
Care home staff can find out whether residents can use mobile devices and whether they will have access to their own device or will need to use a
CH-provided device if this is possible and liaise with local voluntary sector groups for equipment and training provision.
Opportunities for telephone contact and video calls (e.g. Skype, Teams, Zoom, Facebook live, WhatsApp live) with family and friends should be available to residents if appropriate to the needs and abilities of residents, families and friends. Training can be provided for
CH staff and residents (where possible) in using communication devices (see Case 1 for an example of this in practice).
Care homes can consider nominating one or more staff members (e.g. a well-being co-ordinator or companion) to facilitate residents’ video calls to families and friends.
To ensure privacy and convenience of virtual communication, managers can consider setting aside a comfortable ‘Video link room’ equipped with appropriate technology, which all residents can access.
Senior leadership and managers can ensure CHs have sufficient technology (mobile phones and laptops/tablets) and adequate Wi-Fi to run several resident video calls simultaneously.
Caring for residents living with dementia, their families and friends
Where possible, strive for continuity of carers for residents living with dementia.
Consider other approaches to help residents, families and friends keep connected (e.g. letter writing, creating memory boxes for residents with photographs shared by family and special mementoes, gift sharing).
Caring for residents moving into a care home, their families and friends
In guidance for families and friends of an older person moving into a
CH, make it clear that they may face restrictions to visiting in the event of a further
COVID-19 surge.
Care homes can discuss in advance with residents, their families and friends the conditions under which visiting restrictions may be imposed and the ways in which the
CH will facilitate virtual and other forms of communication.
Care homes keeping connected with residents’ families and friends
Care homes can communicate meaningfully with families and friends in different ways. Acknowledging that rules and restrictions can change often, and sometimes suddenly, CHs can anticipate restrictions on visiting by discussing with families and friends in advance which method they will use. Some examples of what worked well:
Newsletters sent via email from the CEO and
CH manager.
Telephone calls from well-being co-ordinators, for example, if residents need personal items.
Remote family feedback sessions facilitated by the CHs.
Posting online photographs of residents participating in activities and entertainment events.
Use of web applications for daily individual resident updates.
Care homes can clarify how the
CH will provide updates about the resident if visiting is suspended. Include this in the resident’s care plan.
Care homes can explore using digital/electronic care planning for residents and with a relative portal if not already in place, and the infrastructure needed to implement this effectively.
Case 1
A CH described revising the shift pattern of well-being co-ordinators so that better support could be provided to families and friends for their remote communication with residents. Once a week they worked a 11.00–19.00 shift to be available to families and friends who work and they also now work weekends. Families and friends can connect with their loved ones 7 days per week.
Caring for families and friends
Priority Area (D) supporting visits from families and friends when visiting is allowed but with restrictions
What is the issue?
Families and friends face rules and restrictions on visiting due to an infection outbreak at the home or because of epidemic conditions in wider society.
‘They told us that there were going to be no visitors because of the pandemic, and they were going to keep us as safe as they could, and I think everybody accepted the fact that we couldn’t have visitors, because if you had visitors they might have brought the pandemic into the home …’.
(Resident)
‘As the restrictions have relaxed we’ve been able to come in and visit Mum, but obviously that has been social distancing, you know, not being able to touch and hug and have a screen between us, and obviously wearing a mask, but that also has its challenges, because you obviously miss the nuances with a mask, you know, smiling or whatever on the face, and Mum sometimes you know, quite can’t hear as well when we’re wearing masks’.
(Family Member)
What we have learnt
(1) Families take comfort from CHs adhering to
IPC guidance and feeling confident that residents are in a safe place and are being looked after well. However, visitor restrictions are confusing and distressing for residents and their family members. They have many negative implications for their physical and mental health (e.g. depression, anxiety, changes to eating and sleeping patterns, feelings of guilt and loss).
(2) Not being permitted to have physical contact with residents (hugs, holding hands etc.) can cause significant distress for residents, families and friends, and staff.
(3) Care home residents have died without their family members present (or without close physical contact from their family members at the time of their death) because of visitor restrictions.
(4) Care home staff are a target of frustration and annoyance from residents and their family members, who are angered by visiting restrictions.
(5) Family members have not been able to have their pre-pandemic relationships with residents and are fearful that their interaction might be a source of harm to the people they love.
You could try this
Communicating well with residents, their families and friends
Communication from CHs to residents, families and friends should be upfront, transparent, and up to date around visiting guidance.
Be as clear as possible about what restrictions are mandated by government, and what are discretionary but taken in everyone’s best interests. Consider if it may be possible to negotiate on discretionary aspects and use the knowledge of families and friends – they have good ideas and solutions too.
All CHs within a local area could collaborate (either independently or through local care associations) on visiting guidance to avoid local variations and inconsistencies, for example, by setting up networking groups and WhatsApp groups.
Communicate clearly and regularly with families about how residents are being cared for, how
IPC guidance is being implemented, and why.
Share resources with families and friends to enable them to seek psychological support – families and friends have faced great trauma and emotional distress during the
COVID-19 pandemic, including the death of residents.
Caring for residents approaching the end of life
Care homes can facilitate family visits without restriction for residents who are nearing the
EoL, such as having ground floor rooms with patio doors so that family members can enter the bedroom without having to access the main
CH (see Case 1 for an example of this in practice). CHs without such existing access may wish to consider building works to change windows to patio doors in some bedrooms to make this possible.
Engage with best practice for
EoL care for residents, for example:
Thinking about care home space
Case 1
A one-storey CH described having bedrooms with patio doors on the ground floor as being key during the pandemic so that family members of residents at the end of their life could use the patio door to enter the resident’s bedroom without having to access the rest of the home.
Caring for care home staff
Priority Area (E) supporting care home staff
What is the issue?
Aspects of CH staff working practices (e.g. workloads, shift length and patterns) have changed because of interventions implemented during the COVID-19 pandemic, as have staff support needs.
‘… it’s not a hundred per cent the same job. Aspects of it are, but it’s not a hundred per cent the same job as it was 1.5–2 years ago … it was just a really natural kind of job. It feels more like a job-job now’.
(Senior Support Worker)
‘… it’s coming to the point now where we’re all fed-up with it, so yeah, you get those times in your job … where you think, you know what, I don’t want to be here today, I want to leave’.
(Senior Care Assistant)
What we have learnt
(1) Care home staff workloads have expanded, with working hours increasingly dominated by tasks such as sanitising the
CH, organising visitor appointments, taking temperatures, and testing residents and visitors for
COVID-19.
(2) Additional
PPE requirements (such as changing
PPE upon entering and leaving residents’ rooms and wearing masks and visors) are accepted to be a vital component of
IPC but are burdensome and time consuming for staff.
(3) Visitor restrictions significantly increase staff workload due to large volumes of telephone enquiries from relatives, time spent facilitating residents’ video calls with family, or observing family visits to ensure they comply with social distancing requirements.
(4) Care home staff experience guilt around maintaining visitor restrictions, particularly during EoL situations. Staff have experienced trauma and emotional distress from witnessing residents prevented from being with their families at the time of their death.
(5) Staff feel mentally and physically exhausted by changes made to their working practices and the emotional traumas they have experienced during the pandemic.
(6) The employment of agency staff within CHs may be prohibited/limited during periods of restriction, which can have financial implications for care workers and staffing difficulties for CHs.
(7) Care home staff have felt undervalued during the pandemic because their contributions have not been recognised by the government or the public in the same way as their
NHS colleagues.
You could try this
New roles, responsibilities and ways of working
Consider allocating some existing members of staff (or recruiting new members of staff) with the specific role of organising visitor appointments, taking temperatures and/or testing residents and visitors, with training and development put in place (see Case 1, for an example of this in practice).
Consider ‘upskilling’ staff not currently delivering care (e.g. receptionists, administrators, restaurant and maintenance workers) so that they can assist with certain aspects of care (such as serving food and drinks, getting residents in and out of bed) during periods of significant staff absence.
Care homes can consider installing a specific telephone line for family enquiries (see Case 2 for an example of this in practice) or placing residents’ care plans and notes on a secure online system so that family members can read information about their relative online instead of calling the
CH for verbal updates.
Alternatively, CHs may wish to organise regular video-call slots with families and friends and use these slots to provide family updates rather than take ad hoc calls from families throughout the day.
Care homes can ensure senior care staff are also skilled to cover managerial duties during periods of manager absence temporarily within the
CH’s registration boundaries.
Senior leadership and managers can ensure business continuity plans set out mechanisms to enable CHs to operate safely during periods of significant staff absence.
Clear, concise and consistent guidance and policies written in plain language
Resources to do the job
Care homes can strategically place ‘Donning and Doffing’ stations and hand sanitiser outside bedrooms and at other key areas in the
CH to aid staff convenience and place posters nearby reminding staff of hygiene procedures.
Care homes can ensure sufficient space is available in the
CH for staff to change in and out of work uniforms, should this be required.
Care homes can ensure all staff, including agency staff, are trained in the correct usage of
PPE and that there is always sufficient stock available (consider having different types of
PPE available for those staff with latex allergies).
Valuing and caring for staff
It is essential to acknowledge the personal impact on staff working throughout the
COVID-19 pandemic and its effect on their physical, mental and emotional well-being.
Being available for staff, willing to have honest conversations around complex issues, and being open to new suggestions and ideas can help
CH managers to counteract negative consequences for their staff.
Having senior leadership and managers who recognise the sacrifices staff have made and express gratitude for their contributions can help staff to feel more supported (e.g. providing paid overtime and financial bonuses for staff where possible or holding staff award ceremonies and celebrations).
Management gratitude can be demonstrated on a small scale by providing staff ‘treats’ (such as chocolate and confectionery) or by encouraging staff to take regular breaks or use annual leave entitlements. On a larger scale, managers may choose to set up ‘food stations’ in the home for staff who are struggling financially.
Where possible,
CH staff who undertake additional agency work in other settings should be offered overtime opportunities within the
CH so that they do not suffer financially.
Managers can consider ways in which staff workload could be decreased, including allocating specific staff to facilitate residents’ video calls or ensure residents have been shown how to make video calls independently.
Care home providers and the sector can engage with how to care for a traumatised workforce, a trauma-informed approach for staff well-being.
Managers can consider undertaking mental health first aid training, or similar, to help them respond appropriately to the trauma experienced by their staff.
Useful resources are
Guidance for Managers and Decision Makers in Supporting
CH Workers during
COVID-19 (COVID Trauma Response Working Group) (University College London, UK). This guidance includes supporting the psychological well-being of staff, and grief and bereavement training and support.
‘Looking after yourself and those around you’– My Home Life Bulletin for
CH managers.
Case 1
One CH used infection control funding to recruit an extra staff member specifically responsible for delivering the home’s testing programme for residents and visitors. This eased pressure on other CH staff, allowing them to focus on different aspects of their role. However, the CH needed to ensure that there was cover for any periods of testing staff absence and that all testing staff were fully trained on how to test accurately and how to enter results onto the computer system.
Case 2
After being inundated on the main CH telephone line with different calls from family members, hospitals and other external organisations, one CH installed a new telephone line solely for family enquiries with a direct line to the Lead Nurse. This freed up the main telephone number for other enquiries and ensured that relatives were able to talk directly to the nurse with minimal delays.
Caring for care home staff
Priority Area (F) supporting care home managers
What is the issue?
During a crisis such as the COVID-19 pandemic, CH managers face many challenges to protect residents, their families and friends, and CH staff.
‘…. it seemed like every day there were different rules, government guidelines were changing, chopping and changing, we were expected to chop and change just the same’.
(Lead Nurse)
‘… the guidance will be published at 5 o’ clock on a Friday afternoon, and we’ve got, we’re sort of dealing with phone calls and hassles all over the weekend and we’re going, “I don’t know anything about this, what do you expect me to say?”’
(Deputy Manager)
What we have learnt
(1) Managers have had a phenomenal workload during the
COVID-19 pandemic and fulfilled many varied roles, including supporting the mental, emotional and physical health and well-being of their staff and residents. The isolation, loneliness and burden for managers were felt acutely. The courage and tenacity of managers must be recognised.
(2) Managers have had to interpret government guidance rather than simply follow it directly. This was because a ‘blanket approach’ to government guidance did not consider the heterogeneity of CHs and
CH residents. Guidance was often too long and complicated, with many different policies to consider, which was confusing. Managers were left with little time to manage government guidance, which tended to be shared with CHs at the same time, or after high-level announcements to the public.
(3) The manager’s role is key to having good teamwork; support from managers also makes the experience of implementing social distancing and isolation interventions easier for staff.
(4) Managers have worried that isolation interventions violated their caring instincts and ruined the ‘family’ feel of their homes.
(5) Communication with GPs and other health and care professionals was conducted mainly online or via the telephone; some staff questioned whether healthcare assessments could be successfully carried out online.
(6) In the absence of GPs and other healthcare professionals, managers have had to make clinical decisions about residents or ensure that they provided external healthcare professionals with all the necessary information about a resident so that they could make an informed decision.
You could try this
Valuing and caring for care home managers
Clear, concise and consistent guidance and policies written in plain language
Senior leadership and
CH managers can collaborate on operational guidance for any future outbreak of
COVID-19, reviewing what went well, what could be improved and lessons learnt.
Senior leadership can work with managers to develop strategies for measures such as social distancing and isolation that reflect the latest government guidance and are meaningful and achievable for all residents (e.g. for those residents ‘who walk with purpose’).
Senior leadership can continue supporting managers in translating government guidance and regulations into local policy.
Senior leadership can facilitate collaboration between CHs in a locality/region (e.g. a rapid reaction team member within a
CH to link with the same person in another
CH to agree on a shared understanding for the area).
Amplifying the voice and expertise of the care home sector in policy development
Senior leadership can bring experts together from different
CH providers, LAs, community, and primary health services and across different regions to collate expertise, support each other and inform official positions.
Senior leadership and stakeholders can lobby for timely communication of government guidance that is clear, concise and comprehensible.
Senior leadership and stakeholders can lobby for having a social care association or organisation supporting CHs in the interpretation and simplifying of government guidance.
Senior leadership and stakeholders can lobby for a central, single platform to host evidence and best practice guidance, helping minimise variations in interpretation of information from several different sources and implementation.