These were the words I said to my manager in the middle of the COVID-19 peak. I was feeling the full impact of the pandemic on the care home residents my team and myself were looking after. The reality of the crisis was unfolding, and never in my 26 years as a registered nurse had I experienced such tragedy and despair.
Our integrated care home service provides a rapid response for care homes in the event of a resident becoming unwell. It also provides proactive support through teaching and training of care home staff. The team is well established, so we share a trusting and collaborative relationship with local homes—even though we work for the NHS and they, for the care sector.
In early March 2020, we felt a real sense of uncertainty and anxiety, having seen the situation in China and then Italy (Safi et al, 2020). As a team, we did not feel prepared. On reflection, this must have been nothing compared to what care home colleagues were feeling. National action plans were being made to ‘protect the NHS’ (Department of Health and Social Care, 2020), but our colleagues in the care sector were struggling for any resemblance of the same leadership and support, being falsely reassured by the Government that it was ‘very unlikely’ the virus would infect residents of care homes (Public Health England, 2020).
So began the repeated requests for personal protective equipment (PPE), which we received eventually but care homes did not always when needed; the race to complete FIT mask testing, an option that care homes did not have; and the Public Health England information overload, with constantly changing guidance, making it almost futile to remain updated.
Staff sickness increased the challenge, as referrals to the service trebled in April. There was an undercurrent of anxiety as an increasing number of residents became symptomatic. Daily COVID status exchange meetings provided an opportunity to raise issues and consider new guidelines, but similar opportunities for care home managers were not obvious, even though they faced the same problems. The reality of the divide between health and social care was exposed.
The toughest times were also some of the most touching: the conversations with families discussing an advance care plan about what the wishes may have been for their loved one, the resident now too unwell to express themselves; the video calls with relatives so they could see their loved ones, sometimes even to say goodbye.
Many questions are being asked about the disproportionate number of deaths of care home residents. It is unclear how care homes will cope physically, mentally and emotionally with the second wave, but with some understanding of lessons learnt, resilience and trust is starting to be rebuilt.
Lessons can be learnt from care homes that did not report any residents with COVID-19 and those that reported a few cases but were able to prevent further spread. What did they do differently and how can this be captured and shared? Some shut their doors very early to visitors and NHS services. Others continued to refer residents with non-COVID-19 illnesses while managing to keep residents COVID-19-free, allaying fears that we were spreading the virus through our visits.
As the second wave emerges, the anxieties are tangible, and the threat of homes once again closing their doors to visitors is ever present. Existing family visiting arrangements provide some comfort, but are still far removed from any normality, and the harmful mental and physical consequences for residents are not difficult to see. The shared experience has brought us closer, not only as a team but also with our care home colleagues too. We were hailed as NHS heroes, but let us never forget our ever-present care home heroes who are once again bracing themselves for what is to come.