Care Homes – the Law of Unintended Consequences

Care Homes – the Law of Unintended Consequences

Based on the overwhelming evidence, it would be reasonable for most commentators at this stage of the coronavirus pandemic to conclude that care homes have experienced a considerable lack of Government support in multiple areas. This includes the provision of personal protective equipment (PPE), the testing of residents and staff, as well as inadequate additional funding.

This injustice has been widely reported in the media. Is there a danger, however, that in our attempt to ensure vulnerable people receive the support they need during this pandemic and in the future, we could have unintentionally ‘thrown the baby out with the bathwater’? Most of the people I have spoken to outside of our sector now see care homes as no go zones. Not surprisingly, therefore, we, along with most providers, have seen enquiries and admissions, along with income, drop dramatically.

Despite the immense injustices care homes have experienced during this pandemic, approximately two-thirds have reported no cases of coronavirus and, because of the exceptional skill and resilience of our staff, some of the frailest members of society who contracted the virus have also recovered.

I am mindful that because of the lack of testing, there is every likelihood that there have been more cases. However, would that have shown that the majority of care home residents and staff have had the virus or the minority? Certainly, from the early test results we are seeing for our residents and staff (who are now all being tested in our homes) I suspect it will be the minority, essentially, because of the valiant efforts of our staff who have willingly worn uncomfortable PPE and religiously followed infection control procedures. Is their reward however, going to be an uphill struggle because we have unintentionally destroyed confidence in the sector? Without any doubt we should be raising awareness of the injustices the sector has suffered, but have we been proportionate with our views? Have we over emphasised the inadequate support we have received compared with the herculean achievements of our staff, who have been continuing to keep care homes essentially a safe place to live? Have our views represented the majority of care homes or the minority?

The number of care home residents who have died during the coronavirus outbreak is now equivalent to at least one in ten of the entire care home population, according to Sky News analysis. Between early March and the first week of May, nearly 54,000 care home residents have died in England, Wales, Scotland and Northern Ireland. This number includes deaths from all causes, and while only a fraction is formally attributed to coronavirus, the cumulative total is now well over double the historical average for deaths at this point in the year.

For the avoidance of any doubt, I don’t want to diminish the profound impact any family member experiences when a loved one living in a care home contracts coronavirus or dies from it. We know from our own distressing experience of managing residents with the virus, along with those who have died, the devastating effect this illness has on a person and their family as well as our staff. Unfortunately some care homes have had an exceptionally high number of residents who have contracted coronavirus. However, in our own organisation the infection level has been small compared to our total resident population; we have one home where none of the residents or staff have had coronavirus.

Another misconception that is contributing to the drop in admissions is that families are not permitted to have any contact with a resident. At present visitors are unable to enter a care home. Contact is being maintained, however, through video technology as well as viewing family members through an external window and talking on a telephone. These arrangements are unquestionably not the same as personal contact. However, they explode the myth that you are not permitted to have any contact at all.

Even before this pandemic the care home market was very fragile. Decades of underfunding by Government needs to be addressed and I believe this must form a key element in any subsequent public enquiry into this pandemic. Data produced by Company Watch in 2019 shows that the percentage of care home companies with a 1 in 4 chance of going into insolvency or in need of major restructuring in the next 3 years had increased from 24% in March 2014 to 30% in September 2019. The cost of improving our standards of care demanded by the Care Quality Commission, which I fully support, together with the increase in the Living Wage continues to accelerate the rate of closures. In addition to this, it is forecast that the UK will need at least 75,000 additional elderly care beds by 2030 and that, based on trends before the pandemic, demand will outstrip supply by 2022.

One of the fundamental pillars that supports all companies is business confidence. This was severely damaged in the care sector following the horrific discoveries at Winterbourne View in June 2011 by the BBC Panorama programme. I believe all of us who are striving to provide outstanding care fully support the prosecutions and other enforcement actions that were taken subsequently. The extensive reporting of this, however, cast a massive shadow over the sector, severely damaging business confidence. While some other homes were subsequently discovered to be inadequate, the vast majority of homes were not. All of us, however, paid an enormous reputational and commercial penalty as a result of this.

All of us in the sector know that care homes are comparable to a life support machine for some of the frailest members of our society who need assistance eating and drinking along with their personal care, because they can no longer be cared for in the community. This pandemic has created considerable uncertainty for every sector and profession which will hopefully begin to ease as we exit from it. For the vulnerable people in care homes, however, it doesn’t end; they went into this pandemic with a fragile future and will come out facing a potentially catastrophic one, unless we can rapidly change the misconception that exists regarding care homes being no go zones and attract new admissions again.

Is it reasonable for the public to conclude that care homes are no go zones? I have not had an opportunity to read every article on this subject, particularly as there are a considerable number, but from those that I have along with the experience from our own homes, there appears to be a significant disparity between what is actually happening in care homes and what is being reported in the media. Urgent efforts need to be made to ensure that people outside of the sector fully understand that care homes essentially continue to provide safe care. Whist it would be reckless in the extreme to suggest that there is no likelihood of a resident catching coronavirus, the reality is, approximately two-thirds of homes have not had any cases and family members can stay in contact with their loved ones following admission.

Quite simply, we are open for admissions. Regrettably, however, by raising awareness of the current difficulties in an attempt to improve the sector, we may have unintentionally created a perception that care homes are no go zones. This has resulted in admissions plummeting to unsustainable levels and, as a consequence, the number of care home closures will increase at a time when demand will begin to outstrip supply.

Now is the time to reassure people that our care homes are a safe and caring environment for their loved ones. The sector looks after 410,000 residents compared to 141,000 beds in NHS hospitals. We deserve more plaudits for the enormous contribution we make to society.

Leon Steer
Chief Executive Officer of
Rapport Housing and Care