Highs and Lows: Reflections from the frontline of managing COVID-19 in care homes

Featured article - 10 June 2020
By Anita Astle MBE, Managing Director, Wren Hall Nursing Home, Nottingham

In 30 years of working as a nurse in social care I have sadly faced prejudice, belittlement, and lack of respect from multi-disciplinary colleagues in the National Health Service and Local Authority. This has been brought into sharp relief with the onset of COVID-19 and the lack of consideration as to how this would impact the independent care home sector.

I first qualified as a registered nurse, specialising in Burns and Plastics - and then gained a BSc in Advanced Professional Practice.I also worked in Intensive Care. I then left the NHS to temporarily run our family-owned Nursing Home. But, three decades on, and despite the terrible experiences that I mention above, I am still there, as Managing Director/Registered Manager.

• Wren Hall
• SCIE: COVID-19 support for social care

Responding to fear and anxiety generated by the media, poor guidance from Government and lack of research evidence on managing the Coronavirus, we decided to set up a local WhatsApp group co-facilitated by Professor Adam Gordon, a Consultant Geriatrician with a specialist interest in care homes to tap into each other’s experience and expertise. The App went live on 17 March 2020 and within 2 weeks grew to include 230 participants from all over the UK.

Through this App, we shared information to help other Care Home and Home Care teams to plan strategies/care pathways for their residents and clients. In particular, we tried to support care providers and staff, who had no clinically qualified staff on site to manage this life-threatening virus. Good job, as NHS Teams meant to be supporting step-up, step-down, intermediate care, and community nursing stopped coming; leaving us feeling even more isolated and ignored than ever before.

"Everyone was scared"

Walking away was not an option for us. I contracted COVID-19 and began self-isolation on Saturday 21 March 2020. Despite feeling dreadful I was up each morning by 06.00 hours, sat at my home office desk answering emails, reading guidance and writing Covid-19 protocols, with my phone to my ear talking to other social care nurses, who were also trying to make sense of what was happening. Everyone was scared and no-one was clear on what to do.

By Easter weekend I was at rock bottom, feeling generally unsupported by NHS and LA colleagues, guilty for not being directly with my team, weak from two weeks of Covid-19 symptoms, tired from working day and night shifts following self-isolation, and grieving the loss of nine residents. I decided to speak to the Media.

I wanted to highlight several issues:

• Large numbers of frail older people dying in Care Homes and not being included in Government death figures
• Difficulties and anxieties about sourcing appropriate PPE
• Staff feeling alone and deserted by NHS colleagues
• Being expected to work outside of usual scope of practice (e.g. residential care home staff being asked to verify deaths and complete advance care plans without any training)
• Battling alone without Government and public acknowledgement
• Dealing with understandably anxious relatives.

Through speaking to the media, we gained much support. Donations of PPE, hand- made masks and washable cloth bags, scrubs, toiletries, sweets, cakes and even a buffet were donated. These gifts boosted my team’s morale and brought smiles to our faces. The emotional highs and lows were often too much. I would find myself breaking down in floods of tears. My fears about the financial viability of my CQC rated ‘outstanding’ care home were immense. At one stage, we had 13 empty beds, lost income of £60K per month yet a full complement of staff to pay. Our bank account was overdrawn £50k and I was petrified that I was going to make our 41 residents homeless, our 142 staff jobless, and my own family homeless too.

It is now a number of weeks since all this madness started.

Presently, my team and I continue to do the best we can for one another and for those in our care. I feel a sense of numbness and my resilience is frayed. I have a fragility that I have never experienced before, and I am not sure I know what this means.

Professor Julienne Meyer CBE, Professor Emeritus of Nursing: Care for Older People and Co-founder My Home Life at City, University of London, adds:

Anita’s story shows that immediate local business and financial advice is urgently needed for care homes at risk of closure; from experts who understand the independent sector, together with a feedback loop to Government. Perhaps now is the time for Government to build on the learning from COVID-19 and create a new system of health and social care for frail older people that is fit for purpose. Let’s be in this for the long haul; working in better partnership, nationally and locally, to give older people what they truly deserve.