Curiosity and the crisis in our care homes

I’ve mentioned before that one of the challenges we have as a society is the lack of curiosity we have when seeking to understand what is going on. It means that we often stay at a level of safety which enables us to have emotional reports that express pain, hurt, outrage even but never get to the real issues.

Take the situation in our care homes for example. There have been lots of media reports about the shockingly high numbers of deaths in our care homes from COVID-19. Those reports have rightly highlighted the heroics of care home staff, rightly asked questions about provision of PPE but have stopped there.

The real question is “Why are there any deaths in our care homes at all?”

I am being intentionally provocative here. I am guessing the obvious and immediate answer is “What a silly question to ask Dave. Of course you are going to get deaths in care homes. The residents are elderly people in one of the most at risk categories. It is unavoidable but should it have been that high.”

Why do I stick with the seemingly ridiculous question? Well it forces us to challenge assumptions. What if we had started with the assumption that we were going to avoid deaths in our care homes. Where would that have led us in terms of our strategy.

You see, there are some good reasons why, despite the age and frailty of residences we could have avoided deaths. Let me explain.

  • Care homes are there to care for elderly people. They are not there to treat extremely ill people with highly contagious, untreatable illnesses.  They are not hospitals
  • At the same time, care homes are discreet premises which it is possible to secure.
  • We are now 7 weeks away from the full lockdown but also over 2 months from when  we realised that there was a serious health risk with particular dangers to the elderly.

From that I would extrapolate the following. First of all, it would be concerning if those patients dying from COVID-19 in our care homes are people who have caught the virus since lockdown started. This would suggest that there were problems with quarantining.  Indeed, there is a more general question here about the number of people dying who have caught the virus recently and those who were already ill at the start of lockdown.  Alongside that I would also want to identify hospital patients dying from COVID-19 who have been transferred from care homes.

Secondly, I think we have to ask questions about the policies determining how critically ill people with infectious diseases are cared for. I think people are now starting to catch onto this and that is why there has been a shift in the messages from “protect the NHS” to “control the virus” [1] You see, the message that we needed to protect our NHS carries a risk. The point was that we needed to help give the NHS a fighting chance of building capacity by delaying the peak. It looks like that was achieved. However, it is possible that this came at a cost if it led to people not going into hospital or delaying going in if they were showing severe symptoms. So, I have some questions about what happened between care homes and NHS hospitals. If the policies means that people did not go to hospital from care homes who needed to or that care home residents were returned early then that would be deeply concerning.

So, at the stage, I am still asking questions because I’m not the expert and I don’t have all the information but I think I can at this stage ask a few “what if questions.”

  • What if care homes had been subject to an earlier lockdown so that families were not entering at the stage the virus began to take off?
  • What if the NHS had drawn care homes into an integrated operation to respond to the illness?
  • What if residents with COVID-19 had been swiftly quarantined off site for specialist care such as at the Nightingale hospitals.

Could any of those scenarios or a mix of all three led to a better outcome for care home residents? Would it have meant that care staff were better protected and better supported.

I am not in a position to know the answer to these questions but I hope that someone somewhere is asking them.

[1] Of course there are better messages still. See this article from James Ballentyne  though “love your neighbour” really depends on a society that loves God first.

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