Coronavirus: Refuse Covid patients if you can’t stop spread of virus, care homes told

Care homes should refuse to take coronavirus patients from hospitals if they cannot prevent the spread of the disease, the care watchdog has told The Independent.

Staff should admit these patients only if care homes are equipped with the right PPE and infection prevention measures, the Care Quality Commission said.

During the first wave of the pandemic, care homes saw widespread outbreaks of the virus with 16,000 deaths. Homes struggled to access protective clothing for staff and were forced to take 25,000 untested patients discharged from hospitals.

In an in-depth interview, Kate Terroni, the CQC’s chief inspector of social care, said care homes should not be put under pressure during a second wave to take infected patients they could not properly look after.

She said any home that refused to admit patients would have her support.

“Care home providers should only admit a resident when they are confident they can meet their care needs, so where they are confident they’ve got good infection prevention control, they’ve got the right PPE, they’ve got the right workforce.

“We will absolutely support a provider to say they cannot admit someone if those ingredients aren’t in place.”

Ms Terroni, a registered social worker and former director of social care at Oxfordshire County Council, warned the care sector was in a “fragile” state after years of underfunding.

She said some of the largest care home providers had been hit by a drop in occupancy rates to as low as 80 per cent due to residents dying and people choosing to avoid going into care homes.

“We saw over the last six months, that increased numbers of people, sadly dying, and a reduction of people choosing to go into care homes. We’ve seen another wave of short term financial support coming into the sector but it just takes me back to that longer term sustainable funding point again.

“Successive governments have not come up with that long term funding solution. Coronavirus has highlighted more than ever why that is so critical: you can’t have an adequately funded health system and an underfunded social care system and expect it all to work together as we would wish.

“We went into this crisis with there not being a long term funding resolution for how to fund social care. Since about 2015, we at CQC have been calling for that.”

Additional funding from the government during the pandemic had been welcome, she said, but added: “That doesn’t take away from the fact that we need that long term sustainable funding solution; we need a workforce that is recognised and valued with the right terms and conditions.

“As we go into a possible wave two and winter, we need to make sure that there is equal attention, resources and focus paid to the whole system.”

She revealed the regulator was planning to launch 500 inspections of care homes during the next six to eight weeks specifically targeted at infection prevention processes to make sure care homes were geared up for the second wave.

It followed hundreds of inspections over the summer where in most cases care homes met the standards expected.

“This is about protecting residents,” Ms Terroni said. “We will look at staffing, at how staff are being trained around good infection prevention control, whether they are skilled and expert in using personal protective equipment. We will also look at how providers are minimising staff movement between different homes or services because we know that is one of the main major risks.”

In a message to care homes, local GPs and health organisations, she said the watchdog would not tolerate the use of blanket do not resuscitate orders. Earlier this year, multiple examples of the unlawful use of the orders were reported, prompting CQC and other bodies to issue a warning.

Ms Terroni said: “It absolutely flies in the face of human rights and person-centred care. It is something we absolutely do not expect to see happen again. We issued a really clear statement on this and we will absolutely investigate and take whatever action is needed, should we find instances of a blanket approach being taken again.”

Despite challenges facing the sector, Ms Terroni said 84 per cent of the 25,000 care providers regulated by the CQC were rated good or outstanding going into the pandemic.

“It is one of the toughest but most rewarding jobs that I’ve ever done. These are people who aren’t paid a vast amount of money, who, when the rest of the world were shutting their doors and shielding and keeping themselves safe, continued to go and work a shift in their care home and continue to drive around the country and go into people’s homes to deliver personal care. We saw them going to extraordinary lengths to make sure that people were getting safe care.”

But she added the regulator saw a mixed picture in local systems working together, which she said was crucial in a second wave. Some care homes had reported feeling abandoned.

“In order for social care to deliver well and keep people safe, they don’t work in isolation, they work closely with the GP, with the local hospital with the dentist.

“Social care only works if all the other components around it are also supporting them.

“The focus at the beginning of the pandemic, when none of us quite knew what this would look like, was about supporting the NHS and ensuring that there were enough beds for people requiring hospitalisation. There was an absolute logic to that.

“What’s important, as we think about this winter, is that every part of the system needs to have the right resources and attention in order for it to work.

“My plea would be that everyone in health and social care thinks about how they behave in the system first; thinks about how they are joining up services to ensure people get a good outcome.”