Real lessons from the UK frontline

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An operator’s advice one week out from the COVID-19 peak

Last Tuesday, 7 April, Ansell Strategic organised a 60-minute Zoom video conference with Tom Lyons (Managing Director) and Brett Burton (Director) of the UK’s Black Swan Care Group, which operates 20 aged care homes across East Britain, now including two with COVID-19 outbreaks.

Importantly, England is three weeks ahead of Australia with the pandemic, which is forecast to ‘peak’ in five days’ time – 14 April.

The video conference objective: use the UK’s aged care experience as a warning rather than a prediction, with lessons to be learnt in preparations for the ‘peak’.

Also sitting in were Sean Rooney (LASA CEO), Pat Sparrow (ACSA CEO), Kate Gainer (Senior Analyst at Uniting Australia), with Amber Cartwright and Cam Ansell (Ansell Strategic).

It is compelling viewing for any operator (and bureaucrat). Watch it below:

Below are the major points.

Black Swan’s virus experience

Across the two homes that have COVID-19 infections, 37 residents have tested positive, three have died, three are in hospital and three are at a palliative stage. And one staff member is in critical care.

15% of the staff have self-isolated on sick leave and are ‘scared’.

Before the outbreaks they had implemented ‘no visitors’. Following guidelines, PPEs were not used, and fresh stocks were not generally available.

The infection in one home came from a resident returning from hospital who was isolated for seven days after being brought to the home as per the Government’s guidelines. On the eight day, they showed symptoms.

The infection in the second home was transmitted by a staff member returning from a trip to Spain with no symptoms and before testing protocols had been put in place. They were on night roster and had visited multiple resident rooms.

Infections in this home went from 0 to 20 in three days, and then one to two a day.

The immediate impact was: “you can’t get staff and you can’t share staff”.

Following the outbreak, no doctors were prepared to visit the homes for 10 days and no one could be tested.

The lack of hospital beds mean that residents who had advanced UTIs and falls were deemed to be unsuitable for admission by paramedics – leaving them in the home.

External nurses also refused to attend, resulting in residents missing medications such as insulin.

Agency staff refused to work in infected homes.

The phones were ‘inundated’. 

Staff

The first 48 hours after the infection is critical for motivation. Staff are scared and greatly impacted by the media, especially social media.

A significant minority stated ‘they did not sign up for this’ and ‘can easily get home care jobs for the same money around the corner’, and without risking their family.

With the 15% self-isolating, the remaining staff are working double shifts.

Some floor staff and regional management are self-isolating, dispatching their families to other relatives. The leadership team is concerned about this given the potential length of the pandemic.

Communication, constant reassurance and motivation by the leadership is vital. 5am phone calls to the homes, making sure each employee’s name is known in the conversation, plus attendance on the floor seven days a week out of hours, bringing chocolates etc to add to the atmosphere.

Staff want to wear PPE all the time – which is not possible.

They also believe there should be no new admissions. Explanation of the financials is delicate.

Morale is damaged by lack of recognition of care workers compared to the high public recognition given to NHS workers.

One positive point is that the regulator is being less intrusive and the ban on visitors means the homes are ‘quiet’. Staff are enjoying being able to get their work done, including paperwork.

PPEs

Staff need constant explanation that PPE are not available and the guidelines limit their use.

Each home was allocated 300 masks per week. No other PPE is available. Black Swan purchased 4,000 bin liners as aprons. Face visors “were impossible” to secure so they use goggles, which they disinfect after each use.

They were paying 8 pence a year ago for masks and 29 pence just before the pandemic. Other operators who had not prepared supply are now paying £2.60 for a mask that can be worn for just one hour.

Families are demanding to know why staff are not wearing masks all the time.

Families

80% of families are okay and 20% are “beyond scared and extremely worried”.

It is surprising that families have NOT taken people out of the homes.

However, they have had no new private admissions, with occupancy halving in the infected homes.

Family volunteers have been really positive; and difficult family members have been advised they should consider volunteering.

Hospitals – a major challenge

Their ‘worry’ is that hospitals will send them infected palliative patients to die and they do not have PPE.

Hospitals are being disingenuous in who they send to the homes. Staff are sent back to the hospitals to check records and are discovering that some hospitals have ‘lied’, resulting in the resident being sent back to the hospital.

One patient delivered by the hospital, it was discovered, had been received by the hospital from jail because he had stabbed his wife. The home had not been given this information.

Another hospital transfer had had their medical records altered.

Again, the staff believe transfers from the hospital should not be accepted.

Financial challenges and other operators

Costs have escalated, (plus the minimum wage has gone up 6%).

A significant number of providers will run out of cash in the next two to three months.

Less financially secure operators are taking high-risk clients to maintain cash flow and fill vacancies.

These operators are having to resort to supermarkets to supply food and groceries – with order fulfilments significantly incomplete.

Hospitals call daily requesting to take COVID-19 patients. Other operators take them because they need the cash.

‘New build’ homes are taking three to four NHS patients a month to fill vacancies; some are isolating separate areas.

“Our concern is government will say you have no choice because hospitals are overrun – that is now law – you have no choice” but to take COVID-19 patients.

What would you do if you had your time over?

Ensure a plentiful supply of PPE so staff feel safe to come to work.

‘Manage the message’. To counter what is in the media, particularly around the perceived security against infection that PPE deliver, which panics staff.

Get the government to deliver cash.

Get the government to value ‘social care workers’.

Reassure staff about what things will look like in three months’ time (positive).

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