The only reliable way to safeguard care homes from hospital-introduced infection is to stop all discharges direct from hospital
15,500 more deaths registrations than normal occurred in England and Wales’ care homes between mid March and April 24. On average in weeks 11-17 in the last 5 years there were 15,670 care home deaths. In 2020, there were 31,200 deaths.
It has been widely acknowledged that sending patients discharged from hospitals into care homes has been one contributory factor to this tragic crisis. Yet even now, the Government are still asking care homes to take patients who can be discharged from hospitals but are not ready to go home.
Implementing this policy, Devon County Council is offering homes which take these patients an extra 4 per cent on their commissioned placements. I have been told that important safeguards have been introduced:
- All patients are tested before hospital discharge, and the care home notified of the test result. In many cases the individual will have been in hospital for the full 14 day isolation period already. Even if the test is negative but patients are showing symptoms they are likely to remain in the hospital for the isolation period.
- In all cases of people discharged from hospital to care homes, even if tested negative, the home is advised to isolate the individual for 14 days for the safety of other residents.
- Care homes continue to have the right to refuse any admission if they don’t feel able to provide the right care and support.
However the fact remains that homes are being encouraged to introduce patients who have been in a hospital environment, where Covid is present, and who may have had the disease themselves, into care homes.
The terrible tragedies of the last two months have shown that care homes are not suitable environments for discharged hospital patients in this pandemic. Care home staff are not trained to manage highly infectious diseases and buildings are not adapted for this purpose.
- While the new testing and transfer arrangements are a real improvement, as many as 30 per cent of tests may give false results, and it could be that false negatives are particularly likely to occur in asymptomatic patients.
- There are confirmed reports of infection after 21 as well as 14 days.
Equally, while it is good that care home managers have discretion, they may well feel pressured to take patients. Given the financial difficulties of the sector, the incentive may be difficult to resist.
Advising care homes to isolate the patients is not the same as the NHS keeping them in a properly managed clinical environment. Since I gather that numbers of Covid patients in hospitals and of new cases are declining, I do not see the need for any patients to be discharged to care homes during this pandemic.
If patients cannot be kept in the non-Covid areas of acute hospitals, they should be transferred to dedicated wards in separate facilities, such as community hospitals or private hospitals, where proper clinical control can be maintained.
We are probably only at the beginning of the pandemic, which could last at least a year. It is therefore essential that we adopt the best possible procedures now to avoid any repetition at all over the coming months of the disastrous spread of Covid among vulnerable care home residents which has happened since March. This surely follows from our duty of care.
I have therefore asked the Council to request the NHS to develop procedures which avoid any discharge of patients direct from acute hospitals into care homes, and to withdraw the proposed incentive.