Kinder to leave elderly people with coronavirus in care homes?

The hospital treatment is too severe for a frail elderly person and it would be cruel to attempt resuscitation, as would intubation in readiness for ventilators.

I heard someone on the radio (I presume a doctor) saying that ventilating a very elderly patient wouldn’t have a good outcome and I think it’s a quite traumatic procedure.
I think the decision to refer to hospital has to be taken after discussion with both the patient and the family. But in the end it comes down to how long doctors should ‘strive officiously to keep alive’.

Yes, I think it would be kinder to keep people in familiar surroundings, with people they know.
Would it be possible, though, for them to be comfortable enough without any medical care?

Care homes are not nursing homes. How kind is it to the very poorly paid and unqualified staff to expect them to nurse residents in what could be their terminal illness?

And how kind is it to the other residents, and to staff, to expose them to a high risk of infection?

I understand where the OP is coming from, but surely care homes are not the appropriate setting in which to deal with very sick residents who have a highly contagious disease.

I heard I think the manager of a care home say how distressing it is to even attempt to test elderly and especially dementia patients so I am sure moving them to a hospital such as one of the Nightingales as suggested to Dominic Raab this afternoon n the Covid19 briefing would be terrifying for them.Sometimes just because you can does not always mean you should.
And yes, despite having unqualified respect for the sanctity of life, I think there will be many cases where a peaceful end would be vastly preferable to “officiously striving to keep alive”, but I could not possibly say that should apply except in the case of someone close to me.
At the end, Paw had signed a DNR and so we knew that despite all the best efforts to support his organs in the hope that some of all would recover, it was a hopeless task. Had he suffered from dementia or been very old and frail, I would still have felt invasive treatment or a move to a vast field hospital like any of the Nightingales would not have been what he wanted either.

Elderly people die in care homes as well as nursing homes.

My OH's uncle is on a ventilator in ITU ,he wasn't expected to make it through last night but he's still here and we have our fingers crossed he'll make it through.Hes a lovely man and my MIL is in bits that no one can visit .Its really hard on the family ,I dont think it would make it better by leaving folk in care homes though as at least he's getting the best help available. Uncle was in his own home and we have no idea how he has caught it ,unless while shopping ,hes a very healthy fit man who has always looked after himself .

Nursing homes will always have qualified nursing staff on duty.
A care home doesn't necessarily have medically qualified staff on duty but will be staffed by qualified care assistants, so yes, there is a difference.
A home dealing with dementia patients will have medically qualified staff who should be further trained in dementia care so could possibly be the best people to nurse confused patients.

A doctor would need to assess whether an elderly person with dementia would benefit from intervention and surely the family, if there is one, should be involved in the decision too?

Yes I agree with you Mazie, my stepdaughter is a manager in a care home
She and her staff have inadequate PPE, her hands are blistered and sore with washing . She agrees that she is not qualified to deal with this
They are, sadly, fighting a losing battle
There are now positive cases in the home
We are extremely worried about her, yet still she goes to work, to do what she can
You know, just give these people the equipment they deserve to protect themselves, while they are doing their very best to protect the most vulnerable in society

My DH spent many weeks in ICU in an induced coma and on a ventilator at the end of last year . I spent almost my every awaking hour just sitting there holding his hand listening to the sound of the ventilator keeping him alive. I cannot for the life of me imagine what It might be like for a loved one not to be allowed to visit .

It’s heartbreaking .

Just watched the news tonight showing the extremely high (death rate) statistics for care homes in Scotland . Those poor people.

I think each case should be judged individually to try and jointly make the best decision for that person. If someone is unlikely to recover whatever is done, it can be best to spare them the trauma of urgent admission procedures, noisy A&E departments, tubes and drips and other invasive treatments, when their interests might best be served by remaining in a context that they know so that they can depart this life in peace with people they know around them.

It is a case by case decision.

our deaths are standing around 2000 with 39% of those from care homes,figures are updated weekly .Deaths IN hospitals are dropping while care home ones haven't peaked.Due mainly to people being sent back to care homes after just one test ,new rules now in place where they must be tested and have at least two negative tests days apart before they can go back .I believe there were over 4000 added to the English figure today and that it was said to be an underestimate .

I was thinking just that, today.
Having worked in care homes, with many people having dementia, it was often the case that people who had sufficient understanding would refuse life extending treatment.
Presumably they felt it would be too much of an ordeal for too little gain.
The main risk of keeping covid sufferers in the care home, of course, is that of infecting other residents and the staff.

Many people who are in care homes have signed a DNR so will not be offered Intensive Care Treatment, or even be sent to a hospital, they will only be offered Palliative care. So the death rate will be high.

Everybody should have the right to be allowed to die in their own home if time allows.

Care homes have no right to effectively evict someone for being ill or dying by dumping them in acute hospitals. Or by refusing to have them back if they are not getting any treatment in hospital.

There is NOTHING nice or comfortable about being in an acute hospital unless you are there for medical or surgical treatment.
If you arent there for treatment, you are better off at home.

Evictions were supposed to be banned during lockdown. Some care homes seem to have not got that memo.

Only people for treatments should be admitted to hospital from their homes

Simply being in hospital makes frail people and people with dementia deteriorate .

Not allowing people to stay or to come home as soon as theyrr not being treated is cruel and wrong. It is their home

Someone who goes into hospital for CV treatment from a home caught it in the home so for the home to then refuse to allow them home because they have CV is illogical and immoral. Their "household" already has it

Yes I agree with you Mazie, my stepdaughter is a manager in a care home
She and her staff have inadequate PPE, her hands are blistered and sore with washing .
Why is that new for her? Was she not washing her hands between patients and tasks before CV? If her hands are suddenly reacting to doing the correct amount of hand washing as per universal precautions, then she obviously wasnt bothering to do it before.

She agrees that she is not qualified to deal with this
A person who is not for hospital treatment and is ill with or dying of CV has no extra needs than any other elderly person who is ill or dying of a respiratory disease.
Its very very basic care
How was she caring for people before if shes not qualified to care now? Did nobody ever get ill or die in her care home before? I doubt it. Care is care.
CV+ residents who arent for hospital treatments have no specialist nursing needs . Just basic good care. What part of that is she not "qualified" to do? Sounds more unwilling than unqualified. There are no qualifications required beyond basic care skills.

My newly qualified medic daughter has been going to care homes as part of her training. In this area at least, all residents have a DNR directive to say what their wishes are in that instance and everyone also has a directive to say what they wish to happen in the event of future illness.

Surely that should be standard practise in all care homes?

Notanan It’s inaccurate to say a care home resident who is dying from covid 19 has no specialist nursing needs. Staff must be in full PPE to tend to them and keep them comfortable. It’s a well established fact that supplies of PPE to care homes have been inadequate. But they must do their best under extremely difficult circumstances to provide compassionate end of life care while at the same time try to prevent the infection spreading to other residents and staff. Are you aware of how many care staff have died in recent weeks in care settings? They are striving to care for their patients with compassion and kindness often risking their own safety. Numerous examples of care homes where staff have volunteered to live 24/7 on the premises since the start of the outbreak and haven’t seen their own families. They are sleeping in bunk beds and in some cases camper vans in the car park. I don’t recall ever seeing that happen under “normal” circumstances

Surely that should be standard practise in all care homes?

It should have been. All along. Regardless of covid. But it clearly wasn't given the rush to "catch up" on all the undone reviews during the pandemic.

Just goes to show that care homes were not giving best practice care in the first place and are now blaming covid for things that should have been in place as standard all along.

Grannynannywanny

Regarding the care home managet who said she wasnt "qualified" to do that. Why not? Was she not doing it properly before for people with other productive or infectious respiratory issues?

There are no NEW skills needed.

Any PPE issue should solely be an issue of supply/stock.

She and her staff should have already been familiar with using it. Just less frequently. None of it is new kit. Its all stuff they should have been familiar with from using it for flu or TB positive residents who use nebulisers or residents with productive coughs or other antibiotic resistant strains of pneumonia etc. All common in care home settings. The only difference should be that more people need it at once!

So for her to say now "not qualified" to give that type care, means they werent giving it properly before.

Because there is nothing that a covid +ive patient needs that wasnt previously needed by care home residents. The challenge of Covid is the QUANTITY of people needing it all at once. There is nothing new about the care or skills or qualifications required for those tasks at community level.

So she is either "not qualified" because she never bothered to learn best practice until it was risky to her personally not just a risk to her staff and residents.

Or. When she says "not qualified" she really means not willing: she wants it to be someone elses job!

I guess that shows that some care homes are better than others, Notanan. Why on earth wouldn’t they put plans in place as soon as a resident moved there? Are these things not taken into account on inspections?

Thankfully, I’ve little experience of care homes although a family member was in one last year for the final weeks of a terminal illness. I was horrified when I visited, and even more so when I was told it was the best of the bunch.