“I have never written so many death notifications in such a short time,” a care home manager who lost 23 residents to coronavirus in just two weeks told the Guardian last month. “Every member of staff is lost. One day, a resident was walking around with a mild temperature. I went home and the next morning they were dead.”
Some of the hardest-to-hear stories of this pandemic have come from Britain’s care homes; of sons and daughters who have been separated from their parents for weeks unable to see them before they die; of staff who are paid a pittance for invaluable, and now life-endangering, work, struggling to cope with the scale of the loss.
At his first press conference since his return to work, Boris Johnson celebrated the fact that Britain is “past the peak”. But there was little mention of care homes, where the picture is altogether different. In England, almost a third have reported coronavirus outbreaks and yesterday the president of the Association of Directors of Adult Social Services, James Bullion, warned that the situation in care services is getting worse. Until last week, care home deaths were not even included in the official death toll, but we learned on Tuesday that in England and Wales there had been more than 4,300 deaths in just a fortnight, suggesting that even as the hospital death toll has been consistently falling, the death rate in care homes continues to accelerate.
The health secretary, Matt Hancock, has claimed that care homes “have been a top priority right from the start”. But the government acted far too late to prevent a dire situation. An important part of its pandemic strategy has rightly been to “shield” those most at risk from the virus from exposure to it. But the big flaw in this plan is that some of the most vulnerable are those older people and people with a disability who rely on professional carers for intimate support with everyday tasks, in their own homes or in care homes. They simply cannot be shielded from the outside world. And so it becomes absolutely critical that those who care for them are able to access ample stocks of personal protective equipment and are regularly tested. Otherwise, the most vulnerable will be among those put most at risk of contracting the virus.
Properly protecting those living in care homes and who use care services in their own homes would be a logistical challenge for any government. It would have required an immense amount of forethought and planning. News that nursing homes in the US and Australia are also facing terrible death tolls shows that it is not just the British government that has made mistakes. But the extraordinary efforts that went into building the Nightingale hospitals are a testament to what can be achieved when something is made a political priority. That level of energy has not been invested in protecting older and disabled people who rely on professional care services.
Even as some care workers have made huge sacrifices to keep the people they look after safe, including moving into care homes to protect older residents and their own children, they have had to struggle with completely inadequate levels of protective equipment. For weeks, care homes have struggled to access testing and people have been discharged from hospitals into care homes without being tested first. Managers report grappling with difficult decisions, with little guidance from the government: do they accept new residents who have been in hospital when they have not been tested, potentially putting other residents at risk; do they let relatives in to say goodbye to their loved ones; how do they prevent workers making a dozen home visits a day, who may be asymptomatic, spreading the virus to those who are most in danger from it, when there isn’t enough protective equipment or tests? And it can be almost impossible for care workers, who are invariably low paid and sometimes on insecure contracts, to speak out about unsafe conditions: five carers have reportedly lost their jobs in the past fortnight after speaking out about their concerns.
Without urgent action by the government, there is a risk that the care home death toll carries on growing long after the infection rate has dropped in the country at large. The same level of emergency planning that was deployed in relation to the Nightingale hospitals now needs to be invested in averting further care home deaths. Extra emergency funding must be immediately directed towards the sector to help providers cope with extra costs, including agency staff and the cost of protective equipment.
Too many older people will have unnecessarily lost their lives as a result of this pandemic. It is a painful reminder of the ageism that runs through our society, the way in which the lives of those who need support to be able to live are assumed to count for a lot less. Funding for social care has declined in the past 10 years, even as demand for care has risen as a result of an ageing population. The result is that every day an estimated 1.5 million older people – one in seven over-65s – go without the help they need with tasks such as washing, dressing and eating. Meanwhile, too many care workers are not even paid the minimum wage for skilled work that can be emotionally and physically tough, but potentially so rewarding, and private equity finance has flooded into Britain’s largest care home chains, loading them up with unsustainable levels of debt as private financiers seek to extract significant returns from taxpayer-funded care.
So it is shocking, but hardly surprising, that our older mothers and fathers, aunts and uncles, grandparents and friends have been left vulnerable to the worst effects of this pandemic. It’s the inevitable product of living in a society that gets its approach to ageing so wrong, where those who rely on professional care are somehow seen as having a diminished right to a flourishing life. The tragedy unfolding in our care homes must surely be the wake-up call that we need to change that.