Shielding the vulnerable

“If all the relatives and friends of someone over 80 are staying away as a means of shielding them, the carers could be their only visitors for the next few months. That makes them the only potential source of infection.” Green peer Jenny Jones has called for care workers looking after the elderly and vulnerable to be provided with PPE to limit the risk of transmitting coronavirus to their patients.

Jenny Jones speaking
Jenny Jones speaking

Image: Stephan Röhl / Flickr / cc by-sa 2.0

Jenny Jones

I was shocked to discover that carers regularly visiting the elderly are not advised to take the basic precaution of wearing masks and gloves, unless the person starts displaying symptoms. Carers are vital at this time and doing a wonderful job, but the guidance should be protecting the people they look after as much as it is about protecting them.

If all the relatives and friends of someone over 80 are staying away as a means of shielding them, the carers could be their only visitors for the next few months. That makes them the only potential source of infection. The same applies to staff in care homes for the elderly and other residential establishments that have stopped all visitors.

Shielding the elderly appears to have been one of the better aspects of the government’s strategy. The media did a great job of getting out an early message about those over 70 being at risk and needing to tuck themselves away. The supermarkets have made significant efforts to make the vulnerable a priority for the food deliveries, although many still fall between the gaps, and the hospitals have not faced the same deluge of elderly patients that swamped the healthcare system in Italy. We just need to make this aspect of social care as watertight as possible.

As I understand it, the guidance for home carers was updated on 19 March, but still isn’t strict enough. I know that Green Party councillors around the country are reviewing how their care providers are operating and pushing for masks to be used.

The same rules should be applied to those working in care homes. The new guidance does have provision for shielding the most vulnerable, such as those with cancer, or respiratory conditions, but age itself is not a criteria. A 91-year-old great-grandmother is clearly a candidate for shielding, but might not be if the criteria were strictly observed. Local choices are impacted by calculations about the amount of personal protective equipment (PPE) available and the guidance will be part of this consideration.

I don’t know if the lack of PPE has been a factor in the case of the thirteen people who died at the Burlington Court Care home in Lanarkshire, Scotland, but the shortage is certainly a concern throughout the sector. It is worrying that none of these people were tested for coronavirus, which indicates that many other care home fatalities will have been unreported in the coronavirus death toll. Post-mortems and notifying relatives are leading to a delay in the Office of National Statistics (ONS) figures that show the true scale of the Covid-19-related deaths outside of hospital.  

The Guardian reported on the case of Wren Hall nursing home in Nottinghamshire, where nine residents are in isolation with suspected Covid-19. The manager paid £9,000 for a consignment of masks at £2.74 each – five times the usual price – because the government’s first delivery of supplies was 160 masks. The manager said. “I told them we were using 312 a day. I waited four days and got 400. The supply chain is completely useless.”

At Burlington Court, a clear link was made because two staff tested positive in hospital for coronavirus. Surely, all deaths in care homes need an instant test to enable the managers to make choices about strict quarantine measures to contain any local outbreak?

There is also the issue of how elderly people are treated if they do get it. With GPs sending out Do Not Resuscitate forms to hundreds of their patients, are we expecting our old folk to die at home or in hospital? Many anguished relatives will not want their parents, or favourite aunts, to die alone, especially if they have been unable to see them for weeks. The provision of PPE to such hospital visitors may not seem a priority but it really is. If people are caring for their relatives at home in their final hours, then they need protecting as much as staff in hospital.

The government has yet to release figures giving their estimate for PPE needed each week during this crisis. Despite repeated assurances, it is clear to everyone that they don’t have enough and that is the reason why no one at the top of government wants to give their purchasing sections any instruction except ‘buy as much as you can’. As with testing, they are running to catch up and it is heartening to see clothing/fashion businesses respond to the challenge. My appeal is to look outside of the hospitals and to change the guidance on PPE to include elderly people being cared for at home and in care homes. 

Jenny Jones is a Green peer sitting in the House of Lords as Baroness Jones of Moulsecoomb.