Why are they STILL locked away from loved ones?

In 2020, our award-winning front page laid bare the agony of care home residents and their relatives torn apart by draconian Covid rules. But with Omicron so much milder...

WITH her face pressed close to the window pane and in a strong voice belying her 99 years, care home resident Frances Heaton reads aloud from the piece of paper fluttering in her hand.

It’s a poem the great-grandmother has composed to describe her desolation at being separated from loved ones during the pandemic.

Filmed at her Yorkshire care home by daughter Linda standing outside, on the other side of the glass, Frances speaks: ‘I’m 99. I enjoyed my life. Now it’s an existence. I enjoyed my family. Now they’re unreachable. I enjoyed my outings. Now I’m trapped. I’m 99. I need my family. I’m so lonely. I need a hug. It’s not allowed. I need a chat. But there’s endless silence. I’m a prisoner. But I’m innocent. I have rights. But they are ignored. I fought for freedom [during the war] but now I have none. I’m 99. Please help.’

In 2020, at the start of the pandemic, Frances spent two months isolated in her room. At times, even ‘window visits’ weren’t allowed because of fears of the virus spreading. And even when they were permitted, the fact that she is deaf made communication with her family through the glass almost impossible.

Frances’s poem, written in the early months of lockdown, echoed the experience of many of the almost half a million people living in care homes in the UK during the dark days of early 2021, when the virus ran rife.

More than a year on, the situation has vastly improved: the latest NHS figures show 95 per cent of care home residents in England have had two vaccine doses and 81 per cent have had their booster, too. The Omicron variant, though highly transmissible, seems to trigger milder symptoms in those who are vaccinated.

Significantly, there were 40 deaths attributed to Covid in care homes in England in the week to Christmas Eve, compared with a peak of about 1,800 in a week in January 2021.

AND yet thousands of care home residents are effectively being imprisoned once again as a result of new Government guidelines — introduced on December 14 (and updated on December 30) — and some care homes’ over-interpretation of the rules, leaving many continuing to feel the pain expressed so eloquently by Frances Heaton.

The resident of one home, Jim Pegg, 88, told his family he felt ‘imprisoned’ — which is tragically ironic, given he is a former prison officer (see box, right).

It’s not surprising, perhaps, that experts are now warning the resulting isolation stemming from such rules poses a serious risk to residents’ health and well-being.

A report by researchers from Oxford University called for an inquiry into tens of thousands of non-Covid deaths in care homes after they found evidence that vulnerable residents had died of thirst, starvation and ‘broken hearts’ in the pandemic.

Their shocking report said almost 40 per cent of excess fatalities were not caused by the virus, with many people dying of neglect and loneliness. While staff absenteeism and lack of training was partly to blame for this, crucially, the researchers identified a ban on visitors to look after and monitor residents as also a key factor.

Around 70 per cent of people in care homes have dementia or severe memory problems, but many have other health problems that require residential care. All these residents benefit from stimulation that comes from visits with loved ones.

In its updated guidance on care home visitation — introduced as a precaution ‘as we learn more about real-world vaccine effectiveness and disease severity of the Omicron variant’ — the Government acknowledges that ‘visiting is an integral part of care home life. It is vitally important for maintaining the health, well-being and quality of life of residents.’

However, the guidance says that if there is an outbreak in a care home, there can be no indoor visits for up to 28 days following the last positive case. An ‘outbreak’ is defined as at least two people testing positive within the home. Although it was reported last weekend that this has now been reduced to 14 days, the transmissibility of this variant means that some care home residents are subjected to a cycle of restrictions and weeks of isolation. The rule compares with the one covering the general population, where you can go back to normal days after a positive test, providing you test negative on days six and seven. Even where there is no outbreak, a resident can nominate only three visitors who can enter the care home for regular visits.

They can also elect someone as an essential caregiver (ECG) — a family member or friend who can provide extra care, such as feeding them a meal or taking them for a walk. An ECG ‘should be allowed to continue to visit during periods of isolation or when there is an outbreak’. However, because this isn’t a statutory requirement, care homes have the power to turn ECGs away.

‘People have been telling us about care homes either picking and choosing bits of guidance or allowing no visitation at all — so it’s a postcode lottery of whether you will be able to see a loved one,’ says Diane Mayhew, co-founder of Rights For Residents, which is campaigning against ‘current inhumane restrictions to visiting loved ones’ in care homes.

Even if people in care homes are living among others, they can still

JIM, 88, CAN ONLY SEE HIS GREATGRANDCHILDREN THROUGH A WINDOW

feel lonely as they aren’t physically connected with friends and family, adds Dr Mani Krishnan, chair of the old age faculty at the Royal College of Psychiatrists.

‘Isolation and loneliness in older people can be damaging for their physical and mental health and can increase the likelihood of mortality,’ he says. ‘The effect of loneliness is so great that research has found it to be comparable to other risk factors, such as obesity and smoking cigarettes.’

Isolation can also ‘exacerbate pre-existing mental illness’ and trigger anxiety and depression in people who don’t have a mental illness.

It can also speed up any decline in mental performance, says Dr Trisha Macnair, a Surrey-based GP specialising in care for the elderly and palliative care. ‘If residents in care homes are isolated, they may not eat well, get up or even stretch their legs. And there can be a decline in cognitive ability.’ She adds that if the brain isn’t ‘stirred up’ through challenging memory and working through processes, ‘there’s a subtle switching down of brain function. This can worsen dementia.’

What seems particularly ‘unfair’ is that people living in care away from their families have faced far more stringent restrictions than the rest of the country, says Helen Wildbore, director of the Relatives & Residents Association (R&RA), which champions the rights of older people in care in England.

‘Our helpline hears daily about the devastating impact on families who’ve been separated from their loved ones. They talk of terrible loneliness and of not being able to see their family when they are in the final stages of life. They want to live, not merely to exist.’

Last week, Jeremy Richardson, the chief executive of Four Seasons Health Care, one of the UK’s largest care home providers, pointed out that since March 2021, 2,320 Four Seasons residents had died from all causes, and only 29 of them (1.25 per cent) from Covid.

In that period, the overall death rate has been below the four-year average prior to Covid. ‘We are depriving people of their right to visitors, which is an absolute outrage,’ he says.

In a joint letter on January 5 to local health and care leaders and seen by Good Health, campaigners including Rights For Residents and Dr Caroline Emmer De Albuquerque Green from the Health & Social Care Workforce Research Unit of King’s College London called on them to end ‘harmful isolation practices’.

The British Geriatrics Society has also joined calls for care homes to remain open to visitors whenever it is safe to do so.

Adam Gordon, the society’s president-elect and a professor of care of older people at Nottingham University, told Good Health: ‘It’s important that we keep care home routines and visiting schedules as normal as possible when we can, to maintain a normal life for residents and their families, and minimise the risk of deterioration associated with social isolation.’

Campaigners also point to a cruel anomaly in the rules where visitation restrictions are lifted when residents appear to be in terminal decline. ‘So we have a perverse situation where residents distressed by lack of contact with loved ones refuse to eat and drink, become so ill they are given endof-life care — and this triggers a permissible family visit,’ says Helen Wildbore. ‘The care resident then begins to improve thanks to the contact, so the visits stop.’

Richard Hawes, chief executive of Elizabeth Finn Homes, which runs nine care homes across the country, has tried to support families and residents with their safe and practical interpretation of Government guidance. He says their homes have been fully open. ‘I think that care homes — with testing, vaccinations, boosters and PPE — are some of the safest places right now and will continue to be so. We find those visiting are really understanding of the risks

and recognise that to keep their loved ones safe, they themselves have to be safe; in my opinion, they can be relied on to follow sensible behaviours.’

Jenny Morrison, a co-founder of the R&RA campaign, knows how devastating Covid-enforced isolation can be. her 87-year-old mother Jean died in her care home in August last year. ‘Before the pandemic, even though she was physically frail and had mild dementia, Mum had a good quality of life and loved our visits.

‘During the three months of lockdown when we couldn’t go in, she went downhill. She couldn’t understand why we had to be on the other side of the window. She seemed to think she was in prison because she used to say: “Get away from the window, the guards will come.” The rate of deterioration was terrible.’

These days, Frances heaton, now 100, is one of the ‘lucky ones’. her daughter Linda has essential caregiver status, and the care home permits her to take her mother out to see the family or do some shopping. Otherwise, Frances has to isolate in her room and says this is ‘no life’.

But campaigners want the Government to enshrine its guidance in law.

‘if other occupations can go back to work in seven days [after a positive test for Covid], we have to learn to live with the new situation,’ says helen Wildbore. ‘Residents with capacity, or family members in the case of those who don’t, should be able to decide the level of risk. So that they can have everything they need that comes with being in a loving home environment.’

And not feel, as many do, that they are in prison.