It is vital that care homes survive this crisis

Residential providers are the most efficient way of looking after the elderly. What happens if they fail?

As the virus seems to be loosening its deadly grip on UK hospitals, news emerging from care homes suggests that the problem may have simply been transferred. Figures released yesterday showed Covid-19 death rates in care homes at more than 2,000 a week. We now know that the Government, in its desperate quest to free up hospital beds for critically ill patients, gave instructions for hundreds of elderly “bed-blockers” to be sent back into their care homes.

In pre-covid days, discharging patients into the more familiar setting of a care home might have seemed a sensible use of resources. Rather than the anonymity of a hospital ward, the frail elderly could convalesce in their own rooms, cared for by staff known to them. Indeed, a care home resident close to death would often prefer not to spend their last days in hospital.

But with a virus as infectious as Covid-19, the discharge policy now looks reckless. Protecting other residents and staff from infection, especially when lacking protective equipment, has proved to be an impossible task. Some care home staff, determined to keep their residents safe, have moved into the homes where they work, to avoid bringing in infection. Virus testing is – in theory, at least – now available to care workers, but there is still huge pressure on supplies of personal protective equipment.

After recent headlines, who would now admit themselves, or their relatives, to a care home? Recently we have seen hospital admissions for all non-covid illnesses fall away dramatically. Hospital wards lie empty, GPS have time on their hands, because no one wants to risk infection. It is not hard to predict that a similar fear will lead to a huge drop in applications for care home places, now that these too are viewed as virus hotspots.

This surely means that many of the frail elderly will battle on at home, while their families face an agonising decision: is it riskier to let an elderly relative stay at home unaided, or go to a care home which might harbour the virus? Current estimates suggest that around two-thirds of the UK’S care homes are still virus-free, but the difficulties in providing totally reliable testing make it difficult to be certain.

The hard facts must be faced. We know that this disease poses a much bigger threat to the very elderly than to the young. Even in “normal” circumstances, respiratory infections are a leading cause of death amongst the old. Nor is the problem unique to this country. The World Health Organisation declared last week that around half of European deaths from the pandemic have taken place in care homes.

Social and residential care went into this crisis as the Cinderella of our health system, with successive governments promising and then postponing reform. Care fees have escalated as council budgets have shrunk. Privately-provided care at home is unaffordable for most, yet the personal care provided by social services is minimal. For most frail elderly, life in a residential home has been the only choice.

Understandably, residential care providers are now fearful for their future. With existing residents dying in large numbers, and prospective clients declining to apply, what will be left when we eventually emerge from the current crisis?

Five years from now the post-war “baby boomers” will be hitting their 80s. It seems unlikely that the UK will adopt a southern European model of multi-generational families living together; indeed the Italian experience suggests this model carries greater risk. But with an economy still reeling from the after-effects of coronavirus, will we really be able to fund individual care at home for everyone who needs it?

A well-run, purpose-built residential home with dedicated staff will still represent the best and most affordable way of meeting the needs of those who can no longer care for themselves. We need such homes to survive and thrive.

Our cumbersome nationalised health service was ill-prepared to meet this pandemic. Thanks largely to its front-line staff (though not its administrators), it has avoided meltdown – so far. Unreformed, the NHS will always be hungry for more funds. But as the pandemic has shown, we cannot meet its needs by sending social care to the back of the queue.