Local managers imposed unlawful do not resuscitate orders on residents.
The QNI asked nurses working in all community and social care settings to submit case studies that show how their service has adapted to the Covid-19 pandemic. The findings are damning.
Nursing homes were put under “constant” pressure to accept patients with coronavirus while being regularly refused treatment from hospitals and GPs for residents who became ill at the height of the Covid crisis, a landmark study has revealed.
A report by the Queen’s Nursing Institute (QNI) found homes were told hospitals had a blanket ‘no admissions’ policy at the height of the pandemic and local managers imposed unlawful do not resuscitate orders on residents.
The QNI, a charity which focuses on the improvement of nursing care of people in their own home, found care home residents were regularly refused treatment in April and May.
The findings have emerged in a survey by the QNI, the world’s oldest nursing charity, which surveyed 163 care home nurses and managers working across the country.
The research found GPs and local managers in some homes had placed unlawful do not resuscitate orders on residents.
The survey of nurses and managers in 163 care homes across England, Wales and Northern Ireland found 56% said their physical and mental health had suffered due to the stress of the pandemic.
Seventy homes, 43% of those surveyed, said they had received a patient discharged from hospital during March or April that had not been tested for the virus.
A fifth said they had received a patient discharged from hospital who was Covid-19 positive.
One nurse said they were under “constant pressure to admit people who were Covid positive” while another said: “The acute sector pushed us to take untested admissions. The two weeks of daily deaths during an outbreak were possibly the two worst weeks of my 35-year nursing career.”
Staff described the toll on their mental and physical health as a result of the workload with some feeling abandoned and ignored by the rest of the health system.
Although two-thirds of care home staff said they always had access to protective clothing such as masks and aprons, others were not given proper protection and some reported buying their own or making it themselves.
Staff responding to the survey revealed the use of blanket do not attempt resuscitation (DNAR) decisions by GPs, hospitals and NHS managers.
One nurse said: “We were asked to change the status of all our residents to do not resuscitate and not for escalation to hospital. We refused.”
Another added: “All residents with suspected or confirmed Covid-19 were automatically made DNAR and given emergency health-care plans to stay in the home.”
Another said they challenged an instruction by local NHS managers to impose a DNAR on all residents as “unethical”.
In total, 16 homes reported examples of poor end-of-life care and four-fifths of the nurses reported negative experiences of working in the pandemic with more than half, 56 per cent, saying their physical and mental health had suffered.
Professor Alison Leary, an author of the study, said: “It is clear from this survey that the care home workforce has faced very challenging issues. Many have felt unsupported and their wellbeing has suffered. We need to support this workforce to face the challenges ahead.”
Crystal Oldman, chief executive of the Queen’s Nursing Institute, said the findings of the survey and the lack of support and access to health services were “symbolic” of how the care home sector was viewed by those in the NHS and government.
“The care being delivered in a home can at times be as intensive as in a hospital – in particular for end-of-life care – and it is hugely skilled work.”
She said she was concerned to see homes had struggled to access district nursing, GP and hospital services.
“We were really surprised to see this. These are universal health services. It is completely opposite to the protective ring around care homes that was being talked about at the time.”
With winter approaching, she said it was now vital the sector was involved in planning ahead of any second wave of coronavirus.
“These homes need to be equal partners, not abandoned and not have things done to them.
“If anything positive comes from what we have been through it’s that care homes cannot be viewed in that way again. It is everyone’s problem.”
Between 2 March and 12 June almost one in every three deaths among care home residents (29.3 per cent) involved Covid-19, with 19,394 people dying having tested positive for the virus, according to the latest data from the Office for National Statistics.
Of those deaths, the majority occurred in a care home setting – with 74.9 per cent taking place in care homes compared to the 24.8 per cent of fatalities which were recorded in hospitals.
Across the period the virus became the leading cause of death in male care home residents, and the second among women after dementia and Alzheimer’s disease.
Crystal Oldman said she was worried by the number of homes that had been unable to access support from GPs, district nurses and hospitals.
In April a report by NHS Providers, a body representing more than 200 NHS trusts in England, boasted that the health service had freed up 33,000 beds by ‘tearing up red tape’ and overhauling discharge policies.
It said in a report that ‘the NHS has completely rewritten its discharge procedures in a week to enable a much more rapid discharge process,’ adding ‘hospitals have discharged record numbers of patients in record time’.
Nearly 19,400 care home residents died from Covid-19 in England and Wales between March 2 and June 12, according to the most recent government data. The grim statistics were coupled with multiple reports about care home staff struggling to get vital protective gear, such as masks and gloves.
The death toll in the care sector sparked constant criticism of the government, with many bereaved family’s feeling hurt and let down by a system that did not do as promised and care for their loved ones with the respect dignity and safety this society expects.
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