Sarah Armstrong: Covid-19 and care homes—why now is the time to invest in carers’ skills

The past few weeks have been difficult for all of us, but the care sector has been particularly hard hit by the coronavirus pandemic. With outbreaks of illness, staff sickness and subsequent shortages, and widespread fear, the challenges that they have faced have been unprecedented. They have also been subject to intense media scrutiny—for inadequate personal protective equipment (PPE), lack of testing, and for high death rates. Yet buried among these headlines are the good news stories. 

I’ve heard stories of carers who have moved into campervans and tents on the grounds of the care homes where they work, in order to minimise their risk of outside exposure to the virus. Stories of care homes trialling new technology to ensure that residents can stay in touch with loved ones. In these stories, I see echoed the dedication and humanity that I have been fortunate enough to witness in the care homes with which I work. 

As a GP by trade, I feel privileged to work very closely with care homes, providing clinical support, as well as training and education. Over the past few weeks, I have continued to provide this clinical support, using video technology. Day in, day out, as I sit in my consulting room, the carers are there with their residents. Each day, I see the same familiar faces half-hidden behind their masks. They are exhausted with the intensity of their workload, and the emotional toll of caring for people who have become like family to them. But still they work tirelessly, holding the video device in one hand and the resident’s hand in the other. They tell me that they are reassured by my calls, but the truth is it is me who is reassured by them—knowing that my patients will receive the best possible care in the community. I continue to feel humbled by their commitment. 

The role of the carer has changed immensely over the past few years. Residents in care homes are getting older, frailer, and their health needs are more complex than ever before. Carers in care homes are now required to do an increasing variety of tasks, far exceeding their initial remit. Medicines administrations, basic observations, end of life care, and recognition of deterioration are now all part of the work of care home staff. They are, to their residents, healthcare assistants, nurses, counsellors, hairdressers, taxi drivers, friends, and in some cases, family.

Historically, there has been underinvestment in this sector, both financially and educationally. I know that where I work, various groups have been seeking to address this, including UCLPartners, Health Education England, Healthy London Partnership, Medicus Health Partners, North East London Foundation Trust, Care City, Basildon and Brentwood clinical commissioning group (CCG), and CCG endorsed care home assessment teams. These organisations provide training on topics such as recognising deterioration, communication, falls, urinary tract infections, and end of life care to name but a few. This training is exceptionally well received. But it is really important that such education programmes are validated, nationally accredited, and implemented at scale. They should and must reach every care worker in every care home.

Care home staff usually hold a diploma or NVQ in health and social care. These are fantastic qualifications but what is asked of carers now goes beyond this. In the care homes, they are the eyes and ears of other healthcare professionals. They know their residents better than anyone and can often spot the subtle early signs of deterioration before medical or nursing staff can. From the resident that can’t concentrate to read the newspaper that he has been reading every day for 10 years, to the resident that doesn’t want her favourite hot chocolate, or the resident that suddenly struggles to walk to the bathroom, it’s the care staff that notice these things. 

“An optimist sees the opportunity in every difficulty,” said Winston Churchill, during different challenging times. Certainly, throughout the bleakness of the past few weeks, there have been glimmers of positivity. The kindness that I have seen from care staff towards their residents, and their desire to provide good care, even to the detriment of their own health, will remain with me. 

This crisis has presented opportunities for change, and for growth. For me, this has meant reflecting on the vital work done by care staff and looking at ways that we can support this. Other healthcare professionals have a clear career development pathway, linked to either academic attainment, or experience gained. This should also be true for carers.  We have a real opportunity to harness the experience and drive of this group of people and develop a standardised training programme around recognition of deterioration, common medical problems, end of life care, and other such vital topics. 

UCLPartners are working with our stakeholders to promote education and training in care homes. From Significant Care, a tool to help identify the early signs of deterioration, to “Is my resident well—10 questions to ask” to “What’s best for Lily” end of life training. This support will be made available to all care homes. In the future, there is so much potential for this to be expanded into formalised, compulsory training.

So as I stand outside my house on a Thursday evening, banging a spoon on a saucepan, I am thinking of Sue and Jayne, of Fatima and Tracey, Priscilla and Lee and Joy, who are still there in the care homes, still working, still providing care. For me, acknowledging the skills they hold, and supporting them in the development of new ones, is the best way to thank them. 

Sarah Armstrong has been a GP for seven years, and is currently a GP education fellow. She splits her time between general practice in Enfield (Medicus Health Partners) and academic work with UCLPartners. She has worked in care homes, supporting education and training in deterioration and medical problems.

This blog was originally published in the BMJ