Kate Martin has worked as an infection control nurse for over 10 years in hospitals. This is her first winter season in the community. Every year she reflects, but this year has been very different…
The Orders of St John Care Trust at my last count has 70 care homes spreading from Oxfordshire to Wiltshire and up to Lincolnshire. It’s geographically challenging, so you prepare for winter, you teach outbreak control, and you drive the importance of good hand hygiene.
You can’t stop the winter bugs getting in, in the same way you can’t stop visitors or admissions from hospital or the community.
Winter preparedness is about planning to stop the spread. It sounds simple. We all know the policy. But how does it really work in a care home when our services are under such pressure?
Here’s a familiar scene. One bright Tuesday morning, Joan walks her usual route round the home to the dining room. She’s always a little late down and others are already tucking into their dinner.
“Every bed is important in an acute trust. Every winter harder”
It’s busy, and there is always a congenial chatter and laughter at meal times as residents and staff sit together. Most of the residents here have different stages of dementia with different needs.
Joan has quite advanced dementia and she appears quite content walking freely throughout the home. But at one point she walks a little unsteadily, places her hands on the table and vomits. Our first case of norovirus. The table’s cleaned, and Joan is taken back to her room and made comfortable.
My phone call is always the next day. Nine residents are now vomiting and a whole team of carers are off sick. The care home is closed to admissions. The impact is enormous.
It’s the infection control version of the butterfly effect. The symptoms of norovirus are evident – but it is also the risk of dehydration and hospitalisation that is a major concern. Then there is the wider impact because each home closed equates to beds lost to the local hospital.
Every bed is important in an acute trust. Every winter harder. I know the pressures – I’ve sat at the meetings where everyone is pushing for just one more bed. Accident and emergency departments are full, ambulances waiting to be off-loaded.
“Would I take the risk and go to a home with an outbreak? I think I would, another unknown bug could be just be round the corner if I were waiting in hospital”
Then there is other side of the coin: the elderly patient sat in a bed waiting for a care home placement – waiting so long they pick up another bug and never leave hospital.
I wonder sometimes whether care homes should be closed. Are there other ways to manage the risk?
I think of some of the audits I’ve done of care homes within the Orders of St John and also at acute trusts, and of the level of care and kindness shown to residents compared with how I would feel left in a hospital waiting if I were a patient.
Would I take the risk and go to a home with an outbreak? I think I would. Another unknown bug could be just be round the corner if I were waiting in hospital.
A simple solution would be to give the patients in hospital that choice. But few are likely to have the capacity to make that decision and even if they were, how many homes would have enough staff during an outbreak to assess residents and care for extra people?
Ultimately, to deal with winter pressures, I believe we need flexibility in all services.
“Look after your staff, be flexible, don’t pay the agent fees – and then you can really start tackling the pressures”
In the care home sector, there needs to be forward planning and additional staff – that includes GPs and carers, and nurses who are skilled and available to move where needed. A winter pot of money for extra staff that can be used all year is required.
These extra team members could be used instead of additional agency staff, and in return deployed in varying ways – even to the point of staffing a new care home in a particular region when the “winter crisis” peeks.
Critics may ask how we would find the staff and the simple answer for me is to pay the same as the agencies. Look after your staff, be flexible, don’t pay the agent fees – and then you can really start tackling the pressures.
Kate Martin, quality improvement lead (infection control), the Orders of St John Care Trust