The government has been warned it is throwing “a lit match into a haystack” by discharging Covid-positive patients to care homes, with politicians demanding that the safety of residents and staff is guaranteed under the new policy.
During the first wave of the pandemic, approximately 25,000 hospital patients were sent to care homes – many of whom were not tested – which helped spread the virus among residents. Around 16,000 care home deaths have been linked to Covid-19 since the start of the crisis.
The strategy was one of the government’s “biggest and most devastating mistakes” of the crisis, says Amnesty International, and questions have been raised over the decision to introduce a similar policy as the UK’s second wave intensifies.
As part of the 2020 adult social care winter plan, the government has called on local authorities and care providers to establish “stand-alone units” – so-called ‘hot homes’ – that would be able to receive and treat Covid hospital patients while they recover from the disease.
There is also an expectation that, due to housing pressures and a shortage of suitable facilities, some patients may be discharged to “zoned accommodation” within a home, before being allowed to return to normal living settings once they test negative for the virus.
Councils have been told to start identifying and notifying the Care Quality Commission of appropriate accommodation, and to ensure high infection prevention standards are met.
Under the requirements outlined by the government, discharged patients “must have a reported Covid test result”. However, The Independent revealed on Monday that these rules have not been followed in some cases, with a recent British Red Cross survey finding that 26 per cent of respondents had not been tested before being discharged to a care home.
There is also concern whether care homes possess enough adequate personal protective equipment to prevent outbreaks, with the CQC revealing last month that PPE was still not being worn in some sites.
The government later pledged to provide care homes with free supplies of masks, aprons and gloves during the winter months.
However, Amnesty International has said it remains unclear what quantities and quality of PPE will be supplied to care homes, saying that staff currently don’t have access to the enhanced protective gear typically worn by hospital workers on Covid wards.
“As the country heads towards another peak of cases, it is incredibly worrying that care homes are being asked to take in Covid-19 patients without adequate support, effectively putting the lives of their residents and staff at risk,” said Kate Allen, Amnesty International UK Director. “It is like throwing a lit match into a haystack."
Amnesty added that the new “units” or Covid “zones” would also place immense pressure on care home staff, who do not have the same training as their hospital counterparts yet are being asked to run what are, in effect, small on-site wards alongside their usual duties.
The charity warned that given the financial pressures many care homes are facing due to lower occupancy and increased Covid-19 expenditure, some sites still may feel obliged to accept Covid-positive patients without having the means to do so safely.
In response to the new plans, care homes have been seeking legal advice as to whether they can knowingly accept patients with Covid. Some have been warned their insurance could be invalidated if they do so, The Independent understands, making them liable to charges of corporate manslaughter if there are subsequent outbreaks that culminate in the loss of life.
While the government has admitted that “given the diversity of existing provision and arrangements, it is acknowledged that there needs to be flexibility to meet local circumstances”, both Labour and the Liberal Democrats have demanded greater clarity regarding the policy.
Liz Kendall, MP for Leicester West and Labour’s shadow social care minister, told The Independent: “Care homes have faced immense pressures throughout this pandemic. Many were asked to accept Covid-19 patients without testing, despite not having the resources or facilities to effectively isolate them.”
“Ministers and the CQC now need to guarantee that no care home will be forced to accept Covid-19 positive patients. The safety of residents and staff must come first, and we need urgent clarity on this issue to keep all elderly and disabled residents safe.”
Nadra Ahmed OBE, executive chairman of the National Care Association, said it was “amibitious” to expect providers to accept Covid-positive patients into their service. “From the outset of this proposal we have been deeply concerned about the concept and felt there were more questions than answers,” she told The Independent.
Ms Ahmed said the proposed Covid units and zones risked bringing the disease to “the door of facilities where vulnerable people reside”, adding that it was vital to ensure no amenities are shared.
She also warned of the “challenges for asymptomatic Covid positive individuals and the impact on people with dementia who may have to adjust to various settings and carers during a recovery period.” Ms Ahmed added that “testing will have to be key at all time, consistent and available”.
Munira Wilson, MP for Twickenham and the health and social care spokesperson for the Liberal Democrats, said it was vital the government makes sure the Covid units and zones in care homes have every resource to ensure effective infection control.
“This must include access to very regular, rapid testing for staff and residents alike, to reduce the risks and keep people safe,” she told The Independent. “The government must also issue clear guidance about the legal implications for care homes taking in residents who are Covid positive.
"In addition, ministers must work with local authorities to determine the most appropriate approach to Covid positive patient discharge in their area, rather than attempting to impose a blanket, top-down system that may not be suitable for all parts of the country.”
A Department of Health and Social Care spokesperson said:“No care home will be forced to admit an existing or new resident if they are unable to cope with the person’s COVID-19 illness safely. Local authorities remain responsible for providing alternative accommodation.
“Through the Adult Social Care Winter Plan we are providing £1.1 billion in funding for infection control measures, free PPE, and regular testing for staff and residents.
“We continue to work with the Care Quality Commission and the NHS so that everyone discharged to a care home has an up-to-date COVID-19 test result and anyone positive is discharged to a setting CQC has assured is able to provide safe care.