Nurse's diary strips bare the scandalous state of our care homes
‘There is so much death… it’s horrific’: Nurse’s desperate diary strips bare the scandalous state of our care homes as she reveals the agony of watching coronavirus-hit residents saying goodbye to their loved ones on the phone
- Here’s how to help people impacted by Covid-19
Coronavirus has ravaged Newfield Nursing Home in Sheffield, where half of the residents have tested positive. Clinical lead nurse Laura Hibbard recounts a harrowing week on the front line…
FRIDAY: ‘He grasps my hand as he passes away’
Last week, 16 of our 30 residents had tested positive for coronavirus, so I’m not sleeping well at the moment. Yesterday we lost Richard, a bright resident with a great sense of humour who deteriorated suddenly. He was our fourth coronavirus death since the outbreak began.
My alarm goes off at 5.45am and I arrive at Newfield at 6.50am. I’m told to keep a close eye on two residents, David and Edna, who are Covid-positive and have deteriorated.
I change into my uniform. The only PPE we wear full-time is gloves and a plastic apron — we only don mouth masks and visors to enter the room of a Covid-positive resident. We were told we wouldn’t get more masks until June, and a delivery from Sheffield City Council last week failed to materialise.
Clinical Lead Nurse Laura Hibbard manages the Newfield Nursing Home in Sheffield, South Yorkshire
I’m covering for the manager, who is on week seven of a 12-week isolation, and I oversee around 60 staff. At 8.30am I start the medication rounds, while the care staff serve breakfast and help people with their hygiene.
‘Morning David!’ I say chirpily as I check on him. ‘Good morning,’ he replies.
David, who is 84, is a charming, well-mannered gentleman who is particular about having his hair neat, but today he is sedate.
This morning staff sit with him. If he takes a turn for the worse, we have a plan in place with the family for him to remain with us and not enter hospital.
I visit David at three o’clock. His breathing rate has changed, he looks ashen and his skin is mottled. From experience, I know the end is close, so we contact his family.
Usually relatives would come in. But at the moment, partners — and even children — of the residents are at an age where they’re at risk of coronavirus themselves.
We use David’s phone to set up a FaceTime video call with his daughter, and my colleague holds the phone up so they can say their goodbyes. His daughter tells him she loves him. It’s a distressing call and very brief.
After the call, I sit with David for a while and hold his hand. He suddenly grasps my hand, then shortly afterwards he passes away. It’s 4.30pm. Sitting with someone like this means we’re one staff member short on the main floor, but we would never want someone to be on their own at this time.
I’m trained to verify death, so after someone’s passing I complete the paperwork and inform the GP and the family. Then we freshen him up, change his clothes and call the funeral directors, who are very busy at the moment. They arrive at around 6pm.
Whenever the funeral directors come, we usher residents into their rooms and make sure all the doors are closed. We follow the trolley out of the building and stand by while the body is placed in a private ambulance, then watch it drive off.
Our team debrief usually starts at about 6.45pm, and we hand over to the night team at 6.55pm. Before leaving, I throw my PPE in a hazardous waste bin, shower on site and put my uniform in a carrier bag.
At 8pm I drive home and wash my uniform at 60c. It takes 40 minutes to wash, then another 45 minutes to dry, so sometimes I don’t relax until after 9.30pm.
To try to come down from the day, I have a glass of red wine and watch light television.
Saturday: ‘I’m sorry, you’ve tested positive’
During this morning’s handover, I am told that Edna passed away in the night. She was 88. The funeral directors are on call 24 hours a day, so she had already been taken away by the time I got to the home.
I’m told that one of our younger residents, Joseph, showed coronavirus symptoms overnight, so at 7.30am I visit him. He has a dry cough and a temperature of 38.2c.
Clinical Lead Nurse Laura Hibbard dressed in basic PPE
We’re lucky in that, unlike most care homes, we have access to swab-testing kits because we’re an NHS overspill home. I wear a full-face visor and mask to swab Joseph’s nostrils and throat. The swab is then sealed to be taken to the labs.
The courier only works weekdays, so today we use a local cabbie to deliver the samples. The taxi firm knows its cargo’s contents and the driver wears a mask and gloves.
Joseph is 57 and here temporarily for health and social care reasons. He talks a lot about going home and likes to watch old game shows on TV in the communal room. I take my daily break at 3pm, and two hours later we get a phone call from the lab with Joseph’s results.
‘Joseph, unfortunately you’ve tested positive,’ I tell him. But because we had chatted it through earlier, he takes it well.
Tomorrow was supposed to be my day off but we’re short-staffed and can’t get cover, so I’m going back in. Last week, one colleague went into hospital with coronavirus and now he’s in intensive care.
Sunday: ‘Two residents are at end-of-life’
This morning I’m drafted into our sister care home, Westbourne House, and told immediately that there are two Covid-positive residents, Barbara and Edward, who are at end-of-life.
As soon as I check on Edward, at 8am, I can see he won’t be with us for much longer. I make sure he isn’t in any pain before asking a member of staff to sit with him. Edward’s wife and son had wanted to come and say goodbye but can’t because they’re self-isolating.
After a while, the staff member asks me to come into the room. There’s no breathing and I check his pulse. By 9am Edward has passed away, aged 82.
As it’s a Sunday, I need to call 111 and not the GP to proceed with the death verification process. I call the funeral directors and Edward’s son to break the news. He was expecting it but it’s still a shock and he is very distressed.
When I go into Covid-positive residents’ rooms, some of them are confused about why we have so much PPE on. They don’t see a smile; only our eyes. It’s difficult communicating with people who are hard of hearing, who usually rely on our facial expressions and lip movements.
Throughout the day I’ve done checks on Barbara and made sure she is comfortable. Unfortunately, she too reaches the end of her life, and a staff member is with her when she passes away at 4.45pm.
When someone resides here, a conversation has been had with the family and GP about whether they should be resuscitated. Would they like to die in a hospital or in their own room here, with staff they’ve known for weeks, months or sometimes years? Here, it’s more of a family environment.
Barbara was 92 and her next of kin was her neighbour. I go through the routine: verify the death, call the next of kin, the doctor and the funeral directors, do the paperwork. At 8.30pm I’m still here, waiting for the funeral directors to arrive.
We’re not used to dealing with so much death. It’s horrific. I now recognise a typical ‘coronavirus death’: coughing, breathlessness and they really do seem to fight for their lives. I’m concerned about the spread of the virus and how many more lives we’ll lose.
Monday: ‘What would I have done without you?’
We’re preparing to reopen the care home to hospital discharges — people who are medically well enough to leave hospital but need care before they can return home.
We’re apprehensive because we believe the home was infected in the first place by people returning from hospital. We had to halt discharges because our staffing levels fell to such a degree that at one point nearly 40 per cent of our staff were off sick.
It’s scary, but we know the acute sector is struggling. To protect against the virus, we have a floor to quarantine hospital discharges while the other residents are on a separate floor. This also helps us ration the PPE.
We’ve been told that everyone will be swabbed before they leave the hospital. But will we know the result of the swab before they come to us? A swab is only accurate at the time it’s done. People could pick up coronavirus in the ambulance on the way here.
This afternoon we have the good news of our own discharges — two residents who are well enough to go home. One is a 92-year-old who survived coronavirus and is going back to be with his family.
We are especially pleased to be able to wave goodbye to Alice, who is in her 80s and has been with us for three months. During that time she caught the virus and was very ill for 17 days.
To nurse someone back to health, we encourage fluids and rest. But we also jolly on the residents with success stories — the people who survived. Alice became one of those success stories. As she leaves, she tells us: ‘I don’t know what I would have done without you these past few weeks.’
Tuesday: Red nail polish and Nat King Cole
TODAY is one of those days — a rarity now — when everything is calm. At 6.50am, before my shift begins, I have time for a cup of tea with some of the girls.
At the briefing, I’m told everyone slept well and is settled.
We have a decent number of staff on today, and at around 3pm two of our girls who are former hairdressers decide to have a pamper session with some of the ladies.
They set their hair in rollers and paint their nails. We have a box of colours but the ladies always go for pink and red. The residents are delighted with the makeover and have pictures taken to send to their families.
Another lady loves to sing and wants music, so we put on CDs — old crooners like Nat King Cole and Frank Sinatra. The staff have a singalong with her in her room. It’s a morale boost when we can have a bit of fun like this. After work, I have a video call and some drinks with two close friends.
Wednesday: ‘In a face visor, I meet two Covid patients’
AT 10.30am we welcome the first of three hospital discharges from the Northern General Hospital, two of whom are Covid-positive.
They were in hospital for other reasons and contracted the virus there, but as their symptoms are mild they’re deemed medically fit to be discharged. Likewise, residents may come down with it here but either aren’t poorly enough to go to the hospital, or they and their family have decided they won’t be admitted. We keep a close eye on people to monitor them.
I’ve heard some hospitals have been discharging patients to care homes without telling them they are Covid-positive.
Early in the pandemic, people weren’t tested before they were sent to us, so who knows? But in the past week people have been tested before they come to us.
When I welcome someone to the care home, I like to make them feel comfortable. But now there’s an added barrier because I’m wearing full PPE and a face visor throughout the conversation.
My parents, who I live with, are scared for me. I’m worried about my own health but I try not to think about it. I stay in one room in the house — it’s isolating but no different from what everyone else is experiencing. My parents understand I’m needed in my job. I haven’t hugged them in weeks.
Some people ask why I want to be a care home nurse, but I’ve wanted to be a nurse since I was at school. I love working with the elderly — I have a lot of respect for that generation. They’ve done so much for us and sometimes they get a rough deal at the end. Anything we can do to make their lives better is hugely important to me.
Care providers are the forgotten sector. Reflecting on the beginning of the pandemic, we were definitely forgotten about –— especially how the people dying of Covid weren’t counted. In the past couple of weeks I think people are realising the work care homes do.
Thursday: ‘Thank you for getting her home’
From 10am I’m preparing for Julia, who is 86, to be discharged from the care home.
She has been with us for two months, having first been discharged from hospital, and every day her husband Reginald calls her on her mobile phone. They’ve been married for almost 60 years and before she went into hospital they’d never spent a night apart.
This month she had a temperature and a dry cough, and swabs came back positive. Two days later she couldn’t eat, drink or talk. We didn’t think she was going to make it. Reginald tried to call Julia multiple times a day and I spoke to him every time he rang.
Julia was ill for a week, then suddenly rallied overnight. By the morning she was almost her usual self. That was six days ago and now she’s ready to leave.
We have a false start at lunchtime when the wrong type of ambulance arrives to collect her, but by four o’clock she is leaving.
I speak to Reginald on the phone one more time.
‘She’s on her way,’ I tell him.
‘Thank you so much for getting her better and getting her home,’ he replies.
I can tell he is over the moon.
- All names have been changed.
Revealed: Horrifying scale of of the care homes betrayal
Sophie Borland for the Daily Mail
Care homes have been abandoned to coronavirus and forced to accept infected patients with little means of preventing outbreaks, a survey reveals today.
A third of homes have taken hospital patients with the virus, despite fewer than half being able to isolate them and control further spread.
Deaths in care homes have also outstripped those in hospital.
Three quarters claim GPs are reluctant to visit and more than half are not confident they can get enough protective clothing.
Dedicated care home workers at Pilgrim Wood Residential care home in Surrey are sleeping in tents to protect their residents from catching the coronavirus
The survey of 105 care homes by the Alzheimer’s Society also found that one in four had struggled to get residents seriously ill with the virus admitted to hospital.
Kate Lee, chief executive of the charity, said: ‘It’s tragically clear care homes were left to fend for themselves against coronavirus – and, unfortunately, still are. Despite the heroic efforts of care workers, the precious lives of people with dementia and all those in homes are still being put in danger.
‘Up to 70 per cent of people in homes have dementia, and it feels like they are being written off.’
Number of all deaths linked to outbreak tops 50,000
More than 50,000 Britons have died as a result of the coronavirus pandemic – at least a quarter of whom were never even infected, official figures reveal.
Experts suggest the indirect deaths are ‘collateral damage’ of the Government’s ‘Stay At Home’ slogan, which has led to heart attack and stroke victims avoiding hospitals.
The Office for National Statistics yesterday said there were 50,979 ‘excess deaths’ – the number recorded above the normal level for the time of year – across the UK in the five weeks to May 1. Around 28 per cent were not directly caused by the virus, the data revealed.
And, in a sign of the tragedy unfolding in the country’s care homes, the figures also showed, in the week to May 1, the total number of deaths in homes – both coronavirus and non-coronavirus related – exceeded those in hospitals.
Nick Stripe, the ONS’s head of health analysis and life events, said: ‘For the first time I can remember there were more deaths in total in care homes than there were in hospitals in that week… I’ve never seen that before.’
The data shows the UK’s coronavirus death toll stood at 40,496 as of May 8, significantly higher than any other European country.
But statisticians are particularly alarmed at the thousands of indirect deaths which have occurred in addition to those directly caused by the virus.
In a stark warning, Professor Sir David Spiegelhalter, of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, said many of these patients ‘may well have lived longer had they been able to get to hospital’. He added: ‘When we look back at this whole episode, this rise in non-Covid, extra deaths outside of hospitals is something I hope will be given really severe attention. Many are indirect deaths, collateral damage of the health service disruption. While some of those will have been under-diagnosis, we have got a huge number of unexplained deaths in homes and care homes. This is extraordinary.’ He explained thousands of non-Covid deaths had been ‘exported back to the community because of the almost-closure of hospitals’.
His own analysis of the figures shows 30,000 of these excess deaths in the last five weeks have occurred in hospitals and care homes. ‘That’s a staggering burden compared with the normal 22,000 they would expect,’ he said.
Meanwhile Professor Carl Heneghan, director of the Centre for Evidence-Based Medicine at Oxford University said: ‘It has never been as quiet in frontline health care as I’ve seen in 20 years.
‘This suggests the message of ‘Stay At Home’ has potentially been interpreted by people, who have been unwell, [to stay] at home and potentially led to excess deaths. Part of this is potentially people with cardiovascular disease, so the message is anyone with chest pain or abnormal shortness of breath should present in urgent care.’
Iain Bell, deputy national statistician at the ONS, said the excess deaths could be ‘where symptoms of Covid-19 were less obvious, but people were infected and underlying health conditions were exacerbated’. He added: ‘They could also be deaths where normal care pathways have been interrupted. This may have led to additional deaths… that might have been preventable normally.’
Figures released yesterday by the Office for National Statistics showed nearly 10,000 care home residents have died from coronavirus so far, although this is likely to be an underestimate.
The data also revealed that the total number of deaths in care homes had overtaken hospital deaths for the most recent week – which one statistician said he had ‘never seen before’.
Care homes accounted for 40 per cent of all covid deaths in the week to May 1 and, although they are starting to fall, they are declining at a much slower rate than deaths in hospital. The Alzheimer’s Society survey found 32 per cent of care homes had taken covid-positive patients from hospitals since the outbreak started.
Several managers have explained how they felt pressured to accept these patients either directly by NHS or council officials or through an underlying sense that it was their duty to society.
But 58 per cent of homes did not feel they could effectively isolate infected patients, putting them at risk of triggering outbreaks.
Another 75 per cent said GPs had been ‘reluctant’ to visit during the outbreak, either to see sick residents or sign death certificates.
One care home manager said doctors preferred to treat patients remotely as well as sign death certificates over the phone to avoid contracting the virus.
The survey, which was completed by care home managers across the UK in the past fortnight, also found that just 43 per cent were confident they could get hold of enough personal protective equipment (PPE) in the coming weeks.
One home said staff had resorted to taping bags around their arms, hair and feet, while another sourced visors from a school.
A further 25 per cent said there were occasions when residents who were seriously ill with coronavirus should have been admitted to hospital, but weren’t.
But the fact that a third accepted covid-positive patients despite not having adequate PPE or measures to stop the infection spreading will raise serious concerns.
Last Saturday, the Mail revealed how the Care Quality Commission watchdog was investigating whether hospitals had sent covid-positive patients into care homes without telling them.
Caroline Abrahams, charity director at Age UK, said: ‘The way in which patients with covid-19 were sent back to care homes ill-equipped to respond looks like a catastrophic mistake. The fact that this survey suggests some care homes were pressured to take these patients in is really worrying and regrettable.’
Niall Dickson, chief executive of the NHS Confederation, which represents organisations across healthcare, said: ‘Care homes have not received the support they need during this crisis. We have a fractured system which does not encourage joint working. There are great examples of GPs, community nurses and infection control nurses as well as geriatricians offering fantastic support and advice. But it is not universal and the divide between health and social care often gets in the way.’
Mike Padgham, who owns a care home in Scarborough, North Yorkshire, said it had admitted a patient with coronavirus who died after infecting other residents.
‘I don’t think the NHS had a handle on it about how important it was to test residents before they were discharged into care homes.
‘They didn’t realise that care homes were going to be more susceptible than anywhere. Care home owners get caught in this dilemma where they want to help society and the NHS but they don’t want to infect staff and residents.
‘It feels as though care homes have been forgotten about.’
Yesterday, research by Sky News found that some councils were threatening to withhold vital funding from care homes unless they agreed to accept covid patients.
Darren Somauroo, director of D&L Care Homes in Uxbridge, west London, said NHS managers tried to force him to take these patients, but he refused. He told Sky News: ‘There were raised voices, they were threatening, telling us we had to take these residents.
‘I made it clear we were not going to buckle under this.
‘Our duty was to make sure we didn’t spread it in the home. Unfortunately other providers felt they had no choice.’
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