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Over the past number of weeks,

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all of us have had to adapt
and change everything that we do:

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limiting our contact with people,

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being scrupulous about washing our hands,

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standing patiently in line
to enter a supermarket,

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and staying at home.

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The word 'home' has become
loaded with meaning.

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For many of us, home is a place
of safety and sanctuary.

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But this is not the case for everyone.

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What has become very apparent
over the past few weeks

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is that care homes for older people
have not been places of safety

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either for staff or for residents.

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The care home setting has been
the forgotten front line in the UK.

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Numbers of cases and deaths
in UK care homes were not reported

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in the early stages of the pandemic.

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And it is only now

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that we're beginning to understand
the scale and the impact

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that the coronavirus has had
in this environment.

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Many, who like me,

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who've conducted research in care homes
and are familiar with the sector

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are, sadly, not surprised
by what has happened.

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So why has it happened?

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And what lessons can be learned
from this tragedy?

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Care homes,

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which is a term sometimes used
to describe nursing or residential homes,

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provide care,

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usually to older people who are unable
to continue to live in their own homes.

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The average age of residents
is around 80 years.

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The population is largely women -
about 70 percent.

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And most will have two or three
medical conditions, including dementia.

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This means that they will be taking
a number of medications,

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and in some cases, more than 10.

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Care home residents
tend to be more prone to infection.

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And research that we did
in Northern Ireland in 2011

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showed that there were higher levels
of antibiotic prescribing

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used to treat infections
in Northern Ireland nursing homes

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compared to homes
in other European countries.

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Another study, which we published in 2010,

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found high levels
of a bacteria called MRSA

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in both residents and staff.

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Further research showed

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that controlling infection in care homes
was difficult for staff

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because of lack of time

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and they didn't have the resources

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to purchase the necessary equipment
to prevent infection.

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A survey conducted by Mather LifeWays,

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which provides care services
to older people in US nursing homes,

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found that staff felt ill-prepared
to deal with public health emergencies.

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In the UK context,

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care homes are not seen
as part of the National Health Service.

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Many of them are privately owned,

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and this may affect access
to personal protective equipment, PPE.

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And, importantly, as the name suggests,
care homes are homes.

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They are the residents' homes,

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albeit on a communal basis,

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and staff will try to enhance
that homely environment

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rather than create a clinical environment,

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which would be commonly seen
in the hospital.

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So all of this background

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highlights how a perfect storm
has been created in care homes

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during this pandemic:

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a vulnerable population,

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a high-risk environment,

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and lack of resources.

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But, perhaps, there's also been
an intangible factor at play

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and something this society
may not have been prepared to admit:

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do we really care
about what happens in care homes?

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The residents are old
and are probably going to die anyway.

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So why bother to test?

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And why bother to count
the number of cases and deaths?

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Prime minister Boris Johnson
stated in the UK Parliament

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on Wednesday, May the 6th:

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'There is an epidemic
going on in care homes,

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which is something I bitterly regret.'

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There's been growing recognition

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that care homes were left behind
and forgotten in the early stages.

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and there's now a concerted effort
to play catch-up with testing,

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the provision of PPE,

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and further support from the NHS,

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with hospital nurses
now working in care homes

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and other staff providing advice
on infection control.

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Care home staff have worked
under the most difficult of circumstances

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to provide the best care to residents,

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to the extent that many
are now living on-site

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to maintain lockdown conditions
and minimise the risk of transmission.

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As we move towards a possible lifting

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of some of the more extreme
elements of lockdown,

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might the experience
witnessed in care homes

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lead to a more sustained
and permanent change

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in how society views older people

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and particularly those
who reside in care homes?

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Might care homes be seen

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as an important part
of health and social care,

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not sitting at the periphery of the NHS

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and often viewed

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as the care provider of last resort?

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In 2007,

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the British journalist Polly Toynbee

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wrote in an opinion piece
for The Guardian:

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'Schools are hot politics;

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old folks' homes aren't.'

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13 years later, in 2020,

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care homes have become hot politics,
but for all the wrong reasons,

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and society has been appalled
at what has happened.

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But perhaps this tragedy will be
the catalyst for change in care homes.

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On a Thursday night,

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we stand on our doorsteps
to applaud those working in the NHS

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and other front-line workers.

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Let us reflect, in particular,
about care homes -

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the staff, the residents -

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and what they have faced
over the course of this pandemic.

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It is timely that we think
about what we value

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when it comes to the care and protection
of some of the most vulnerable in society.

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And we should think
about what we would want for ourselves

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if, in the future,
we become care home residents.

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Alan Bennett, the writer and playwright,

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has been an advocate
for improving care for older people.

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He has written movingly about
his own mother's time in a care home,

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where she eventually died.

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In his book 'Telling Tales',

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he reminds us that old age will come
to many of us despite what we think.

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He writes the following:

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'And one of the ways the young
think they are safeguarded

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against the fate and the future
of their grandparents is by their names.

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Sharons don't suffer from dementia
or Damiens from incontinence.'

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Alan Bennett goes on to warn us
that our names are not enough to save us.

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I quote:

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'But coming up the road are the Danes
and the Darrens and the Waynes,

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and they too shall fail.

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It won't be long before
even Tiffany is a grandmother

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and her cot got ready in the corner.

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Her children, middle-aged
and vaguely resentful,

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come and sit with her
on Sunday afternoons

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while she tries to remember
who they are and who she is.

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"You're Tiffany, Mother,

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and this is your little granddaughter."

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And what will her name be?'