Who cares? COVID-19 in care homes for older people | Carmel Hughes | TEDxQueensUniversityBelfast

Professor Carmel Hughes considers the impact of COVID-19 in care homes for older people and if, following the pandemic, society’s approach to such care may change.

Professor Carmel Hughes is a pharmacist and head of the school of pharmacy at Queen's University Belfast. Professor Hughes’s main research focuses on the use of medicines in older people, particularly those living in care homes.
She was formerly joint clinical lead for the Northern Ireland Clinical Research Network (Primary Care), was the first pharmacist to have been awarded a Harkness Fellowship in Health Care Policy, and was the only pharmacist to have received a National Primary Care Career Scientist Award from the Research and Development Division of the UK’s Department of Health.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

Over the past number of weeks,

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

limiting our contact with people,

being scrupulous about washing our hands,

standing patiently in line
to enter a supermarket,

and staying at home.

The word 'home' has become
loaded with meaning.

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

But this is not the case for everyone.

What has become very apparent
over the past few weeks

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

either for staff or for residents.

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

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

in the early stages of the pandemic.

And it is only now

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

that the coronavirus has had
in this environment.

Many, who like me,

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

are, sadly, not surprised
by what has happened.

So why has it happened?

And what lessons can be learned
from this tragedy?

Care homes,

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

provide care,

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

The average age of residents
is around 80 years.

The population is largely women -
about 70 percent.

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

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

and in some cases, more than 10.

Care home residents
tend to be more prone to infection.

And research that we did
in Northern Ireland in 2011

showed that there were higher levels
of antibiotic prescribing

used to treat infections
in Northern Ireland nursing homes

compared to homes
in other European countries.

Another study, which we published in 2010,

found high levels
of a bacteria called MRSA

in both residents and staff.

Further research showed

that controlling infection in care homes
was difficult for staff

because of lack of time

and they didn't have the resources

to purchase the necessary equipment
to prevent infection.

A survey conducted by Mather LifeWays,

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

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

In the UK context,

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

Many of them are privately owned,

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

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

They are the residents' homes,

albeit on a communal basis,

and staff will try to enhance
that homely environment

rather than create a clinical environment,

which would be commonly seen
in the hospital.

So all of this background

highlights how a perfect storm
has been created in care homes

during this pandemic:

a vulnerable population,

a high-risk environment,

and lack of resources.

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

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

do we really care
about what happens in care homes?

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

So why bother to test?

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

Prime minister Boris Johnson
stated in the UK Parliament

on Wednesday, May the 6th:

'There is an epidemic
going on in care homes,

which is something I bitterly regret.'

There's been growing recognition

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

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

the provision of PPE,

and further support from the NHS,

with hospital nurses
now working in care homes

and other staff providing advice
on infection control.

Care home staff have worked
under the most difficult of circumstances

to provide the best care to residents,

to the extent that many
are now living on-site

to maintain lockdown conditions
and minimise the risk of transmission.

As we move towards a possible lifting

of some of the more extreme
elements of lockdown,

might the experience
witnessed in care homes

lead to a more sustained
and permanent change

in how society views older people

and particularly those
who reside in care homes?

Might care homes be seen

as an important part
of health and social care,

not sitting at the periphery of the NHS

and often viewed

as the care provider of last resort?

In 2007,

the British journalist Polly Toynbee

wrote in an opinion piece
for The Guardian:

'Schools are hot politics;

old folks' homes aren't.'

13 years later, in 2020,

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

and society has been appalled
at what has happened.

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

On a Thursday night,

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

and other front-line workers.

Let us reflect, in particular,
about care homes -

the staff, the residents -

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

It is timely that we think
about what we value

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

And we should think
about what we would want for ourselves

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

Alan Bennett, the writer and playwright,

has been an advocate
for improving care for older people.

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

where she eventually died.

In his book 'Telling Tales',

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

He writes the following:

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

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

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

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

I quote:

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

and they too shall fail.

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

and her cot got ready in the corner.

Her children, middle-aged
and vaguely resentful,

come and sit with her
on Sunday afternoons

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

"You're Tiffany, Mother,

and this is your little granddaughter."

And what will her name be?'