Mistakes are inevitable (Huw Fairclough/Getty Images)
Within minutes of arriving at work this evening, I am warned that one of our residents had died the previous morning. Joseph was 82 and had been suffering from pneumonia caused by a chest infection for several days. When I last saw him on my shift two days earlier, he wasn’t eating or drinking, so I knew he’d probably not survive the week.
Yet still it hurts. Heâd also developed a moisture lesion, the start of a pressure sore, on his lower back â a consequence of not being repositioned regularly. Joseph’s death wasn’t caused by anything we did, but what we were unable to do. Had we had our full team of staff, I’m sure that we could have moved him more regularly and perhaps have prevented the lesion, which no doubt hastened his decline.
One of us could have sat with him and fed him, listened to him and held his hand. But we simply don’t have the time. The loss of one permanent member of staff a few weeks ago because she refused to be vaccinated, and the resulting reliance on agency staff, has had a devastating impact on the standard of care in our home. When it becomes compulsory next April for staff to be jabbed unless they have a medical exemption â at the moment care homes can decide their own policy â the situation will only deteriorate. Some estimates suggest more than 100,000 unvaccinated care home workers could be forced to quit.
Tonight’s shift is intensely busy, as always. We have 30 residents in our private care home in Sheffield. They all need feeding, washing and changing â and I don’t stop for a moment. It’s six hours into my shift when I’m stopped by my colleague Lisa. Grabbing my arm, she practically throws me into the room and onto the sofa and tells me to sit down for five minutes.
âYouâve not stopped,â she says. âEat something!â I check the clock. She is right. It is almost 1.30am and I haven’t eaten a thing since I clocked on at 7pm. The only time Iâve stopped is to pop to the toilet and take a few sips of cold coffee. It is time for a quick break.
I sit down to eat a sandwich, but a pile of paperwork sits on my desk and I can’t ignore it. As the senior member of staff on duty that night, it’s my responsibility to be in charge of the medications, so I might as well audit the drugs paperwork while I eat my dinner. It will save time later.
Barely five minutes have passed when another colleague, Sheila, asks for some help moving one of our residents, Anne, who has soiled herself. Many of our residents are incontinent and accidents are common, but itâs often impossible for care workers to move residents on their own, particularly when theyâre only 5ft 2ins like Sheila. If we donât clean and move them swiftly, bed sores can develop and thatâs when residents are at risk of infections which can be fatal.
We find Anne in some discomfort and distress. Who knows how long sheâs been lying in her mess? The staff tonight are spread even more thinly than usual: Clare, one of the younger members of the team, called in sick and no agency nurse has turned up. We clean Anne up and make her comfortable and she sleeps.
It’s a small consolation. I have worked in the care sector for ten years and while weâve always been busy, itâs becoming clear that things are dangerously close to breaking point now. The pandemic was stressful but now we have the added burden of being short-staffed. Carly, the unvaccinated nurse, left a fortnight ago and we are unable to find a permanent replacement.
Carly is one of many careworkers who refuses to have the Covid vaccination. Sheâs not what youâd call an âanti-vaxxerâ because sheâs had other vaccinations such as flu; she simply didnât trust this one. She felt it hadnât been tested rigorously enough and could harm her health in the future. Iâve no idea why. The rest of us tried to persuade her that it was safer â for the residents, herself and us. It felt like another level of protection.
But for whatever reason, Carly was adamant she didnât want it. She initially thought the Government might perform a U-turn but when it became clear they wouldnât, she looked for a new job. Sheâs working in a school now.
Of course, itâs a shame. She loved her job and she was good at it. But if sheâs going to put others at risk, I canât blame the Government for wanting her out.
Yet her departure leaves us in the lurch and it makes me nervous about what lies ahead. Although I have a 36-hour-a-week contract, Iâm regularly working up to 60 hours â all for ÂŁ9.60 per hour and Iâm exhausted. Thereâs no bonus for overtime. I suppose I should count my blessings. I know of another home that has lost four members of staff who refused to have the vaccine.
Once Anne is cleaned, I return to the staffroom to finish the drugs paperwork. Iâm always terrified of making a mistake when Iâm tired. Only two weeks ago Iâd been so busy rushing from room to room that Iâd forgotten to give someone his epilepsy drug. He ended up having a seizure and although we found him in time and he was fine, I felt dreadful. I held my hands up. I knew it was my fault. But with so few staff, mistakes are going to happen. Not long ago a lady fell in our lounge area and broke her hip. I watched it happen, almost in slow motion but I couldnât get to her in time. Would that have happened if weâd had enough staff members? Possibly. But I couldnât help but feel she might have been saved if someone had been able to keep a closer eye on her that day.
I thought things might improve when the pandemic started to subside this spring. Like many frontline workers, we had little in the way of PPE at first and had no idea what we were dealing with. Watching people deteriorate when they got the virus was horrific. Iâll never forget them desperately gasping for breath, as if they were drowning. We couldnât do anything except prop them up on their side or turn them over onto their fronts. That seemed to help. But we lost seven of our residents and there would be many nights where Iâd go home in tears.
The terror and paranoia of bringing the virus home has never really left me, even now. After my shift ended, I would undress at work and put my uniform in a tightly sealed bag to take home and boil wash. But when I got home, I was fearful that I still had the virus on me, so Iâd strip off in the hallway and rush up to the shower to scrub myself clean before I went anywhere near my daughters. My husband would grab the bag, put the uniform in the washing machine and then thoroughly scrub his hands.
When the vaccine arrived, it felt like weâd been saved. I managed to have mine early in the year and Iâve now had all three. I donât think anyone should be forced to have the vaccine, but I still canât understand how people in our sector are reluctant to get jabbed. We have people in our homes in their 90s who are completely bedridden with dementia. Even though theyâve been vaccinated, they will be among the most vulnerable if this new Omicron variant takes hold, as it looks like it will.
For the moment weâre relying on agency staff to plug the gaps but this is never ideal. Although theyâre competent enough, the people who need the care can become upset if they see a face they donât recognise. Thereâs no continuity of care. Last week, one of our more vocal residents got spooked. She doesnât speak much English and was screaming and crying about the new staff member.
And so I feel pessimistic about the next few months. We are currently Covid-free in the home but I donât expect that to last. Our residents have all been vaccinated so we know they have some level of protection and thatâs reassuring. But itâs the âstepdown bedsâ â people who arrive in the home for temporary care straight from the local hospital â who we constantly worry about. Although they are tested before they arrive and theyâre put in isolation and tested again on Day 5 of their stay, weâre all worried that one of them will bring in the new variant.
Then what do we do? Will it mean another lockdown? Families unable to visit their loved ones again? Although I hope it doesnât come to that, we are all expecting it.
Donât get me wrong: I love this job and I donât want to leave. But there have been many nights where Iâve come home â sometimes after 16 hours on my feet â and I wonder if itâs worth it. We are all scrambling. And things are only going to get worse.
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Subscribe‘…if sheâs going to put others at risk, I canât blame the Government for wanting her out.’
The killer line. How does she ‘put others at risk’ exactly? And how do vaccinated people not, given that vaccines do not prevent transmission? And why can you not understand the very real concerns about vaccine safety?
This has been reiterated time and time again, and yet this line is still out there, and it drives the current scapegoating of the ‘unvaxxed.’
I would imagine that many care home workers have been exposed to the virus and therefore have natural immunity; when is this going to matter?
The eye popping lack of logic is what led me to fire off a similar comment before reading yours.
It doesn’t seem to matter how many times you say to people using Dawn’s ‘covid logic’ that vaccinated people can transmit the disease. They still insist that having the vaccine somehow protects others. It’s utterly weird.
One my family members has had a significant health problem from the vaccine. She is now seeing specialist physicians and getting testing, etc. We know this because her GP told us it was from the vaccine – it is known risk – but not one we were informed of when getting the shot. I am not advocating against the vaccine – but even before this I would argue that âlow riskâ is not âno risk.â Risk profiles for young people are completely different than those for the old. Pushing it on young people is wrong and pushing it on little children is criminal.
“Of course, itâs a shame. She loved her job and she was good at it. But if sheâs going to put others at risk, I canât blame the Government for wanting her out.”
Got to keep the dementiaed Oldies alive for ever. Back in 1970s I worked in a care home of last resort. It was where the old poor people with no family were sent to die, and it was a hell hole. We were very understaffed, the staff were callused and had become super hardened to the misery of the job, and really did not much care (the pay was low and people who would work there could not get a better job, or they would be gone. , I worked there as part of training to get my nurse’s aid license, I gave up health care after 4 months – although I did get my qualification.
One thing I learned of care homes is if you have no relative or friend visiting to be an advocate for you, you are last for everything. These people mostly never, ever, had visitors, they were a sad bunch – over and over they always would say ‘Nurse, I want to go home!’. But their home was long ago sold or rented, their stuff in the landfill and they did not understand – all dementiaed, and they were there to die alone, in misery mostly.
One rule was we did not ‘Push Water’ if the chart said not to – that means do not encourage them to drink if they did not want their water and refuse it by turning away repeatedly – when people are at the end of any reason to live, and sick and miserable they lose their appetite and thirst, so when they stopped drinking we let them, it takes only a day or two to pass away.
But that was 45 years ago – things were much rougher then, later the USA system was overhauled, and I suppose that sort of place disappeared. But I learned a lot by that all. When it was time to take care of my father (him in his late 90s) in our house – till he died, I knew how. My mother is in her later 90s and lives in my cottage, and will get her end of life care and die in my house too, cared for by us.
“Heâd also developed a moisture lesion, the start of a pressure sore, on his lower back â a consequence of not being repositioned regularly. Josephâs death wasnât caused by anything we did, but what we were unable to do. Had we had our full team of staff, Iâm sure that we could have moved him more regularly and perhaps have prevented the lesion, which no doubt hastened his decline.One of us could have sat with him and fed him, listened to him and held his hand.”
But the reality is this level of end of life care does no one much good after a point. You are not saving them, mostly they are mentally impaired, or if not just in misery. There is a societal cost to end of life care which has to be weighed. The resources every month added to end of life is huge. Those resources are denied to others if that is how they are allocated. As the great economist Thomas Sowell says – ‘there are no solutions, only trade-offs’.
Anyway – hope I do not sound too callus, I am not – but I have seen a great deal, and there are no solutions, only trade-offs, and the Government has made all the wrong tradeoffs, and calls it a solution, in every level of how it has dealt with covid.
I had copied exactly the paragraph you open with. You have saved me the effort. Readers may assume I would have typed exactly the same.
Thank you for such a realistic take on care homes.
Many if not most of today’s inmates have family. We know this because they appear on media to moan about care homes whenever something goes wrong for their relative. If they’re that bothered they could always keep their dearest and nearest at home and look after them themselves.
If nothing else I really think that people in the UK (and elsewhere) should be educated as to the fact that the vaccinated can get this (airborne) virus and transmit the virus.
There is absolutely no chance of there being honesty around the significant harms that the vaccine can cause – scientists and doctors who speak out are vilified, discredited and often sued.
Can someone please explain how being unvaccinated puts the vaccinated at risk? I’ve put this question to several friends including Doctors and it hasn’t been answered.
Yes Nigel – this is so irritating when this fallacy keeps being re-iterated with absolutely no evidence to justify this. I wish we could find a way to hold an appreciation of the choices people make for their own sense of well-being whether it is to be vaccinated or not.
With alpha and delta variants the unvaccinated were much more likely to pass on the virus to others, which is of course a problem for the elderly and immunocompromised. In contrast, omicron appears to be passed on by the vaccinated and unvaccinated equally.
You make the assertion that “with alpha and delta variants the unvaccinated were much more likely to pass on the virus to others” as if this were an irrefutable fact. Yet, while some studies may provide some evidence for this conclusion, the evidence is not at all conclusive, and there are other reputable studies which provide contradictory evidence. Then there is the question: “If indeed it truly is more likely for the unvaccinated to pass along the virus, how much more likely is it, and is it worth old people dying of neglect because we fired good, dedicated caregivers who might possibly have increased their patients chances of dying of the virus?
True – but that is expecting an intelligent informed person in power to understand the big picture. What seems likely is a kind of positive feedback loop as exhausted burnt out VAXXED staff leave as well as the short staffing kicks in – that complemented by the miserable pay, damage to backs etc etc. The industry is doomed and I cant see what would change that except for pay rises and VAX compromise ??
The claim that the unvaccinated “are much more likely” to infect others appears to be untrue – the delta variant has been found to be comparably transmissible in both the vaccinated and unvaccinated.
For example, a commendably rigorous recent Lancet paper (Singanayagam et al., 2021) reported that the infection rate amongst household contacts exposed to the fully vaccinated (25%) was statistically identical to those exposed to the unvaccinated (23%)
Unsurprisingly, given earlier research findings (e.g. the CDC’s Massachusetts study: Brown et al., 2021) they also found that peak viral loads, a key index of transmissibility, were similar for unvaccinated and vaccinated.
A nice lay overview of the study findings can be found here:
https://www.theguardian.com/world/2021/oct/28/covid-vaccinated-likely-unjabbed-infect-cohabiters-study-suggests
The original study is here: https://www.sciencedirect.com/science/article/pii/S1473309921006484
Thanks.
Don’t you know? “It’s all about the science!” How dare you question.
If there are large numbers of care staff who will quit rather than be vaccinated the government will have shot the care industry in the foot or worse. Have they checked how many staff will be lost to the industry as a result? How much protection to third parties does vaccinations actually provide? Where is the cost benefit analysis?
If this government believed in cost-benefit analysis weâd never have had a lockdown in the first place. Theyâll enact whatever restrictions will make for good headlines, or whatever is a nice distraction from embarrassing stories about Downing St Christmas parties or who paid for Borisâ flat refurbishment. Itâs outrageous and infuriating, but Iâm pretty sure itâs true: there is no effort whatsoever to do cost-benefit analysis or any other checks as to whether Covid policy is in the public interest.
If I were in my 90s lying in bed with dementia, I would welcome the whole fff-ing Greek alphabet to bump me off.
I would take action myself first. I do not intend to go into a care home under any circumstances. People should have the right to assisted dying as they have in other countries.
Same here. The prospect of some care home gulag makes me shudder. I’m sure there are good ones out there, but I hear too many horror stories from nurses, doctors and social workers who I cross paths with at work.
They appear to be nightmares – even the good ones – those workers are saints !!
I donât know what the staff profiles are like in the UK but in Sweden there is a high proportion of immigrant staff in the care homes and home care companies. Those employees tend to live in socially deprived suburbs, greater level of crowding, reluctance to being vaccinated (uptake at ca. 40-50%) and are dependent on rush hour public transport. The âstay home if sickâ Covid-policy and the care companiesâ focus on profits has led to an increasing number of hourly paid staff with higher levels of staff rotation, which just makes the infection exposure risk even greater. A government enquiry highlighted these facts as a major contributor to the high level of Covid mortalities in 2020, but the situation since in terms of these issues has instead deteriorated. Mass privatisation of elderly care in the 90s and 00s by both socialist and conservative govts led to a decline in standards and quality of elderly care. Many companies are backed by venture capitalists and foreign organisations and the amount of care facilities left in council/commune operations is only a fraction of the total.
My wife, also immigrant, Polish, worked in home care from the early 80s until 2013, going from four 2-hour visits daily in the 80s in council run care to 12-15 visits daily (incl. travel between visits) from 2000 onwards for private employers. In her last 3 years she was given more time to look after two sisters, 93 and 99, supposedly on their last legs. She took care of them and kept them alive with a reasonable quality of life by preparing simple meals and making sure they eat properly in between constantly cleaning up after their incontinence. Six weeks after she retired, both sisters had gone to meet their maker.
Iâm sure the care companies involved in the Covid struggle are doing their best to manage the care and risks. They canât rectify and change the overall healthcare situation and contributing factors in the foreseeable future, probably never. Hopefully the Swedish public health authority and govt will never enforce mandatory vaccinations but keeping the infection exposure risk manageable with the constraints in reality will not be easy, so donât expect any miracles coming out of Sweden in the next 6 months in this respect.
I can understand and concur with Carlyâs reluctance to be jabbed, she could well be correct in her judgement regarding the safety issues. The level of coercion is comparable to that in certain circumstances during WW2 and the countries leading the charge are the same.
Itâs what happens when facing population ageing, there is no way around it. Elderly care is not value creating, it is only an expense. When there is a wave of elders that needs care, the quality of these services will go down as a result, anything else is unsustainable.
It will be interesting to see if Swedenâs population immunity to Covid will help them against the spread of this Omicron variant.
It irritates me beyond words to hear someone reasserting that being vaccinated gives protection. I would argue that it encourages bravado and a sense that you can do no harm; but this is not true.
Classic risk mitigation and externalisation in one. Similar to the seatbelt analogy the (pro-vax mandate)* group are so fond of using, which also caused an increase in road traffic accidents as a result of people taking more risks in the belief they were safer.
*just to be clear that supporting vaccination in general is not the same as enforcing vaccination en-masse
I was with the writer until she blamed Carly for not taking an experimental vaccine to which she could not give informed consent. Clearly this vaccine does not immunise or stop transmission so where is the protection? Several double vaxxed people I know are sick with Covid. There is absolutely no logic for this mandate that is simply wrecking the care of the elderly and frail when they need it most. Someone very close to me is a senior nurse who stands to lose her job in March. She suffers from various allergies that lead to anaphylaxis and also danlos syndrome- she is not being granted an exemption, so the NHS will lose a fine, hard working nurse for this absurd stubborn belief that the mRNA jabs, and only universal mRNA jabs are the way out of this thing. I can only hope that the writer reads some of the comments below and, despite her exhaustion, does some research and engages in some critical thinking.
Here in New Zealand the unvaccinated are now being barred from most normal societal interactions other than retail and essential medical services. The argument is always âyes the vaccinated can transmit it but are less likely toâ. That argument if true would be at a population level not an individual one. Any one vaccinated individual may at any point in time may be more infectious than any one unvaccinated individual. Discrimination based on the statistics for a population is just plain wrong. Recently a group of midwives here took the government to court to argue against the vaccine mandate for their profession. They lost. Now we are even more short of midwives than we were before. What is a riskier situation for a woman about to give birth – an unvaccinated midwife in attendance or no midwife? Similar logic applies to elder caregivers. I would say that letting go the caregiver Dawn speaks of puts care home residents at greater risk than retaining her in her unvaccinated state. Itâs highly likely she has immunity anyway, and is arguably less of a risk than a vaccinated staff member! The lack of logic which seems to have infected peoples brains over the last 20 months is mind bending.
Dawn,
Your story is so sad. You work so hard, you clearly care about people and few people would have the humanity and the capacity to be able to do your job, particularly for such low pay. I couldnât do it. I cannot imagine how hard it is for you. In a better and fairer society you would be both paid and respected much more for what you do.
But in a better and fairer society, you also wouldnât be subject to systematic lies and psychological abuse by your own government. You wouldnât be sold a story that the product of a multi-billion dollar pharmaceutical industry with a longstanding history of enormous criminal fraud is your and our saviour. You wouldnât be tricked into thinking that people who have chosen not to have taken a vaccine are a threat to you or your clients.
In no way do I blame you for this. It is not your fault. As I am sure that you know better than me, it is hard, very hard, for us to accept that we have become the victims of abuse. But recognising that fact is the first step to coming to terms with what has happened to us, and to being able to do something about it.
It can be hard for those with an abundance of natural human empathy, such as yourself, to comprehend that other people could be so lacking in that quality, so callous and lacking in their capacity to love or be loved, that they would be prepared to do things for their own material gain that could hurt or even kill others. But it is, sadly, true: they donât care about me or about you or about your patients. All those behind all of this care about is themselves. Theirs is a shallow, sad existence. Ours is richer and full of love.
Please know that those of who donât necessarily share your perspective on the vaccines do care about you and all of those around us. We are empathetic, we are intelligent; we are not crazy, we are not misinformed. And we do care about you. I can assure you that our choices are not selfish ones.
I hope you can come through this and can come to terms what has happened to all of us. The human spirit will endure.
Caregivers who were lionized as heros when the pandemic began are now demonized as lepers because they don’t want to be forced to use a product for which the manufacturers and distributors are absolved of all liability. If new airbags with special artificial intelligence from Microsoft were mandated for your car (to save lives), would you possibly be concerned if the government simultaneously absolved Microsoft and the car companies for all liability for injury or death due to design flaws or manufacturing defects in their product? Wake up!
call me cynical but when the government was forced to act against Covid and put measures in place to âstop the elderly from dyingâ, they needed to come up with an alternative approach where they can look like the good guys whilst letting the old folks die again. Hence the care home vaccine mandate.
What is this delusion people have that if we all social distance, wear masks and have a jab, old people will stop dying? They going to die! We all die! Death is the only guarantee in life!
earlier this year a friend of mine went on a facebook rant about how irresponsible people had led to Captain Toms death! He was 100, For goodness sake!
Human beings of any age are not meant to live in institutional settings. We need to allow funding directly to families to care for their own that is equal to the funding poured into institutional settings. Elder care settings could not provide humane care for most prior to covid. Daycare centres for little ones have far too many children per staff and far too many biological pathogens that cannot be adequately cleaned. The same for care of those with disabilities.
There is no economy of scale savings, unless we do not count the costs of all the harms produced by institutional care, and also do not count the worth of the unwaged care provided by family for loved ones (mainly female work. Yes, work.)
OK this will sound harsh but…
Old people in nursing homes die – just like the wind blows, birds fly, and the sun shines. They have one foot in the grave and the other on a banana peel. That’s why they are in a nursing home. If they were robust and healthy with years of life ahead of them (whether old or young), they wouldn’t be there in the first place.
The small nursing home I work in has lost/replaced 14 of 17 residents since COVID hit. Many have died “gasping for breath” (actually not, because we have excellent palliative care and they are properly medicated). Tears have been shed. Even though they are old and “ready to go” (100% of our patients are “Do Not Resuscitate”), they are always someone’s mother, father, sister, brother, uncle. My own grandma died in a nursing home a few years ago, and it was a very difficult thing to go through, even though she was 101 and by her own words “ready for god to take her”.
The thing that’s important to know about our nursing home is that we have had zero COVID cases or deaths. Patients only go to nursing homes when they are near death, so yearly mortality rates are very high. One of our large provincial nursing homes that had a notable outbreak lost 60 residents from COVID over a few months. But their average yearly mortality is actually below what it’s been in previous severe flu years. (Our media has NOT mentioned that fact, just the COVID stats, and a public inquiry has been started).
We all die. Most nursing home residents do NOT have a quality of life such that the patient him/herself or their family wants them to live longer. They want comfort and care, and good palliative care when they are at the end. Talking about their dying as a tragedy is histrionic. Forcing them to die alone and lonely is the real tragedy – more properly “cruelty”, as we have made the decision to enforce social isolation, rather than it having been forced on us by fate.
As to allowing unvaccinated workers to continue is a no-brainer to me. First, it’s debatable how much vaccination reduces one’s ability to be infected with and transmit COVID. Available stats seem to suggest that being looked after by 3 vaccinated staff is riskier than being looked after by 2 unvaccinated staff. So…
Secondly, is it riskier for these patients to be looked after by an unvaccinated person (as was true for 100% of workers before vaccination was available), or to have no care at all? That’s an easy question to answer.