I P&C POL ICY
this so that things may be done differently,” she commented. “As the summer of 2020 came, and the first lockdown was lifted, and guidance changed to allow local discretion, what seemed to happen was that most care homes continued with elimination, and this went on and on, in far too many settings. The whole issue of de-implementation seemed to be a huge challenge. The new normal seemed to be eliminating people from the lives of their loved ones. This rigid focus on elimination had psychological consequences, for all concerned.” She said there was a failure in some in care homes to use IP&C compassionately and asked: “How can we solve this together to ensure we are safe and compassionate?” Storr emphasised that it is not just about ‘making every action count’; we should have been thinking, ‘how can we make sure every day counts for the residents who live here, who may not have very many days left on this earth?’ “The life expectancy of people who live in care homes is estimated to be between 12-24 months, and this matters. In some instances, we ‘protected people to death’,” she commented.12
“They were denied
physical, human interaction – between husbands and wives, mothers and sons; parents, lovers and life-long friends. Before the restrictions were lifted, a life was gone forever.”
Many groups came together to tackle what they perceived as ‘barbaric’ restrictions. Kate Meacock, from ‘Rights for Residents’ recounted how, when her mother had passed away, she had only been able to see her for 10 hours in 18 months and almost entirely through closed double-glazed doors. IP&C policies have had profound consequences, Storr pointed out, The World Alzheimer’s report (2020), for example, stated that: “Restrictions imposed to minimise the risk of harm to residents have accelerated physical and cognitive declines and/or directly contributed to the deaths of some residents.” 13
Storr went on to share some of the harrowing emails she received during the height of the pandemic, including the following from the wife of a care home resident: “I try to talk to him on the phone each day but is getting harder as he seems to be withdrawing and getting quite irritated as he wants me to visit him indoors; says I don’t love him. Before COVID, I would visit him six days per week and stay nearly all day giving him his meals, washing hair, cutting fingernails etc as he doesn’t like other people doing this so tells them to go away and leave him alone. I’m really worried, that if we are still not allowed to go in, what is going to happen to him. I’m so desperate to go in and visit him. I’m desperate!” (Anonymous). There were many heart-breaking stories
DECEMBER 2021
of loved ones who missed saying their goodbyes because of restricted visiting arrangements or they were only allowed to see their relative a few hours away before they died and they were not longer aware. There are consequences arising from misunderstood and misapplied IP&C and Storr said there is a risk that we are “normalising” some interventions. She tweeted on social media describing one care home’s rules for visiting a dying patient as “shameful and unnecessary” (one visitor twice per week, for 20 minutes, in full PPE and at 2m distance).
She went on to write an open letter in
Nursing Times stating that: “IP&C should never be at the expense of compassionate care”.14
It stated:
1. The ‘rules’ of infection prevention and control do not and should not prevent family members and close friends of residents entering a home, even during lockdown. The use of infection prevention and control as a rationale for prohibiting safe entry to homes is a misinterpretation and at times even an abuse of infection prevention and control principles;
2. Infection prevention and control should instead be used as an enabler and supporter of safe entry to homes. If masks, hand hygiene, appropriate use of other personal protective equipment and a hygienic environment are promoted as a protection in all settings, these measures can protect vulnerable residents in homes, when applied properly;
3. The longer the current situation prevails, the more likely it is to become routinised and de-implementation could become a concern in the future. Already we are hearing, for example, that some homes are considering outdoor heaters to support outdoor ‘visits’ by families in winter and the use of video call technology is becoming an unacceptable ‘norm’. This is not the answer; these are peoples’ own
homes, often at the later stages of their lives;
4. Infection prevention and control and compassionate care are not mutually exclusive. The restrictions or bans must be lifted and not just for immediate end of life situations. Families provide (unpaid) care too – all infection prevention and control recommendations for paid carers can be applied to others;
5. In summary, infection prevention and control should be applied as a force for good.
The letter presented six actions to help move forward towards more compassionate IP&C: 1. Nursing, care and residential homes: Allow normal family interactions by stopping restrictions and instead continue to inform and support families on the steps to take for safe contact in a spirit of trust and cooperation. Be confident that restricting visits should not be used as a replacement or shortcut for inadequate infection prevention and control measures – address gaps in safe practices where they exist. Commit to using infection prevention and control as an enabler that will protect staff, residents and families.
2. Government, local authorities/public health departments: Remove any statements that may be seen to justify “blanket bans” on visiting. Instead actively vocalise the need for local decision makers to facilitate safe, normal interaction, appropriate to the local situation. Even where an outbreak occurs and some restrictions may be warranted, make it clear that safe, compassionate exemptions must still prevail and be actively facilitated. Continue to address gaps in safe practices and lack of resources, in order to facilitate infection prevention and control.
3. Infection prevention and control community: Speak up in support of
WWW.CLINICALSERVICESJOURNAL.COM l 17
▲
©mrmohock -
stock.adobe.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56
