It is a legacy of COVID-19 and not necessarily a positive one. As most of us finally begin to look forward, a number of family owned care homes are struggling to survive. Many closed their doors during COVID but some who managed to keep their heads above water during the pandemic, are now facing the possibility of closure.
According to Liz Jones, Policy Director of the National Care Forum, “most smaller care homes just don’t have the capacity to absorb some of the shocks that came with the pandemic, which included reduced occupancy rates and admissions, dealing with the constant changes in Government regulations, pressures on staffing levels, and managing infection prevention and control (IPC) guidance. I think they’re all contributory factors in the stresses they faced — and continue to face.”
A net loss of more than 1,600 care places
Recent data from a CCQ report provides insight into the issue. Its analysis of adult social care locations that ‘provide residential nursing or personal care in England’ shows that in the six months between August 2021 and January 2022, 474 locations de-registered, 340 registered, with a net loss of 134 locations. In terms of capacity, 16,499 beds were de-registered while 14,882 beds were registered – a net loss of 1,617 beds.
Liz says that the figures show that COVID-19 has clearly taken its toll on the sector. “I was quite surprised when I saw the CQC data,” she said. “I know it’s a relatively small proportion of the total number of places in care homes, but usually the overall levels of provision remain quite stable.”
Good ventilation is key
One of the less obvious reasons for some closures is that older homes, built in the 60s or the 70s, are just not designed for modern IPC needs. Some suffer from ventilation issues, and to conform to recommended guidelines would require extensive renovations they can ill afford.
According to Liz, good ventilation is critical to stop viruses such as flu and of course Covid-19 circulating. “For those care providers who have older build properties, the government has talked a lot about the importance of good ventilation, particularly in the latter phases of the pandemic.
“This is because we now better understand how COVID-19 spreads – what in medical terms is called ‘aerosol’ transmission. (Essentially, if you can inhale particles you are breathing in aerosols. This is more likely when people are close, as they are much more concentrated at short range.) But not everyone can afford to install the latest ventilation systems that care homes need.
“Moreover, we haven’t received any kind of concrete advice to help manage the conundrum of keeping fresh air flowing but at the same time making sure people are warm. We probably need some better insights into best practices.
Employing IPC best practices
She does believe that robust IPC policies can help, which providers can source from compliance platforms such as QCS. “Being a small, older care home doesn’t mean you can’t have great infection prevention and control policies in place – even if it’s not viable to fit a whole new set of ventilation systems”, she said.
The design of a building is important in being able to manage IPC, she added. “Having separate en-suite bathrooms, for example, is a really important factor. As is the way that people move around your care setting – whether they have access to outdoor space, how your communal areas work, the flow of activity. The layout of your care home can make that harder or easier of course.”
She went on to say that there are essentially four weapons in a care settings IPC armory, whatever their size: testing, PPE, vaccination and hygiene.
“It’s important to have clearly defined and strictly managed processes around cleaning, and good standards of hygiene,” she said. “Staff should be well trained in effective IPC procedures. And providers can make sure everyone is following the proper guidance about hand washing.
“PPE and mask-wearing are important too, as is following distancing guidelines when someone is unwell. At the moment we have free testing and that needs to be regular occurrence, especially as we now know people can be positive and asymptomatic.”
Finally, she said vaccination is vital in prevention. “A booster programme has just been announced for those aged 65 and over living in a care setting. So that will keep the levels of immunity up.”
Impact of an outbreak on smaller settings
Liz highlighted the devastating impact on a smaller care home if they have an outbreak of COVID-19. “For a smaller care home to be classed as having a COVID-19 outbreak, you just need two people from either staff or residents to test positive. And that then brings a whole raft of restrictions around being able to admit anyone new into the care home, including visitors.
“If these restrictions are in place for an extended period, then it is difficult to keep operations going as they don’t have the economies of scale of the larger settings. If they are unfortunate enough to have an outbreak, they need to focus on making sure testing regimes are in place to stop the spread of infection between residents and between staff.”
Keeping up with changing guidance
She said that what has been particularly challenging for all care providers, but particularly small ones, is the constant changing of IPC and other guidance – whether it’s about testing, about PPE, visiting or isolation of people. “Keeping up to date with this shifting landscape is essentially a full-time job. Our partner QCS, who provides IPC guidelines and standards for the social care sector, has been very supportive throughout the whole period.
“It does the heavy lifting in ensuring providers are following the latest policies and guidance and making the necessary changes to conform to an ever-changing IPC landscape. This can help smaller settings run more efficiently.”
Ultimately, the question is with an increasing demand for care, can the sector afford to let these homes go? The answer to solving some of the issues does not have to be expensive, nor does it have to be complex. It lies in following IPC best practice and compliance. With this in place, not only can they avoid closing, but visitor numbers do not have to be restricted either.