COVID-19 has changed all our lives. And it’s changed the lives of people who live in care settings more than most. One of the strange cruelties of the virus is that it seems itself to discriminate against people on the grounds of age, genetic makeup and underlying conditions. Combined with the practical problems of keeping people safe against the odds, life has changed beyond recognition for everyone using care services, especially in residential settings.
Life is hard for us all, and social isolation hits hardest when people are restricted to their bedroom and not allowed even into the shared areas of what is, after all, their home. Many people in residential settings find technology such as Skype (or even the phone) very hard to use; staff in masks may be unrecognisable or hard to understand, and staff illness may mean having to get to know new people, often in the context of intimate personal care.
A new survey by the Policy Exchange here has found that confidence in social care has taken a serious hit during COVID-19. No doubt that because of reports of deaths in care homes and the unavoidable lockdown of care settings to prevent infection, the poll found that 40% of people aged over 65 – and about a third of their relatives – would be more reluctant than before to consider residential care. What actions can providers take to show frightened people that residential care remains a great option?
Making Care Attractive Again
People who would normally be moving into a care home, and their relatives, are inevitably scared at the moment. It’s really hard for anyone to assess what life would be like in a certain setting, either now, with such restrictions in place, or later on. But now is a good time to start planning for a more positive future. We will need to go on using all the new skills we’re learning about PPE and how to avoid transmission of illness. But we also must reinforce the importance of human rights in the culture of care.
Laws that Rub Against Each Other
The Human Rights Act (HRA) forms the guarantee for all of us that arbitrary decisions cannot be made in public services (including health and care) that restrict our basic rights – such as the right to life, the right to liberty, and the right to maintain relationships with family and friends. Supporting this, the Mental Capacity Act (MCA) is the essential framework for care and treatment for people aged 16 and over who may not be able to make their own decisions.
However, all this must be balanced, during the pandemic, by the need for everyone to abide by the Coronavirus Act 2020 and its regulations, which protect public health. The decisions have been hard to make, and the lives of many service users have become extra bleak, in a way that none of us would have wished to see.
Examples of Human Rights During a Pandemic
So, as the restrictions slowly loosen, think about the main rights that are at risk for each individual service user and how to lessen the intensity or impact of restricting these rights. And of course, be prepared to revisit your decisions regularly as the situation changes. This is human rights in practice: it’s about how best to keep someone – and of course others – safe, while promoting their individual happiness as much as possible.
· Tim’s learning disability means that he simply cannot remember not to hug and kiss his family and the staff who care for him, so the decision is that his family cannot visit at the moment. His carers support him to blow kisses to his mum at a safe distance, and he kisses the screen of his (regularly sanitized) tablet when relatives video-call him, which they do every day. Staff have explained to him that they wear masks when with him so that he is safe from any infection they might have. This shows respect for Tim’s right to be kept safe.
· Mrs A understands about the need to protect herself and others from the virus by social distancing – so, after a month of not doing so, she now goes out (masked) in her electric wheelchair to hear the birds, with a member of staff or even on her own. This respects her right to liberty as long as she’s not harming herself or others – and, of course she must, like all of us, obey the current Coronavirus rules.
· Barry has symptoms that might be COVID-19. His short-term memory is poor, and he is very upset to have no visitors, because he forgets the reasons why. A staff member wearing PPE looks through his family photos with him and posters in his room remind him, in pictures, when his brothers will speak to him on Skype. This protects his right to a ‘private and family life.’
· Miss C has loved animals all her life. She is too frail to go out and has no real understanding of why her life is very restricted because
of COVID-19 in the home. She desperately misses her sister’s visits with her Cockapoo. A carer volunteered to collect for her some of the really cute animal antics on YouTube, which they enjoy together. This again shows respect for her right to maintain, as far as possible, her interests and the activities that give her pleasure.
Show the Humanity of Care
Keep a record of the little things you’re doing, on an individual level, to keep people safe while going the extra mile to make life more interesting and happier. This is proof of person-centred, human rights-centred, effective care.
You will have real practical examples to show the empowering nature of your service, not only to CQC but, crucially, when someone is wondering whether to move in or which home to choose for the person they love who is becoming less able to manage safely at home.
- UK Government guidance and updates here.
- CQC advice and information here.
- CQC Working within the Mental Capacity Act during the Pandemic here.
- Human Rights Act 1998, relevant Articles here.
- Mental Capacity Act 2005 code of practice here.
- Easy-Read Books Beyond Words is an evolving resource of materials about COVID-19, aimed primarily at people with learning disabilities but also useful for other people who do not communicate through written means.
- Easy-Read posters on Coronavirus here.