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COVID-19 and its Impact on Care Homes

Woman in a care home being consoled by a member of staff

How have care homes coped with COVID-19 during the second wave? What were the key concerns that affected care homes during the pandemic? What can we learn from this experience? These are just some of the issues that the Assembly’s Health Committee wanted to explore when it set up its Inquiry into COVID-19 and its Impact on Care Homes.


As part of the inquiry, the Health Committee asked a number of stakeholder groups to give written submissions. Twenty-one submissions were received from a range of groups, spanning public, private and charitable organisations, professional bodies and trade unions.


In addition, the Committee held oral evidence sessions with a number of key stakeholders as well as senior Department of Health officials. To gain the views of those living in care homes, their relatives, owners of care homes and their staff, the Committee also used an online survey that elicited nearly 700 responses.


Among the issues covered by the inquiry, three stand out: the real need for reform of the adult social care system; the importance of involving care homes in pandemic planning; and the importance of real contact between families and those in care, even during a pandemic such as COVID-19.


Even before the pandemic, there have been serious issues facing the care home sector, not least of which was the need to make changes to the entire adult social care system. Long-standing issues such as those identified in the Department of Health’s 2017 report Power to People: proposals to reboot adult care and support in NI, were highlighted, including the need to give greater control to those living in care homes, supporting family carers and crucially, improving conditions for the social care workforce. The costs of the adult care sector, and who should be responsible for these, were brought sharply into focus with the increased need for personal protective equipment (PPE) and the increased responsibility of those working in the care home sector.


In an evidence session to the Committee on Thursday 22 October 2020, Ms Pauline Shepard, representing the Independent Health and Care Providers, highlighted the issues of staff shortages and the difficulty in recruiting suitable workers, in part due to the levels of pay and conditions prevalent within the sector. Progressing these reforms will require the commitment of the Department of Health, something that has been acknowledged and agreed by the Minister.


No one is in any doubt that COVID-19 was a crisis of a magnitude greater than anything that had come before. At the same time, issues arose in the way guidance and advice were developed and put in place. Initiatives were introduced without prior engagement with either the care sector or unions, leading to an undermining of confidence in the guidance provided. These matters were compounded by initial shortages of appropriate PPE and training for their use. To address these specific issues, the Committee has recommended that, during a pandemic, there should be a centralised procurement and supply of PPE to care homes, without charge. In addition, it is important that staff are able to access training as new information emerges.


We all instinctively understand how important it is for those in care homes to have contact with their loved ones, but the Covid regulations have highlighted the negative and sometimes traumatic impact of visiting restrictions on the mental health and well-being of residents and carers alike. Some of the problems highlighted by families were communication issues, where those with loved ones in care homes felt that they had no input in decisions around visiting.


Ensuring that visits could take place was again closely linked to both testing and the availability of PPE, which had financial and resource implications for care homes. The Committee strongly recommended that families be directly involved in decision-making around visiting. For example, virtual visiting, while welcome, was not suitable for all care home residents, particularly those with cognitive or sensory impairment, while the recent use of visiting pods was welcomed.


One thread that connected all the different issues was that of keeping people’s human rights front and centre when designing and implementing any regulations and guidance. The physical and mental well-being of residents, families of those in care, as well as the dedicated staff – this is just as important as appropriate testing and PPE regimes.


While the COVID-19 pandemic might be a once in a generation event, the issues affecting the adult care sector have been recognised for some time. The recommendations made by the Committee, working with the Department and all stakeholders, should improve the entire sector as well as increasing its resilience in any future pandemic.

Watch MLAs discuss the report during Plenary below:

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