The British Geriatrics Society has published guidance to help care home staff and the healthcare professionals who work with them to support residents through the COVID-19 pandemic.
The pandemic is expected to add to the strain on care home staff who were already working under challenging circumstances and feel isolated and exposed. Most are not nurses and will not be trained in managing outbreaks of infectious diseases.
The guidance is also for NHS staff who plan for, work with and support care home staff, many of whom are trying to develop standardised approaches to care home residents in light of the pandemic.
Approximately 400,000 older people in the UK live in care homes and a significant proportion of these will be living with frailty.
Care home residents are vulnerable to the infection
The guidance says that there is emerging evidence from countries ahead of the UK in the COVID-19 pandemic that suggests that care home residents are particularly vulnerable to the infection as a consequence of their complex medical problems and advanced frailty.
It adds that advice on the pandemic shifts on a daily basis and care home managers may struggle to support staff who feel isolated from the rest of the health and social care system and hence vulnerable.
Among the recommendations are that care home staff are trained to check the temperature of residents displaying possible signs of COVID-19 infection, using a tympanic thermometer (inserted into the ear).
Also, where possible, they should be trained to measure other vital signs including blood pressure, heart rate, pulse oximetry and respiratory rate. This will enable external healthcare practitioners to triage and prioritise support of residents according to need.
The RESTORE2 tool should be used to recognise deterioration in residents, measure vital signs and communicate concerns to healthcare professionals.
Primary care clinicians should share information on the level of frailty of residents (mild, moderate, severe frailty) with care homes, and use the Clinical Frailty Scale to help inform urgent triage decisions.
For residents who are prone to wandering due to cognitive impairment, behavioural interventions may be employed but physical restraint should not be used.
Advance care planning for COVID-19
The guidance also recommends that care homes should work with GPs, community healthcare staff and community geriatricians to review Advance Care Plans as a matter of urgency with care home residents. This should include discussions about how COVID-19 may cause residents to become critically unwell, and a clear decision about whether hospital admission would be considered in this circumstance.
Advance Care Plans must be recorded in a way that is useful for healthcare professionals called in an emergency situation. A paper copy should be filed in the care home records and, where the facility already exists, an electronic version used which can be shared with relevant services.
As part of the efforts to ensure capacity for new COVID cases in acute hospitals, care homes should remain open to new admissions as much as possible throughout the pandemic.
They should be prepared to receive back care home residents who are COVID positive and to isolate them on return and they should follow the advice from Public Health England when accepting residents without COVID back when there are confirmed COVID cases within a home.
Multiprofessional local or regional WhatsApp groups may also help staff who feel isolated and worried by the pandemic. A national Whatsapp group, led by Anita Astle, is emerging, and care home staff, NHS and social care professionals are encouraged to join by emailing Anita at: email@example.com. The Queens Nursing Institute has set up a Facebook support page for Care Home Registered Nurses.
Collaboration on a scale that we haven’t seen before
Adam Gordon, BGS Vice President for Academic Affairs and Professor of Care of Older People at University of Nottingham, said: “Most care home residents live with frailty and we know from other countries further ahead of the UK in terms of COVID-19 that they are particularly vulnerable to the virus. Care home staff can also feel isolated because they work in small teams, separated from much of the rest of health and social care.
"Supporting care home residents through the COVID-19 pandemic will require collaborative working between the NHS and care homes on a scale and at a pace that we haven’t seen before. These guidelines draw attention to important considerations as this work takes place.
"It is important to consider which treatments care home residents would want, and which they wouldn’t want, in advance of any change in their health. It is important to consider how the care home would manage a resident with COVID 19 who ‘walked with purpose’, often a feature of dementia. It is important that staff enable residents to stay in touch with their families electronically, where possible, and that staff support each other through this challenging time. We have outlined recommendations for these concerns, and other important considerations, in the hope it will focus the minds of those working with and in care homes, as they plan for their response to this pandemic.”
The BGS has a range of resources available relating to older people and the current COVID-19 pandemic.