Fears have been raised that care home residents who are seriously ill with coronavirus are being kept away from hospital after national guidelines suggested they should only be admitted if ‘appropriate’.
The advice, in two separate sets of guidance, says care home managers should consider whether being sent to hospital is ‘the best course of action’ for a resident and warns that ambulances may not be sent if ‘conservative care’ at the home is deemed preferable.
Recommendations from the British Geriatrics Society, a professional body representing 3,900 doctors and specialists in healthcare for the elderly, say care home managers should discuss possible admissions with paramedics, doctors and other healthcare staff.
The advice adds: ‘They should be aware that transfer to hospital may not be offered if it is not likely to benefit the resident and if palliative or conservative care within the home is deemed more appropriate.
‘Care homes should work with healthcare providers to support families and residents through this.’
Separate guidance from the Department of Health, Public Health England and the NHS instructs care home managers to ‘assess the appropriateness of hospitalisation’ if residents become seriously ill with the virus. It adds that they should hold discussions with a resident and their family to ‘determine if hospitalisation is the best course of action for the resident’.
Charities fear that the policies will result in patients not being taken to hospital even when it is in their best interests.
The Alzheimer’s Society warned that the guidance would be ‘misinterpreted’ by staff and ‘inadvertently prevent access to critical care to people who need it’.
Age UK stressed that decisions on whether to take a patient to hospital must always be based on ‘individual circumstances’ rather than a blanket policy,
Earlier this month care homes in Brighton were told that residents would not be admitted to hospital because it might increase their suffering.
One care home manager said they felt ‘shocked and numb’ at the advice issued by Brighton and Hove Clinical Commissioning Group (CCG), adding that a GP had even told them ‘none of your residents aged over 75 will be admitted to hospital’.
Another said: ‘We have been told flatly that it would be highly unlikely that they would be accepted into hospital.’ Similar guidelines were sent out to family doctors in north-west London, who were told that they would face ‘difficult decisions’ about whether to admit care home residents to hospital.
Why can’t they all be treated here?
NHS Nightingale hospitals remain largely empty with just a few dozen patients being treated at the three biggest sites.
It led to calls last night for the temporary hospitals to be adapted to cater for care home residents who had tested positive for coronavirus amid fears that homes are struggling to cope.
Temporary hospitals have recently opened in London, Manchester and Birmingham, which combined have the capacity for as many as 10,000 patients.
Others are being set up in Bristol, Harrogate, Exeter and Sunderland. But only 19 patients needed to be treated at the ExCel centre hospital in east London over the Easter weekend, leaving hundreds of beds with ventilators spare, the Health Service Journal reported.
The temporary hospital has 500 beds with ventilators and room for 3,500 more patients.
The Prime Minister’s spokesman said NHS Nightingale in Birmingham was ready to take patients and NHS Nightingale in Manchester had already received patients.
But it is understood that the three sites have only received a few dozen patients because normal hospitals have had spare capacity.
Liz Kendall, Labour’s social care spokesman, said: ‘If there is any spare capacity in NHS Nightingale hospitals we need to make sure they are used for those who need it most, including elderly people with coronavirus who would otherwise have to go into care homes with all the risks that brings.’
The documents, obtained by Pulse magazine from the region’s eight CCGs, stated that frail, older patients ‘do not benefit from aggressive hospital treatment’.
Care home residents are far less likely to survive if they are given intensive oxygen therapy or put on a ventilator compared with otherwise healthy patients.
That said, they will still benefit from the close monitoring of doctors and less invasive oxygen treatments that will be offered in hospital.
Sally Copley, director of policy and campaigns at Alzheimer’s Society, said: ‘People with dementia who have Covid-19 and need to go to hospital should be able to, just like anybody else.
‘These guidelines should always be applied on a case-by-case basis, and take into account the person’s needs. Our worry would be if stretched and exhausted health and care workers misinterpret these guidelines, and inadvertently prevent access to critical care to people who need it.’
Caroline Abrahams, charity director at Age UK said: ‘Decisions about transferring care home residents to hospital must be made by doctors, together with the older people themselves wherever possible, and with their families too.
‘They need to take into account any wishes older people have already expressed about treatment and going into hospital and recognise that unfortunately, any admission at present runs the risk of exposing residents to the virus.
‘Above all, these decisions must always be based on individual circumstances, not a blanket policy.’
Professor Martin Marshall, chair of the Royal College of GPs, said: ‘Whether during a pandemic or not, decisions about a patient’s care must be made based on their individual medical needs, as well as their individual wishes.
‘Some patients will not want to die in hospital, so if it sadly gets to this stage, whether related to Covid-19 or not, admittance to hospital would not be appropriate.’
The recommendations from the British Geriatrics Society, published at the end of last month, explain: ‘Care homes should be aware that escalation decisions to hospital will be taken in discussion with paramedics, general practitioners and other healthcare support staff.’
The Department of Health’s guidance, produced with PHE, the NHS and the Care Quality Commission at the beginning of the month, states that if a resident might need to go to hospital with coronavirus symptoms, staff should ‘consult the resident’s advance care plan or treatment escalation plan and discuss with the resident and/or their family’.
A quarter of coronavirus deaths in Scotland have been in care homes, the country’s National Records office revealed yesterday – 237 of the 962 suspected victims north of the border.
First Minister Nicola Sturgeon said all residents showing symptoms of the disease will now be tested.