protecting the elderly - hasn't really worked all that well

tabby aspreme

wheresthebeef wrote: »

Private nursing homes are strangled by government and are funded to an average of 50% less than public homes. Private homes also systematically perform better on HIQA inspections compared to HSE run homes. You can verify that by looking at HIQAs annual list of fully compliant nursing homes.

HSE nursing home my mother is , charges in excess of €1700 /week

wheresthebeef

tabby aspreme wrote: »

HSE nursing home my mother is , charges in excess of €1700 /week

Private average is €980. Either way, hope your Mum is happy there and well cared for and stays safe during this awful time.

The One Doctor

Del Griffith wrote: »

It's this. It's inconceivable that workers in 29 separate facilities just happen to have a positive Corona staff member.

My bet is we all have it, or a huge amount of people anyway, and have no symptoms or very mild symptoms.

This would mean the % death rate and rates needing hospitalisation are far lower than the current figures too.

The estimates are that between 10% and 50% of people are asymptomatic.

beolight

wheresthebeef wrote: »

Any place where people live together increases the risk of infection. Same as cruise ship issue.

Home care appears cheaper because it's only for 2 or 3 hours a day and is only the cost of the staff time and they are care assistants only. A nursing home has to employ a Nurse Manager, Registered Nurses, Carers, Cleaners, Chefs, Activities staff, Maintenance and there are the costs of the building, light and heat, food, medical supplies, therapists, often a mortgage to pay, insurance, commercial rates etc...

The family issue is truly heartbreaking. You cant win either way, by keeping families out you are impairing their ability to grieve and by letting them in you are increasing risk to others. The whole situation is cruel on every front.

Thank you for your post and answers

Can I ask a question ? Anytime I have been in Nursing Homes I couldn’t help but notice that all the Nurses we’re very task oriented, you would see one Nurse doing the meds and then another Nurse doing dressings and so on so basically multiple interactions with Nurses and resident not to mention care staff meals drinks etc.and multiply this by change of shifts. With this type of work practice it is quite easy to see how quickly and easily a virus can spread from resident to nursing home staff and vice versa. Is this how your Nursing Home operates?

wheresthebeef

beolight wrote: »

Thank you for your post and answers

Can I ask a question ? Anytime I have been in Nursing Homes I couldn’t help but notice that all the Nurses we’re very task oriented, you would see one Nurse doing the meds and then another Nurse doing dressings and so on so basically multiple interactions with Nurses and resident not to mention care staff meals drinks etc.and multiply this by change of shifts. With this type of work practice it is quite easy to see how quickly and easily a virus can spread from resident to nursing home staff and vice versa. Is this how your Nursing Home operates?

Task oriented is a sort of negative term so for starters I think anyone would be reluctant to say they were task oriented. Each resident has an assigned nurse and assigned carer for each shift. Those staff however obviously have assignments with other residents too. In a long term care setting the staffing is heavily weighted towards Care Assistants so 1 carer might have 6 or 8 people on their 'group' and 1 nurse might have 20 residents on their group. So we wouldn't have staff roaming between huge cohorts of patients, obviously we couldn't provide 1 to 1 care. Carers have the most contact with residents and they operate in the smallest groups, which is a benefit. Since the start of Covid season we have minimised the rotation of staff between groups so that same staff are looking after same small groups of residents repeatedly. Shift changes obviously cant be avoided either as staff have to rest.
If staff were to be looking after Covid patients, they would not be allowed to then look after non-Covid patients regardless of the groups. That will obviously put additional pressures on the rest of the team, and then added to again if staffing is depleted due to sick leave. Meals are all taking place 1 to 1 in residents own rooms. The movement/rotation is at the minimum it can possibly be and the hygiene measures between residents has been maximised. As I said previously a number of us are now suffering with contact dermatitis from the frequency of hand washing and we are all wearing masks when we are within 2 metres of each other or residents to stop us asymptomatically depositing our respiratory droplets on anyone. Cleaning staff are using bleach on hand rails, switches, buttons, door handles throughout the day. Where the building layout is conducive to compartmentalisation, we've tried to use those features to section off areas. However we have to balance all these measures against residents rights and quality of life too.
It's a very fine balancing act. Some of these measures are more onerous than the HSE advice in some respects and in implementing them, we have to be careful not to do more harm. For example, if we ask residents to limit their movement, we might increase their risk of bowel issues or increase their risk of getting a normal bacterial chest infection as they arent moving as much as they would normally. There is also the obvious risks to peoples mental health too. The ideal scenario is one where we implement the most protective measures possible, and have sufficient compensating measures to reduce the risks of those protections. All of this adds hugely to the stress and workload of staff which can then have a knock on effect on their wellbeing.
For example, the decision to wear a mask at all times is seen as not required by the HSE guidance. So we had to purchase those masks privately at inflated cost. In deciding to advise wearing them, we had to consider if the staff would take this as a sign of increased perceived threat to their safety and if it would cause a rise in absences. We also had to consider that breathing through a mask all day can make you feel very stuffy and short of breath. Carers work can be physically strenuous at the best of times. It's really not easy to decide what the best course of action is. Over the last 3 weeks, we've found ourselves ahead of the advice on a number of occasions which has given us a head start. I would be hopeful that the measures we've taken this week might be incorporated into official guidance soon which would indicate we're on the right track.

In saying that, I am familiar with one of the nursing homes that currently has a large cluster and they would be one of the best resourced and best managed nursing homes out there and it still happened to them. To me, that speaks to the extreme difficulty in controlling this virus unless you can implement 100% cocooning, which we can not. That's why I am filled with dread. You can do everything right and it still comes for you.

beolight

Thanks

What was your reaction to the CMO admonishing Nursing Homes for acting unilaterally and the Taoiseach chiming in the same day!

“Chief Medical Officer Dr Tony Holohan has insisted the risk of contracting Covid-19 in Ireland remains low.

He appealed again to organisations... not to act unilaterally...following the decision of the Nursing Homes Ireland to implement visitor restrictions nationwide."

I remember Leo Varadker using the same words later that day in his briefing.

NHI made their decision on March 6 and even if it was too late,thankfully a lot ignored the CMO and Taoiseach but unfortunately HSE run Nursing Homes would of been obliged to follow it.




https://www.rte.ie/new...1120765-coronavirus/

Rodney Bathgate

lalababa wrote: »

The cheapest private nursing home near me is 950 euro a week. The public one is 1500 a week. They are both run well and have caring staff.
How it costs a grand a week to care for somebody when a home carer might do it for 200 carers allowance beats me. But there you go.

The home carer is not providing accommodation for a start.

Danzy

hmmm wrote: »

Do we know why there are so many cases in nursing homes? Looking at the stats there are very few recorded outbreaks in employers, but lots in nursing homes. I'd have thought both would be likely.

Is it because the people in the homes tend towards worse outcomes, and are more likely to need hospitalisation? That would point towards significant undetected spread in the general community.

I'm Guessing that fresh air, open windows might not be common in nursing homes, maybe how they all go in to the day room, all day.touching hand rails.

100 people confined to a small building with closed windows is my guess.

wheresthebeef

beolight wrote: »

Thanks

What was your reaction to the CMO admonishing Nursing Homes for acting unilaterally and the Taoiseach chiming in the same day!

“Chief Medical Officer Dr Tony Holohan has insisted the risk of contracting Covid-19 in Ireland remains low.

He appealed again to organisations... not to act unilaterally...following the decision of the Nursing Homes Ireland to implement visitor restrictions nationwide."

I remember Leo Varadker using the same words later that day in his briefing.

NHI made their decision on March 6 and even if it was too late,thankfully a lot ignored the CMO and Taoiseach but unfortunately HSE run Nursing Homes would of been obliged to follow it.




https://www.rte.ie/new...1120765-coronavirus/

I was disappointed reading it, but looking back there were a number of HSE hospitals doing it too. We thought very hard on it and decided to boil it down to simple maths - resident has contact with 30% less people = 30% less risk. Our families were also supportive of the move even though it was tough on them. As you know, days later, the government gave in on that recommendation so we were vindicated in a way.

wheresthebeef

Danzy wrote: »

I'm Guessing that fresh air, open windows might not be common in nursing homes, maybe how they all go in to the day room, all day.touching hand rails.

100 people confined to a small building with closed windows is my guess.

A lot of older people feel the cold. It can be hard to get them to agree to an open window in blistering weather we had last summer, nevermind in April. We opened all the windows on corridors and communal areas though. Theres almost nobody in day rooms anymore.

DeVore

In truth, with an R0 of 2.2 , most people are going to contract Covid at some stage. The intent is not so much "to protect the elderly" as it is to protect the hospitals so that when the elderly get sick, we can treat them effectively.

Danzy

wheresthebeef wrote: »

A lot of older people feel the cold. It can be hard to get them to agree to an open window in blistering weather we had last summer, nevermind in April. We opened all the windows on corridors and communal areas though. Theres almost nobody in day rooms anymore.

I agree, my point was referring to the explosive potential a nursing home represents.

There is a massive effort being made to keep people safe there, just to clarify I'm not doubting that at all.

Danzy

DeVore wrote: »

In truth, with an R0 of 2.2 , most people are going to contract Covid at some stage. The intent is not so much "to protect the elderly" as it is to protect the hospitals so that when the elderly get sick, we can treat them effectively.

The R0 number changes with weather and circumstances.

In all probability the Corona virus will be here for good, but more time will mean a milder version and drug/treatment to manage it.

beolight

DeVore wrote: »

In truth, with an R0 of 2.2 , most people are going to contract Covid at some stage. The intent is not so much "to protect the elderly" as it is to protect the hospitals so that when the elderly get sick, we can treat them effectively.

Exactly we need to realise the Nursing Home environment is just a microcosm if every neighbourhood/ community/ workplace.

200 residents and staff interacting makes it inevitable once containment ( South Korea:Taiwan style )doesn’t stop it spreading in the community ... then at least 10% of the 200 will have it and unless twice daily monitoring ( at least) of everyone plus everyone wearing PPE with suspected cases immediately isolated it will spread and spread and unfortunately Nursing Home residents will score poor on the Fraility Index so ICU not a viable option especially when ventilators are in such short supply

Boris’s original herd immunity plan was based on not only isolating the old and vulnerable ( group A)but on also isolating the health care staff( group . Group C was everyone else whom it was argued should be strong enough to get over it. The theoretical flaw in that plan was the healthcare workers had families and all the problems that entailed

MadYaker

The sad reality of this situation is that no matter what we do it isn't possible to protect everyone.

DeVore

It isnt possible to protect everyone. However that doesnt mean you dont attempt to protect as many as possible.

The minute someone stuck their dick in a bat in China, some people were going to die. However by careful management of resources we can minimise that number.

SuperRabbit

DeVore wrote: »

It isnt possible to protect everyone. However that doesnt mean you dont attempt to protect as many as possible.

The minute someone stuck their dick in a bat in China, some people were going to die. However by careful management of resources we can minimise that number.

**** off. What happened to your positivity? Go stick your dick in yourself, racist.

ILoveYourVibes

peasant wrote: »

https://www.irishexaminer.com/breakingnews
And before people start going on about Irish inadequacies etc ...posterboy Germany has plenty of cases (and sadly also plenty of deaths) in care homes for the elderly.
(Don't trust me? Go to google news. de and type "Seniorenheim" into the search function and google translate away)

Do you realize what the german death rate is compared to ours?
https://www.businessinsider.com/why-germany-has-a-low-covid-19-mortality-rate-2020-4?r=US&IR=T


https://www.irishtimes.com/news/health/coronavirus-irish-death-rate-from-covid-19-rises-to-2-4-of-cases-1.4217851?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fhealth%2Fcoronavirus-irish-death-rate-from-covid-19-rises-to-2-4-of-cases-1.4217851

Still waters

SuperRabbit wrote: »

**** off. What happened to your positivity? Go stick your dick in yourself, racist.

Lol

ILoveYourVibes

[QUOTE=DeVore;113044570

The minute someone stuck their dick in a bat in China, some people were going to die..[/QUOTE]
I think you have some odd ideas of what a wet market is DeVore.

Alf Veedersane

ILoveYourVibes wrote: »

Do you realize what the german death rate is compared to ours?
https://www.businessinsider.com/why-germany-has-a-low-covid-19-mortality-rate-2020-4?r=US&IR=T


https://www.irishtimes.com/news/health/coronavirus-irish-death-rate-from-covid-19-rises-to-2-4-of-cases-1.4217851?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fhealth%2Fcoronavirus-irish-death-rate-from-covid-19-rises-to-2-4-of-cases-1.4217851

Part of the reasoning for that is the age profile of the confirmed cases.

Jumping into this thread - apologies if broached already.

Because of the localised nature of nursing homes are our current death rates significantly impacted by nursing home deaths. If these are stripped out are our 'other death' figures peaking/plateauing?

Ultimately it's the general population death rates that will be the basis of whether our social distancing/lock down efforts are working.

Alf Veedersane

[Deleted User] wrote: »

Jumping into this thread - apologies if broached already.

Because of the localised nature of nursing homes are our current death rates significantly impacted by nursing home deaths. If these are stripped out are our 'other death' figures peaking/plateauing?

Ultimately it's the general population death rates that will be the basis of whether our social distancing/lock down efforts are working.

They haven't been hugely transparent with the data to date so that won't be known publicly.

BrianD3

DeVore wrote: »

In truth, with an R0 of 2.2 , most people are going to contract Covid at some stage. The intent is not so much "to protect the elderly" as it is to protect the hospitals so that when the elderly get sick, we can treat them effectively.

Elderly people are hit hardest by Covid-19 and have comprised the majority of deaths. The majority of deaths have occurred outside of ICU while numbers of occupied ICU beds have been well below the stated number of beds available. This is based on the official figures.

Clearly, sick elderly people are not being taken into ICU even when there is capacity. There are obviously valid ethical reasons for not taking in some elderly people into ICU. However, I also have some suspicions here that the authorities have been so fearful of the forthcoming "surge" that they gone to the other extreme and turned away people from hospital who would otherwise have been admitted. If in doubt, keep them out etc.

And of course, we do need various measures to reduce the number of cases of all ages who might need ICU.

Care of the elderly is not a priority in this country - if it were, the home care system would not be such an underfunded shambles and nursing homes would have been prioritised at the start of the Covid-19 outbreak. Instead, they were told not to restrict visitors and there doesn't appear to have been much thought given to staff PPE requirements

The state pays relatively generous old age pensions to the elderly, other aspects of elder care are sorely lacking and people/families are left to fend for themselves. Now we've "shut down the country", the elderly are still being hit hard by Covid-19 and when this is over, we will have taken a massive economic hit, how are we going to fund home care and the Fair Deal then.

Alf Veedersane

Alf Veedersane wrote: »

They haven't been hugely transparent with the data to date so that won't be known publicly.

It was somewhat rhetorical.

I think our death rates will be higher than expected because of this. But not largely a factor in whether the lock down is working for the general population.

And the Nursing home deaths are just as heart breaking. I'm not insensitive to those deaths, and as someone that recently visited with his wife and her immediate family while my Father in Law was in his last week of life (not Covd19 related) it is a traumatic experience.

ILoveYourVibes

Alf Veedersane wrote: »

Part of the reasoning for that is the age profile of the confirmed cases.

They have the same age profile of confirmed cases as we do. That was the point made in the op no?

I think it was (paraphrasing) ' we should not say its an Irish thing that protecting the old has not worked as Germany also has the same age profile of confirmed elderly patients'.

So either their better death rate is not due having a different age profile within the infected. And if it is ..well them Germany has done a better job of protecting the old.

peasant

ILoveYourVibes wrote: »

I think it was (paraphrasing) ' we should not say its an Irish thing that protecting the old has not worked as Germany also has the same age profile of confirmed elderly patients'.

Close, but no cigar.
I wasn't going all statistical in my first post, all I was saying is that Germany had plenty of cases were there were clusters of infection (and sadly, subsequent deaths) in care homes all over the country.

No matter how well people like to think that Germany is managing this virus in general, in protecting the elderly in their institutions, they didn't exactly do a stellar job.

I guess it would have something to do with the cost of keeping a care home outbreak ready at all times (staff levels, PPE stock, isolation facilities, etc). Homes for the elderly are expensive as it is, but they're run on a shoestring. Equipping them to be ready for the next outbreak might simply be deemed to expensive / not cost effective. Here, as well as in Germany.

ILoveYourVibes

peasant wrote: »

Close, but no cigar.
I wasn't going all statistical in my first post, all I was saying is that Germany had plenty of cases were there were clusters of infection (and sadly, subsequent deaths) in care homes all over the country.

No matter how well people like to think that Germany is managing this virus in general, in protecting the elderly in their institutions, they didn't exactly do a stellar job.

I guess it would have something to do with the cost of keeping a care home outbreak ready at all times (staff levels, PPE stock, isolation facilities, etc). Homes for the elderly are expensive as it is, but they're run on a shoestring. Equipping them to be ready for the next outbreak might simply be deemed to expensive / not cost effective. Here, as well as in Germany.

I didn't say that. I was saying that the whole point i was making is that germany has a lower death rate than us.

Someone else said the age profile or our infected is older ..i was saying it isn't. As you have just demonstrated.

And yes ...old folks homes are really the place you go if you want to get sick.

Iago

ILoveYourVibes wrote: »

I didn't say that. I was saying that the whole point i was making is that germany has a lower death rate than us.

Someone else said the age profile or our infected is older ..i was saying it isn't. As you have just demonstrated.

And yes ...old folks homes are really the place you go if you want to get sick.

bear in mind that Germany has a lower death rate because of how they are reporting deaths. A big issue globally is that everybody is reporting differently.

If I understand correctly Germany are applying a system along the lines of 'if the person would have died of x in the next 12-24 months anyway, that's what we report the death as not covid'

Similarly if you look at the spikes in deaths in various countries from say pneumonia, for example, you will see that nobody is reporting full numbers.

ILoveYourVibes

Iago wrote: »

Similarly if you look at the spikes in deaths in various countries from say pneumonia, for example, you will see that nobody is reporting full numbers.

Worrying.

I mean you would wonder how accurate the statistical information that DRs are telling us is so valuable right now really is.