A third (32%) of care home nurses and managers responding to a recent survey said they struggled to access a GP for residents during the height of the Covid-19 pandemic.
The Queen’s Nursing Institute (QNI) survey of 163 care home nurses and managers also found a quarter (25%) of respondents had faced difficulty accessing hospital care for residents between March and May this year, while 33% said they had problems getting district nursing support.
The majority of respondents (71%) said they had been able to access end of life medication and services when necessary.
In response to the significant impact of Covid-19 on care homes, NHS England issued guidance in May asking general practices and primary care networks to put in place additional support within a fortnight, which included ensuring timely access to clinical advice for staff and residents.
Do not resuscitate orders
The survey, which was carried out between May and June, found that do not resuscitate decisions (DNACPR) had remained the same at the care homes of the majority (95%) of respondents.
However, 16 respondents reported negative changes that they found challenging, such as ‘blanket DNACPR’ decisions, or decisions taken about resuscitation status by others, including ‘GPs, hospital staff or clinical commissioning groups’ without discussion with residents, families or care home staff.
One respondent said: ‘We were advised to have them (DNACPRs) in place for all residents. We acted in accordance with medical advice and resident wishes, not as advised by a directive to put in place for all by a CCG representative. We challenged this as unethical.’
In April, the Care Quality Commission put out a statement to GPs and care providers stating that it was ‘unacceptable for advance care plans, with or without DNAR form completion, to be applied to groups of people of any description’ and these decisions should continue to be made on an individual basis.
Last month, NHS England and Improvement pledged to publish new guidance on the use of the orders.
Thirty-nine respondents did however report Covid-19 as a ‘positive focus for change in talking about end of life care and a discussion of practice or ceiling of care’.
Mitigating risk of Covid-19 outbreaks
The survey also found that between March and April a fifth (21%) of respondents had taken in residents who had tested positive for Covid-19 in hospital, while 43% reported receiving residents from the hospital with an unknown Covid-19 status during the same period.
Two thirds (66%) of respondents also reported ‘always’ having appropriate PPE between March and May, while only two reported never having access to the right equipment during that stage of the pandemic.
Care homes need ‘urgent attention’
Dr Crystal Oldman CBE, QNI chief executive, said: ‘Overall, as would be expected, the picture presented is of an extremely stressful and anxious period for professionals working to care for and protect their residents. The positives represent a silver lining to this cloud and there are numerous testaments to the skill, dedication, professionalism and teamwork that Care Home Nurses have displayed in 2020.
‘In addition, this brief insight into the experiences of the nurses provides an opportunity to consider and plan for the support systems that may be needed in the anticipated second wave of Covid-19.’
She added: ‘More needs to be done to understand the effect of Covid-19 on the workforce and residents in care homes. Urgent attention must be paid to the sector if the workforce is to withstand the additional demands of the pandemic, particularly in planning, guidance and employment practices.’