Care homes and Nightingale hospitals

Sadly in the last week or two, more of those I am involved for caring for have died in care homes.  The bravery of those providing them with the care needed, despite the risks, literally makes me well up with tears when I think about them.

I think that more will pass away in the next week or so as some who are in isolation have now passed.

Which brings me onto why I have posted his.  On Twitter, a few people have noted how the Nightingale hospitals have been stood down.  Opening them was necessary as we in the NHS feared the worst.  The UK has been closely following the curve of Italy and Spain.  And we in healthcare were (and considering that the lockdown measures will be relaxed, still are) concerned that the NHS would be overwhelmed.  That does not seem to have happened due to the changes in what the NHS is doing as well as the way that the attitudes of people towards getting help from the NHS has changed.

Some have asked why patients who do not have COVID who from care homes where COVID is spreading are not transferred there.  There are many problems with that is that.  One is that they may take the disease from the home that is infected to the Nightingale hospital.  The next is that the care needs of those in care homes tend to be different from those in hospital and those nurses who work in hospitals have a different skill mix to those min care homes.  This brings up the next issue, staffing.  Before COVID-19 hit the nation the NHS did not have enough nurses.  Nurses have been taken from other duties but as the NHS prepares to deal with other issues.

While patients from hospitals could be discharged to Nightingale hospitals rather than nursing homes, this would require a lot more logistics to move them across greater distances and any communication issues when a patient is discharged would be harder to resolve.  

And last of all, many who are in care homes have made decisions (or the next of kin has decided) that they are not to be admitted to hospital.  Just as those who want hospital assessment should have it, those who do not wish it should not have it forced on them.