An urgent public debate about various care options is needed

22 May 2020

Promedica24, the European largest provider of live-in care services, urges the public and authorities to carefully evaluate various care options available for older and vulnerable people and prioritise those services which can deliver safe, effective and high-quality care with better chances of limiting the further spread of the pandemic.


“It is with great concern that we observe the consequences of the COVID-19 pandemic and its impact on our communities, which has been the most amplified for those who are in vulnerable groups and the medical and care professionals who are working tirelessly on the front line,” said Paula Beaney, Quality Assurance Director at Promedica24.


The outbreak of COVID-19 has brought the UK’s care system under scrutiny. Due to the lack of accurate testing, shortage of personal protective equipment (PPE), and misjudged decisions to discharge COVID-19 infected people into residential care settings, the predicted death toll at care homes reached 11,000 on 19th May. The events of the recent weeks paint a bleak picture of the state of the UK’s care system.


“Unfortunately, despite the evidence of the COVID-19 pandemic in care homes, they are still being favoured by the hospital discharge teams and are often seen as the default care option upon discharge, without consideration of alternative and safer care options”, explained Paula Beaney


“The problem lies in the little understanding of the public as to what care options are actually available.  The vast majority of people we speak with, including the representatives of local authorities that are in charge of commissioning care in the community, are not aware that one to one care can be provided in the comfort of a person’s home by a highly skilled and fully trained live-in carer.”


“Those who know about the live-in care option, wrongly assume that the cost is significantly higher than paying for residential care. This is simply incorrect – the cost of live-in care is similar, and often lower, than the cost of a nursing bed within a care home.”


Promedica24, which operates both in the UK and Germany, notices significant differences between the two countries in the way the care is provided to older and vulnerable people. The company believes the high level of live-in care services provided in Germany have enabled a higher number of people to self-isolate with the carers at the comfort of their own homes (rather than at care homes). This has ultimately limited the spread of the infection among the most vulnerable groups and decreased the numbers of potential victims.


In Germany, the country with the fifth oldest population in Europe (UK’s population is currently twenty-fifth oldest in Europe) there are 2.9 million people in need of care and just 783,000 in care homes compared to 2.08 million cared for at home, either by relatives or live-in care services.

Contrary to the UK, the German public sees live-in care as the default and best care solution which enables people to remain in the comfort of their own homes, living the lifestyle they enjoy and familiar with. This is particularly important for people living with dementia or memory impairment whose conditions often deteriorate when moved into a residential care setting. Live-in care providers are able to take on new clients with relatively short notice and the majority of them provide carers who are experienced in a range of chronic conditions including cancer, dementia, Parkinson’s, stroke, arthritis and diabetes.


The carers stay with the client, supporting them with day to day activities, personal care and hygiene, stimulating mental and physical health and providing companionship. The importance of emotional support cannot be overestimated during this pandemic and the ability to provide safe isolation for older and most vulnerable people could be an important contributing factor for Germany’s death toll being significantly lower than that of the UK’s.


Although, the official death toll in the German care homes is unknown as the country does not report on those deaths separately from hospital deaths, the Economist estimates that 36% of all COVID-19 deaths in Germany were in care homes, and other sources report that more than 5,700 of the country’s total deaths have been people aged 60 and over.


The tragic statistics both from Germany and UK’s care homes prove that despite the best efforts of the caring staff and leadership teams, providing safe care is extremely challenging during the outbreak of a highly contagious virus.”, commented Paula Beaney.


“However, thanks to the structure of the German care system, where the majority of the care is provided at peoples’ homes, the country has been far more effective than the UK at shielding and protecting the most vulnerable. We hope this example will start the transparent public debate about various care options available in the UK, as well as provide people with information to enable them to make more informed care decisions for their family members and themselves.”


With the UK reporting the highest number of death cases due to COVID-19 in Europe, the current healthcare crisis requires an immediate evaluation of all the care options available and prioritisation of those services which can deliver not only safe, effective and quality care with better chances of limiting the further spread of the pandemic but a more person centred approach focusing on individual health and well-being and achieving positive outcomes for each person.


Background information about UK and Germany’s response to COVID-19


In Germany, Promedica24, supports nearly 3300 older and vulnerable people, all of whom have been able to self-isolate with their carers, significantly lowering the potential exposure to the virus and the risk of infection.


Once the company became aware of this new contagious infection at the beginning of the year, they brought in additional safety measures including rigorous training for the carers, regular health checks, provision of adequate PPE, and sterilised private door to door transport for the staff on their way to the clients. Consequently, only 0.1% of Promedica24’s clients in Germany were tested positive for COVID-19, and there have been no cases reported in the UK.


In the UK, care homes are seen as the default care option and often the only solution for people who require around the clock assistance in their daily lives. There are currently around 18,000 care homes in the UK serving approximately 420,000 residents. The Office for National Statistics (ONS) predicts that by 2030, one in five people in the UK (21.8%) will be aged 65 or over, and 4.5 million over 85 years of age. The likelihood of a person needing care due to disability or multiple chronic and complex health conditions increases with age. With this in mind, as life expectancy increases, so would the time spent by an individual in care during the latter stages of their life. In 2018, the average healthy life expectancy (without chronic conditions) was 63.6 years and disability-free life was 75 years. With the life expectancy being 79.9 years for men and 83.4 years for women, men will spend the last 5 years of their life and women the last 8.5 years suffering from disabilities, as well as close to 20 years with chronic conditions.


COVID-19 has shed more light on the vulnerability of the UK care system, and the systemic lack of awareness about care options available, not only among the general public but also amongst the institutions responsible for commissioning care.


At the beginning of April, when the Government decided to reduce hospital bed-blocking, care homes were seen as the default option for local authorities and hospital discharge teams. Untested patients infected with COVID-19 brought the virus into care home settings, starting the health crisis amongst older and the most vulnerable which, as some experts predict, might not have reached its peak infection count yet. The lack of testing and shortages of PPE have escalated the problem further, making Chris Whitty, Chief Medical Officer, to admit during one of the governmental briefings: “We will see a high mortality rate in care homes sadly because this is a very vulnerable group and people are coming in and out of care homes and that cannot, to some extent, be prevented.”


Despite the clear evidence that residential care settings do not provide an effective care solution during the pandemic, they continue to be favoured, not only by the hospital discharge teams but also the families, who often see them as the only care option available for their vulnerable loved ones. At the same time, the statistics show that 97% of people wouldn’t want to go to care homes themselves, should they require around the clock assistance and support.

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