Urgent action needed

“After four weeks of no contact with dad or the care home, as a family we were extremely worried about his mental and physical well-being” Anonymous R&RA Helpline caller

Coronavirus is having a devastating impact on mental well-being in care. Older people living in care face isolation as usual support networks are cut off to prevent the spread of the virus. Family members tell us of their anxiety, despair and heartache of being away from their relatives. Staff working under incredibly difficult conditions for such a sustained period are facing burnt out.

The Relatives & Residents Association Helpline is hearing daily of the detrimental impact coronavirus is having on mental health. Since the outbreak, at least half of all calls to our helpline have involved a caller raising a concern about the mental health of someone receiving care. We need urgent action to prevent a mental health crisis in care.

Isolation from family/friends

When care homes stopped visits from family and friends to try and control the virus, this ended a crucial source of emotional support for older people. Many family members visit their relatives in care regularly to provide not just company and companionship, but also comfort, reassurance, or to help relieve the distress of those affected by dementia or other conditions. We know that consistent communication, stimulus and interaction, based on familiar and safe relationships make all the difference to well-being and positive outcomes, particularly for those affected by dementia.

Family members and friends also help to provide oversight and advocacy on the well-being of the person receiving care. With knowledge of the person, their background and what is ‘normal’ for them, family and friends can help identify changes or any deterioration of physical or mental health. This is particularly important at a time when care providers are having to rely on fewer staff or more agency staff, and familiar health practitioners may not be able to visit. This oversight role is much more difficult for family members and friends to carry out from afar.

Isolation within homes

Measures in place to try and prevent the spread of the virus within homes are also having a detrimental impact on people’s mental health. Some older people are confined to their rooms, activities and social events may be cancelled and shared areas in the home – such as dining rooms and lounges – may be closed due to physical distancing.

A mental health crisis in care

The combination of isolation from family/friends, and isolation from other residents/wider staff members, can have a devastating impact on residents’ mental well-being and human rights. We hear of people who have stopped eating or drinking, are losing speech, think their family members have ‘abandoned’ them or passed away, and have ‘lost the will to live’. For those living and working in homes that have lost residents and staff members to the virus, seeing friends and colleagues disappear will have a heavy emotional toll now and into the future.

Action needed by care providers

Protecting mental well-being should be as central to good care planning as protecting physical well-being. This is all the more critical at a time when care providers may have to rely on more agency staff, to ensure any change or deterioration in mental health can be identified and acted upon. Individual risk and needs assessments will help identify where urgent action is necessary to protect the person’s mental well-being and rights. Care planning on mental well-being should be built around each person’s needs, preferences and feelings.

Care staff have a key role to play in promoting a positive and stimulating environment within care homes and preventing loneliness and isolation. This was the case before the coronavirus outbreak and is vital now. We know that building personal relationships with those they care for, warmth and communication make all the difference. This is particularly important for older people without any family, and for those affected by dementia or other conditions.

Care staff also have an important role in helping families stay connected. R&RA have published some tips about the steps staff can take, such as supporting residents to use technology to stay in touch with friends and family. The use of screens, windows or other barriers can enable ‘face-to-face’ visits, particularly beneficial for people unable to use technology. We are also encouraging care providers to keep residents and families updated with news on the Covid-status of homes, to ensure an information gap doesn’t lead to unnecessary anxiety.

Action needed by CQC

R&RA has written to the Care Quality Commission expressing our disappointment with the role they have taken during the pandemic. The CQC’s ceasing of routine inspections and introduction of their Emergency Support Framework provided no reassurance for those in care or their families on how well-being would be promoted. CQC needs to urgently reconsider their approach to ensure the rights of people using care services are protected and promoted. They should identify those at risk where urgent oversight and intervention is needed.

Action needed by Government

Guidance on visiting in care homes in England hasn’t been updated since the beginning of April. In the meantime, other guidance has been issued relaxing lockdown restrictions which means physically distant visits in the grounds of care homes are now possible. There is an urgent need for up-to-date, joined up, consistent guidance for care providers to ensure those on the frontline of this pandemic have the support they need to protect the rights of older people. We are calling on the Government to produce a strategy for unlocking care homes. It should set out where urgent action is needed to protect people’s human rights, with stringent processes in place to manage any risk of infection.

Importance of protecting mental health

Throughout this crisis, R&RA has been calling for care services to be recognised and valued as highly as NHS services, on the frontline of managing the pandemic. Coronavirus has shone a spotlight on our care services. It has exposed the problems that we have long been calling to be resolved, and it has also reinforced the critical need for good social care. In particular, the pandemic has highlighted the vital role care staff can play in protecting mental well-being. This goes beyond kindness, to ensuring these vital frontline workers have the training, skills, job security and specialist input and support to ensure they can fulfil their role in protecting older people’s rights.