With five of her six homes rated Outstanding, Karen Rogers, director of Herefordshire Care Homes, is a market leader in providing top quality nursing and residential care. In this article, Karen shares how she has coped with the challenges posed by COVID-19.
Karen was an early mover when news of the devastating impact of the pandemic first began to spread from China and Europe in February last year.
“Throughout February we were keeping a very close eye on what was happening in China, Italy and Spain and making sure that all of our usual standard IPC procedures were in place as well as transmission based precautions, which are additional procedures for outbreak situations, in the event that we needed to step up those processes,” Karen told CHP.
It was during a management meeting on 2 March that Karen and her team took the pre-emptive decision to go into lockdown.
“We closed all of our services,” Karen reflected. “We wrote to all our residents and staff and families and said we are going to close for two weeks to get a better understanding of what was happening and to try and understand the transmissibility of this virus.”
Acting before the government, Karen updated her homes’ admissions policy using guidance from the European Centre for Disease Prevention, which stipulated that residents should not be admitted before having two clear PCR tests.
Zoning strategies were also set up in the homes to prepare for the event of an outbreak.
“We pre-planned what we would do if there were any confirmed cases and we didn’t accept any admissions until testing was introduced and have strictly stuck to that,” Karen noted.
The early preventative action has borne fruit with very few staff testing positive and where this did happen there was no onward transmission.
With all of her homes having adopted the same rigorous IPC and testing programmes Karen said she believed the homes had largely escaped the virus due to recognising transmission through respiratory droplets, controlled by cleaning, reducing direct contact and physical barriers, including PPE, and through understanding the high likelihood of airborne transmission.
“Much more is now understood about the risk of airborne transmission and how important it is to consider occupancy within the volume of space to avoid people sharing the same air,” Karen said.
With staff absences kept to a minimum, Karen succeeded in maintaining her no agency policy throughout the pandemic.
“Where we have had staff who had to isolate, other staff have picked up their shift so we have been able to have a strong workforce throughout the last 12 months,” Karen noted.
Additional nursing staff were recruited at the beginning of the pandemic and nurses and clinical leads have played a pivotal role in providing clinical support while primary care staff have not attended the homes but offered virtual support.
“If there was an area we needed to put additional support and training in some of our nurses would provide that,” Karen noted. “There’s been some real learning opportunities throughout this. It’s not been easy. It’s been really hard work and a real challenge.”
In terms of vaccination, all residents in Karen’s six homes had received both doses when we spoke in mid-April.
The director said all staff had been vaccinated in four of her six homes with the remaining two homes above 95% with a few yet to agree to vaccination.
“We have gone along the line of peer support and encouragement rather than being mandatory,” Karen highlighted.
“There is the bigger ethical issue about mandatory vaccinations for any disease. I would encourage any new staff to have the vaccine. I think you have a professional responsibility if you choose to work in health and social care to have the vaccine.
“I don’t believe vaccinating should become mandatory without weighing up the wider ethical and human rights concerns. Employers should continue to develop vaccine policies with educational campaigns to promote vaccination for existing staff and make it a condition of employment for new staff.
“But if it happens in care homes it must be the same for all NHS employees, including hospitals. It can’t just be they single out care homes.”
As well as keeping her residents and staff safe during the pandemic ensuring the mental health and wellbeing of everyone has also been key for Karen.
This has been achieved through ensuring residents remained mentally and physical active through a packed activities programme and by keeping connected with their loved ones through technology.
“Our Facebook pages are amazing,” Karen noted. “Everybody has been really busy. We have regular contacts with families. We have had Zoom quizzes. We have had barbecues, walking groups and a real focus on the benefits of nature.
“We have had so many virtual and even spiritual events. Our homes have been absolutely bursting
“We have made sure activity in terms of exercise and movement has been a real focus to make sure nobody was deconditioning by sitting or being isolated. We would have a physiotherapist working with our residents to make sure they would always have the opportunity of exercise. We have got the space to do that.”
Looking ahead, Karen said she was optimistic about the future for residential and nursing care as we begin to emerge from the pandemic.
“I think the emergence of integrated care systems requiring all parts of the health and care system to work together brings some exciting opportunities,” Karen told CHP.
“The conversation about the long-term funding of social care is essential but there is an equally important conversation to be had about how we manage frailty and self-care by supporting people to live well at home before they make the decision to move into a good care home. I think there are some real opportunities to be innovative especially in the area of self-care and rehabilitation.”