By Raquel Martínez Gómez, Hygiene and health manager at the Sant Pau Geriatric Residential care home, Barcelona.
I am a geriatric nurse and I have worked over 25 years in care homes.
The profile of people living in care homes has changed enormously since 10-15 years ago. Back then, people moving into care homes used to do so because of lack of social support, usually had experienced with some decrease in functional ability, but other than that, they were generally in a stable health situation.
Current residents are very different, they rarely come from their own homes, now about 95% of our admissions come from hospital or other health facilities, they tend to be fragile and have multiple health conditions. They usually have had repeated admissions to hospital and have often been identified as patients with complex chronic conditions, or have advanced chronic conditions.
This radical change in the profile of residents also requires a radical shift in the model of care that residential and nursing homes should be providing: a patient and family-centered care model carried out by a trained multidisciplinary team that specializes in establishing diagnostic processes, can provide therapy and rehabilitation and are able to make joint decisions with the patient and / or family. Adjusting to this shift, without increased resources, has resulted in a huge burden for the existing staff.
There has been some recognition of this issue at policy level, for example the 2014 Interdepartmental Plan for Social and Health Care Interaction (PIAISS) was developed in Catalonia, which together with the Chronicity Care and Prevention Programme (PPAC), culminated in the preparation of the Health Plan for 2016-2020. The intention of the Health Plan was to coordinate the two regional government departments (health and social affairs) in order to deliver better quality of care. But these changes have not come to fruition in time and the COVID-19 health crisis has magnified all the existing shortcomings.
Our residential care home started to take preventive measures against the possible threat of COVID-19 on the week of February 28th. Care homes in Catalonia are under the Department of Work, Social Affairs and Families. Their ability to respond to the COVID-19 crisis has been relatively limited, their role has mostly involved gathering information and helping manage staff shortages. In the face of a health crisis in care homes, what was needed was an emergency health care response that also included care homes.
The Department of Health (DoH) issued guidance on how to manage COVID-19, for example on how do deal with residents with suspected or confirmed COVID-19, how to isolate and access to personal protection equipment (PPE). The problem was that care homes had no direct communication channel with the DoH and the communication in Barcelona was even more difficult as the health care provision to care homes is channeled through a private healthcare provider who, eventually, has had to ask the local public primary health teams for help in dealing with COVID-19 in care homes.
Staff working in care homes have now been fighting for more than a month to ensure the safety of those who live there. Providing care during a COVID-19 infection in care homes requires that the homes have the enough human resources and physical and organisational capacity to be able to maintain the isolation of residents who are possible, probable and positive cases of COVID-19 and care for those with symptoms, as well as trying to address the usual care needs of residents. Most care homes affected by COVID-19 so far have found this to be impossible.
During this crisis situation, public administration bodies have started to intervene when the remaining staff, who have already spent many days working under very stressful conditions, without PPE and with very low staff to resident ratios, were no longer able to cope with very high proportions of residents with severe COVID-19 infections and the situation was reported by the media.
It is very important that the enormous stress that care home staff have been under and the huge effort and sacrifices they have made, with the few resources available to them, are publicly recognized.
Suggested citation: Martínez Gómez R (2020) Report: reflections on the experience of fighting COVID-19 from a residential care home in Barcelona. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE. Available at https://ltccovid.org/2020/04/08/the-situation-of-24-hour-care-from-the-perspective-of-migrant-caregivers-in-austria/