Keeping contact alive during COVID-19

Jo-Anne Wilson is a Registered Manager for the Royal British Legion in Warwickshire. The 101 bed care home is rated Outstanding with CQC and has achieved Platinum status with GSF. This year Jo-Anne was awarded the status of Queen’s Nurse.

On the 20th March the usual discussion, laughter, sounds of people coming and going, and noises of normal life fell eerily silent. We had gone into a national state of ‘lock down’. I had always avoided using the phrase if we had needed to close our care home to visitors previously, but now it actually felt appropriate. We were locked down and locked in.

This was unknown territory for us all. The guidance was changing daily, and the constant uncertainty, feelings of isolation, and reality of the situation started to dawn on us. There were so many unanswered questions, so few facts and so many theories.

It was Mothering Sunday on 22nd March and we needed to make it special, knowing that there would be no families coming in to celebrate. Little did we know at the time that there would be no families visiting for many months to come. We had several iPads and tablets that had been given to us, but our frustration at poor internet connections had meant they were gathering dust in a filing cabinet. It was time for us to brave the new world of technology and video calling! Where was a tech-savvy 10-year-old when you needed one?

We set up a series of weekly phone calls or, when the internet allowed, video calls. Some of these were a bit hit and miss to start with; lots of views of ceilings, people appearing upside down, no sound, no video and many second tries. But with time and practice, we have become quite adept, embracing one of our ‘new normals’.

Our residents were very stoic, having lived and experienced military life and conflict, and many of them were far more concerned about the people outside of the home. We discussed the daily briefings, were saddened by the deaths, missed our loved ones and friends but vowed to keep going and make the best of it.

The previous busy wellbeing schedule was rewritten to reflect social distancing, with guidance around singing, blowing candles out, and the need for limited physical contact challenging the team to adapt and innovate. We introduced virtual classes, concerts and afternoon teas with our team of volunteers, most of whom were also shielding. Social distancing became the norm but how we missed those hugs!

We have a very active Facebook group where we posted photographs of residents every day and families were able to comment and send messages. It became a great source of contact for families, especially if their loved one was living with dementia and was unable to communicate by phone or video. Seeing life still happening, smiling faces, fun and laughter brought comfort for some but increased the feelings of guilt and loss for others.

Our GP also introduced virtual rounds, which was one of the positives we encountered. This became much more effective for him, and allowed better time management and focus. We embraced the Re-Use of Medication Standard Operating Procedure when we struggled to get access to new end-of-life medication, something that I strongly believe we should keep, moving forward.

As the days and months of lockdown passed, we adjusted to new ways of working and the relative calm and safety of our bubble. The government announcement that visitors would be allowed back to care homes came not as a surprise (we knew it would happen) but as a stark reality check for us. Whilst we longed for the old ways of being, we also dreaded letting go of the tight infection controls we had in place, that had protected our residents over the recent months.

We read and reread the guidance to see how we could possibly do this without letting COVID-19 in, by minimising risk where feasible. Families were keen to get going and it was difficult to slow their demands until we were ready. We started with ‘window visits’ for those that were able. This proved a challenge, with families and residents opening windows to try and touch, exchange gifts and to hear better. It felt very churlish to reprimand people for doing what they desperately wanted to do but also felt necessary to keep people safe.

Government guidance changed again and now families wanted face-to-face visits. We walked the grounds of the home looking for safe spots to set up outside visiting, playing out a range of scenarios that we might need to be prepared for. We used government and local guidance to help us formulate our approach. With much trepidation we contacted all the relatives and told them of the next steps.

Requests for visits flooded in with lots of questions about practicalities. The visit sheet soon became full and we have had to be quite strict with ‘block bookings’ to enable all families to visit. We have been challenged by families, who often want more than we feel able to deliver. Some have just turned up demanding visits and have been cross when they have been turned away.

As feeling beings, our natural instinct is to reassure, to touch, to comfort and it has been hard at times to see the anguish of people and not to be able to react in a natural way. For most, these changes to the rules on visiting have been a wonderful first step. Through facemasks, visors, gloves and aprons and in the great outdoors, residents and their families are adapting to a different way of visiting but being grateful for the opportunity

Covid-19 has tested us beyond anything we could have imagined. Next up we must plan for winter with the possibility of indoor visits, or facing the challenges posed by the great British weather!!