Matt Hancock has announced new proposals to allow people to be with relatives in care homes who are gravely ill with coronavirus before they die, so that they can fulfil their “right to say goodbye”.
But the care sector responded with caution to the promise, saying that far more PPE (personal protective equipment) than is currently available would be needed to make the health secretary’s pledge possible.
Revised guidance for the care home sector, published on Wednesday, says that while homes should limit unnecessary visits, “we are clear that visits at the end of life are important both for the individual and their loved ones and should continue”.
The initiative follows a long series of reports about care homes going into effective lockdown, with relatives forced to say goodbye to loved ones through windows, by phone, or by letters read out by a care worker in protective clothing.
In one care home in Buckinghamshire, the wife of a dying man passed some of her perfume through to a care worker to place under her husband’s chin to evoke a final memory. In another home in Nottinghamshire, one family’s only opportunity to say goodbye was to gather in the car park and watch as undertakers removed their loved one’s body.
The Department for Health and Social Care said that rather than a change of policy, the move was an attempt to help care homes to be as flexible as possible in allowing visits when a resident is approaching death, given proper infection control measures.
Some care homes have been taking steps to allow people in to see their loved ones in final moments, but it has been done on an ad hoc basis.
A spokesperson for MHA, one of the largest charitable providers of care homes, said that the announcement had little practical impact. “There is nothing stopping relatives saying goodbye in care homes now as long as they have sufficient PPE,” they said. “So this goes back to the problem of there not being sufficient PPE for the staff, never mind families.”
Prof Martin Green, the chief executive of Care England, welcomed the promise of “new procedures” to allow loved ones to say goodbye, but noted that it would not be practical in many settings.
“If that is going to be developed, that is great,” he said. “It will be easier to do in some settings than others. Some sites will have to make the decision about whether there is a risk to others in the home. If they provide much higher levels of PPE, that should make it possible.”
Speaking at the daily Downing Street press conference, Hancock said the revised guidelines had been drawn up with Public Health England and the care sector “so we can limit the risk of infection while, wherever possible, giving people’s closest loved ones the chance to say goodbye”.
The new guidelines relate only to care homes. For hospitals, existing NHS England guidance, last updated a week ago, says that during the pandemic, one immediate family member or carer can visit if the person “is receiving end-of-life care”, a category which includes patients who are critically ill with the coronavirus.
The health secretary used the press conference to repeatedly praise carers for the role they had played in the crisis and showed a carers’ badge, intended to provide the same discounts and advantages given by some businesses to NHS staff.
He praised the work of care home staff in providing occupants with “dignity at end of lives”, but said this work had been hampered by the coronavirus. Hancock said this would be changed so that, “wherever possible”, loved ones could say goodbye.
“Wanting to be with someone you love at the end of their life is one of the deepest human instincts and it’s a moment that will be with you forever,” Hancock said. “Done right, it can help those left behind to cope and it brings comfort to those who are dying.
“Coronavirus, of course, has made this much more difficult, and I’ve been really moved and upset by some of the heartbreaking stories of people dying without a loved one nearby.”
Hancock cited the example of Ismail Mohamed Abdulwahab, a 13-year-old boy who died in hospital without any family members present.
“As a father of a 13-year-old myself, the reports of Ismail, dying aged 13 without a parent at his bedside, made me weep,” Hancock said.
Hancock also pledged an end to the occasional practice of older care home residents being categorised as a group as not requiring resuscitation, without consultation with their families.
He said: “We’re making it crystal clear that it is unacceptable for advanced care plans, including ‘do not attempt to resuscitate’ orders, to be applied in a blanket fashion to any group of people. This must always be a personalised process.”
The updated 34-page guidance for care homes stresses this message on mass do-not-resuscitate orders, also covering areas such as how to limit infection, caring for staff and funding options.
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