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Guardian - plan to discharge COVID patients to care homes is madness.

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it's going to a rollercoaster of revalations for you Pete, and take patience from everyone on here.. and may inspire revolution and or revolt if you/me/they/we're not carefuller
 
panpete said:
www.theguardian.com

Plan to discharge Covid patients to care homes in England is 'madness'

DoH guidance says patients would not need to take a test after their isolation period
www.theguardian.com www.theguardian.com
It doesn't say if these care homes would be private?
If so, they cost over a grand a week, nice fat profit.
Click to expand...
What discussion do you want to have here? There's loads of different strands that I could talk about, but I'd be making assumptions about what your questions or idea or starting point is.
 
I think the guardian is a reputable source who fact check and expose corruption pretty well, no matter what I think of their journalists in terms of what kind of people they are or their personal behaviour
 
It looks like it would be all care homes across the board, so that would absolutely include private care homes, I think? Unless I've missed something in the article
 
I agree with this plan.
If patients are not immunosuppressed there is zero evidence of them being infectious after the 14 days. I have personally discharged several patients in this group to care homes (after discussing the case with the manager) . Even those still swabbing positive.
This is because although viral genetic material can be detected on swab, there is no evidence (in the non immunosuppressed) of the virus being viable.
As such there is no benefit in re testing - if they swab positive - discharge. They swab negative - discharge. It just confuses things.

I have had patients still swabbing positive St 50 days. What should we do with them? They are well, and non infectious. Hospital is not a benign place, and they come to harm through hospital acquired infection, deconditioning and emotional distress.

This is a reasonable policy, at clinician discretion. Clickbait headlines help noone and further confuse the public
 
Private v state funded health care and nursing home fees are a whole separate discussion, involving capitalism, inequality, profit, fat cats, minimum wage workers, poor levels of care, abuse by workers towards residents, and also the really good eggs that go the extra mile to genuinely CARE for people.



/Tuppence worth before my walkies
 
Last time I looked at the literature there was no evidence of viable virus able to infect cell cultures after 8 days. Haven't updated my search since then, but this became my hospital policy decided by virology, public health England, infection control and the hpa.
 
tufty79 said:
What discussion do you want to have here? There's loads of different strands that I could talk about, but I'd be making assumptions about what your questions or idea or starting point is.
Click to expand...
To be honest, the first thought that came to my mind was cynical. Are private care homes run by big corporations going to profit from loads of COVID afflicted people if this goes through?
 
panpete said:
:( profiting from COVID, sicko (not you tufty79
Click to expand...
Wherw do you want the patients to live, Pete? They have a home (a care home) for which they pay (or the bill is paid by health and social care). When they no longer need hospital, why can't they go home?

What are your criteria for them going home? If it's a negative test, why? How long should they be exposed to the risks of being in hospital for? Two months? Three?
 
I read over the last couple of days (on here somewhere, sorry can't remember where) that someone who had been infected but recovered could still carry the virus. Is this not true? If not then would be a relief because I (vulnerable) have had contact (socially distanced) with someone who had it and recovered last month.

Haven't read this Guardian article but can understand the concern about releasing covid patients into care homes though, that was a fucking disaster last time. Reassured if you're saying it's different this time, kropotkin
 
kropotkin said:
I started discharging covid+ patients to care homes in early November. It will have been happening all over the country since late autumn.
Click to expand...
I can't tell if this is a joke - no offence I am asperger's and I dont know your job. I used to be embarrassed about this naivety before my diagnosis, and even when self diagnosed used to worry people may think I am using it as an excuse, newly diagnosed now.
I read it as a future plan.
 
kropotkin said:
Wherw do you want the patients to live, Pete? They have a home (a care home) for which they pay (or the bill is paid by health and social care). When they no longer need hospital, why can't they go home?

What are your criteria for them going home? If it's a negative test, why? How long should they be exposed to the risks of being in hospital for? Two months? Three?
Click to expand...
Oh! will the government be paying the bills for these people?
They wanted to put me in a care home for a month, at £1200 a week.
What about workers who earn a wage, if they get covid, will they get to go in the care homes for free? If so, that's not so bad, it's just that the guardian article didn't elaborate on that.
Not so bad for recoverers who are covered ie, those who have no job/assets.
Hosiptals are getting more and more crowded so they do need somewhere to go, I just don't want it to cost people lots of money.
I am not qualified to set criteria for them going home, I merely asked the questions in my first post. Its upto qualified people to decide when they are fit to go home, as hospitals are getting fuller, and IF care homes won't charge the earth, it will be good for COVID people to go in them if that is what the experts think is necessary.
I can't answer your other questions either not being qualified, I merely wondered if private care homes would charge and make a profit.
 
It depends what you mean.
"carry the virus" to me has a clinically important meaning of "can shed viable virus that infects people". The current thinking is if they have a functioning immune system they no longer produce viable virus after around 10 days. Those swabbing positive after this point who are well are thought not to be infectious.

The other clinical question is, "can those who've been positive return to shedding viable virus?". They can definitely become reinfected, but unlikely to be for several months (UK paper on reinfections came out this week).

This story is about the former group though. Some people clear the virus within a couple of weeks once initially infected (and better), but there are other troubling patients who do not become swab-nagative, even when well. In a dangerously overloaded hospital system we need to accept a degree of risk with these patients and enable another sick person to be able to be treated on their place when they no longer need hospital. This policy is riskier than keeping these patients in hospital for ever in terms of getting a call wrong and discharging someone shedding viable virus, but we can only minimise risk and it is important to understand that hospitals are very bad places for elderly people.
 
panpete said:
Oh! will the government be paying the bills for these people?
They wanted to put me in a care home for a month, at £1200 a week.
What about workers who earn a wage, if they get covid, will they get to go in the care homes for free? If so, that's not so bad, it's just that the guardian article didn't elaborate on that.
Hosiptals are getting more and more crowded so they do need somewhere to go, I just don't want it to cost people lots of money.
I am not qualified to set criteria for them going home, I merely asked the questions in my first post. Its upto qualified people to decide when they are fit to go home, as hospitals are getting fuller, and IF care homes won't charge the earth, it will be good for COVID people to go in them if that is what the experts think is necessary.
I can't answer your other questions either not being qualified, I merely wondered if private care homes would charge and make a profit.
Click to expand...

I think there has been a misunderstanding.
They not talking about sending all people recovering from Covid to care homes, only the ones that were already in them or due to go in to one.
 
kropotkin said:
I agree with this plan.
If patients are not immunosuppressed there is zero evidence of them being infectious after the 14 days. I have personally discharged several patients in this group to care homes (after discussing the case with the manager) . Even those still swabbing positive.
This is because although viral genetic material can be detected on swab, there is no evidence (in the non immunosuppressed) of the virus being viable.
As such there is no benefit in re testing - if they swab positive - discharge. They swab negative - discharge. It just confuses things.

I have had patients still swabbing positive St 50 days. What should we do with them? They are well, and non infectious. Hospital is not a benign place, and they come to harm through hospital acquired infection, deconditioning and emotional distress.

This is a reasonable policy, at clinician discretion. Clickbait headlines help noone and further confuse the public
Click to expand...
I agree from an infection protection perspective that the experts should do what they deem necessary, I just feel sorry for a family of working adults, or a situation where a group of adults live together and work, or private homeowners who are unlucky enough to get it and then have to pay thousands for care home fees.
 
kittyP said:
I think there has been a misunderstanding.
They not talking about sending all people recovering from Covid to care homes, only the ones that were already in them or due to go in to one.
Click to expand...
Ah that didn't seem clear from the article. Where did you get that info from as I imagined loads of covid cases of people who had never been to one?
 
panpete said:
www.theguardian.com

Plan to discharge Covid patients to care homes in England is 'madness'

DoH guidance says patients would not need to take a test after their isolation period
www.theguardian.com www.theguardian.com
It doesn't say if these care homes would be private?
If so, they cost over a grand a week, nice fat profit.
Click to expand...
OK, I see your misunderstanding.
This concerns patients who live in care homes, or who need to move to them (not ordinary patients).

if you need a care home newly due to a medical problem (let's say you are borderline coping at home, get covid (in this instance) and then deteriorate to the point of requiring 24hr care) then the system pays for a 6 week care home placement, at which point you are reassessed by social workers. They then decide if you can go back home or require permanebt placement in a care home. If the latter, this is the point at which those with assets over the threshold need tk contribute /fully pay for the home.

For those who already live in a care home, this policy says they can go home once well and through the isolation period.
 
kropotkin said:
OK, I see your misunderstanding.
This concerns patients who live in care homes, or who need to move to them (not ordinary patients).

if you need a care home newly due to a medical problem (let's say you are borderline coping at home, get covid (in this instance) and then deteriorate to the point of requiring 24hr care) then the system pays for a 6 week care home placement, at which point you are reassessed by social workers. They then decide if you can go back home or require permanebt placement in a care home. If the latter, this is the point at which those with assets over the threshold need tk contribute /fully pay for the home.

For those who already live in a care home, this policy says they can go home once well and through the isolation period.
Click to expand...
Thank you kropotkin
Yes I misunderstood, I am no good with vagueness and could see nowhere in the article that only those covid afflicted people, who had been in/were going in care homes would be sent there.
Thank you for explaining that, otherwise I would not have known.
 
kropotkin said:
I agree with this plan.
If patients are not immunosuppressed there is zero evidence of them being infectious after the 14 days. I have personally discharged several patients in this group to care homes (after discussing the case with the manager) . Even those still swabbing positive.
This is because although viral genetic material can be detected on swab, there is no evidence (in the non immunosuppressed) of the virus being viable.
As such there is no benefit in re testing - if they swab positive - discharge. They swab negative - discharge. It just confuses things.

I have had patients still swabbing positive St 50 days. What should we do with them? They are well, and non infectious. Hospital is not a benign place, and they come to harm through hospital acquired infection, deconditioning and emotional distress.

This is a reasonable policy, at clinician discretion. Clickbait headlines help noone and further confuse the public
Click to expand...

Isnt the story here about insurance and those who have not been isolated for 14 days first?

BBC article, my bold:

www.bbc.co.uk

Covid-19: Insurance fears stop care homes taking patients

Homes worry about being sued if people contract the virus while they are staying there.
www.bbc.co.uk

The government originally hoped there would be 500 designated care homes taking in Covid-positive patients.

But Waterside House is one of only 129 which have been set up to take those who have not completed 14 days in isolation.
Click to expand...

And some designated settings stuff from government document: Discharge into care homes: designated settings

Everyone with a COVID-19 positive test result being discharged into or back into a registered care home setting should first be discharged into a designated setting (see section 4 for more information). Designated settings should have the additional policies, procedures, equipment, staffing and training in place to maintain infection control and have the capability to support the care needs of residents as set out in CQC’s IPC protocol. This is an important precaution to protect care home residents and minimise, where possible, the risk of infection.

People should undergo a 14-day period of isolation before moving into a care home from a designated setting, whether that be hospital or local authority commissioned - the total 14-day period of isolation can be shared across 2 designated settings if IPC practices are not breached. Subject to the care home provider’s decision and a clinical assessment to determine if the individual is likely to be infectious, residents will not have to undergo a further period of isolation (see section 4 for further details.
Click to expand...
 
Last edited:
elbows said:
Isnt the story here about insurance and those who have not been isolated for 14 days first?

BBC article, my bold:

www.bbc.co.uk

Covid-19: Insurance fears stop care homes taking patients

Homes worry about being sued if people contract the virus while they are staying there.
www.bbc.co.uk



And soem designated settings stuff from government doc document: Discharge into care homes: designated settings
Click to expand...
Heard something on R4 about care homes who have renewed insurance since this started having been hit with massive increases in premiums.
 
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