REABLEMENT FEATURE
packages, to make ourselves available to support urgent hospital
discharges that would free beds up for COVID-19 care.
Our adult social care services reorganised in line with national
guidelines and Care Act Easements Stage 4 and planned for
Discharge to Assess arrangements.
We identified who of our staff were in vulnerable categories
or had carer responsibilities for vulnerable people and needed
to be ‘socially distanced’ and to work from home. We organised
home working technology and smart phones where possible.
We reviewed our business contingency plan – previously used
successfully in February, when we had to evacuate the service
due to the severe weather and ensuing damage.
Now we looked at Personal Protective Equipment (PPE) and
started trying both to find supplies and anticipate what we needed
for whom and how much.
All of this with the media reporting endlessly of the crisis to
come, the shortage of PPE and the risks to most of our service
users who were largely in the vulnerable groups, but also to staff
experiencing high levels of exposure to the virus.
I needed to research how viruses work, what defined an
‘aerosol generating procedure’ and to get an understanding of
what would be good practice in relation to hand washing, use of
sanitiser, cleaning, donning and doffing PEE, which PPE, and the
correct disposal of it.
But now I was not the only one in a new situation. Suddenly we
were all new together and the team came together to work our
way through.
We then started to get the hospital discharges. Perhaps
naively, I had not anticipated that we would be asked to care for
people who had tested positive for COVID-19, but because they
did not require critical care had been sent home and needed our
care.
Our first experience of this was actually another household
member who had been discharged, but was therefore unable to
care for their family member and so our assistance was required.
So we developed careful protocols for working with COVID-19
positive service users and for working in the home where there
was another COVID-19 positive person living.
Occupational therapy assessments for equipment and quick
adaptations were in high demand for a clientele whose needs
were changing rapidly, but who remained at home rather than go
to hospital.
This meant we built closer relationships with a range of
professionals, such as community nursing and paramedics, as
well as family members, to calculate the best way forward in these
newest of circumstances.
The impact on the carers facing these challenges was
significant. The support that was needed, both emotionally and
practically, to support these scenarios was vital. It involved our
registered manager undertaking one-to-one conversations with all
carers to understand their concerns and their triggers.
We then shared this with senior management and HR to
explore both policy development, to find agreement about good
practice, and consider strategies for staff management as well as
finding resources to assist.
The impact of the dramatic and threatening media messages
meant that anxiety had spilled into the care agencies we worked
alongside and there were times when they were unable to provide
care due to a client having COVID-19.
This meant our staff were dealing with a high proportion of
COVID-19 positive situations and it was essential to ensure they
were protected with good PPE options and that they felt well
protected.
As the manager of a care provider service, challenges have arisen
from the understanding of the handover or discharge information, as
priority for discharge were so different to those we had previously.
Service users were assessed based on their previous 24 hours
in hospital (necessary time management for ward therapists) and
deemed medically fit for discharge based on them not requiring
intense or critical care input, rather than their ability to manage.
Good discharges now relied heavily on social care’s ability to
respond with care packages. Inevitably people were much frailer
when discharged than we had previously been used to, so our
carers were seeing fluctuating scenarios and each call felt
uncertain.
Sometimes carers would find someone who had fallen, or be
present when a service user fell. This was both distressing for our
frightened service users, but also for our care staff. In addition,
logistically it meant delays to care rounds as carers attended to the
person until paramedics arrived and we had to cover later calls with
other staff.
We were also supporting end-of-life care; people coming home
to be with family or just somewhere familiar to make their ending
more dignified. This was an aspect of care we had not previously
experienced and so support to carers was initially personal, via
their supervisors, but we did achieve training via e-learning and as
suggested by our district nurse colleagues.
These challenges were constant, unpredictable and daily. But
it opened a whole new reality for everyone and suddenly I wasn’t
the new one, I wasn’t the one without the answers, I was actively
seeking those answers, working closely with carers, other providers,
senior managers, hospital and community teams, and linked with
district nurses.
Turning points happened when I connected with a local soft
furnishing company that was making gowns and coveralls to donate
to NHS, and another manager obtained a donation of full face visors.
In addition, some of our HR staff and some of our team members
managed to get donations for some gifts. Most important was that
they included some written thoughts by local children. All of which
were significant boosts to morale; so occupational therapy.
I did become somewhat disconnected briefly from my
reablement occupational therapists. They moved to be part of a
wider occupational therapy response team conducting telephone
and video assessments where possible for equipment to support
people’s immediate and short-term needs in the community, while I
focused on the provider arm of the service – our hands-on carers.
OTnews August 2020 27