Decision Date: 12th July 2021
What Happened
Mrs D complained on behalf of her late mother, Mrs F.
Mrs F had been a resident at a care home since 2019. Her daughter, Mrs D lived close by, whilst her son, Mr M lived five hours away.
In March 2020 when the COVID-19 pandemic hit the UK, the Care Home stopped all indoor visits. Visitors were permitted to come to the Home and talk to the residents through windows.
In July 2020 Mrs F suffered a stroke and was admitted to hospital. She was discharged back to the care home on the 31st July.
Mrs D continued to visit Mrs F through the window.
During a visit on the 9th August a nurse asked Mrs D not to open the window and lean in during her visits.
Mrs D complained to the Home about the nurse’s “abrupt attitude” and stated that she had previously been allowed to open the window.
Mrs D alerted the Home to the fact that Mr M was planning to come and have an outside visit with Mrs F on the 17th August.
On the 16th of August the Home called the family to cancel, stating Mrs F was too unwell.
On the same date, the Home contacted a specialist stroke nurse to seek advice as Mrs F’s health was deteriorating and she had been declining food. The nurse recommended a medication review.
On the 17th August the Home contacted Mrs D to ask where Mr M was. They told her that Mrs F was ready and waiting for the visit. It was arranged that Mr M would visit the next day, on the 18th August for 30 minutes.
The Home undertook the medication review with a pharmacist on the 17th, who stated that they would liaise with a GP about the “possibility of end of life care”.
The Home was advised by the GP “not to worry if Mrs F won’t take her meds”, and to wait to be contacted by the palliative care team.
When Mr M visited the next day, Mrs F was unwell but in bright spirits. She was brought outside to sit with Mr M. The report stated that the Home only allowed 15 minutes of visiting time but also that Mr M had arrived 10 minutes late.
The Home contacted Mrs F’s GP again the following day, on the 19th August as her health was continuing to decline. The doctor advised the Home to stop all oral medication and began arrangements for end of life medication.
Mrs D was informed of the situation the same day.
On the 20th the GP reviewed Mrs F’s condition via video call, and she appeared to be comfortable and not in pain.
Mr M travelled back to his home on the 21st August as he was under the impression he would not be permitted to visit Mrs F again.
The same day, Mrs D visited Mrs F through the window, and was told by staff that if Mrs F continued to deteriorate then she and Mr M would be able to visit inside. This news caused distress to Mr M as he had already arrived home.
Unfortunately Mrs F passed away at 6am on the 22nd August without having had an inside visit.
Mrs D collected Mrs F’s belongings a few days later, but her handbag containing some valuables was missing. It had not been labelled and had been given to the family of another resident. It was later returned to Mrs D.
Mrs D complained to the Care Provider on 30th August about the lack of an inside visit, Mr M’s cancelled initial meeting, the interaction she had with the nurse, and the incident with Mrs F’s belongings.
The Care Provider replied, apologising for the poor communication between Mrs D and Mr M in relation to their visits. It also stated that it would carry out a “lessons learned” session to improve practice by:
- Making all staff aware of the need to tie named labels on all items brought to the office for safekeeping and to hand them in person to either the Manager or Administrator.
- Recording all staff briefings on a daily “flash meeting” document
- All nursing and senior care staff speaking to any visitor observed trying to gain access to their relative through the window.
- Having better communication with relatives at the end of the resident’s life.
- Discussing final arrangements with families at admission, especially if end of life care is to be provided.
- Documenting discussions in the care folder.
- Introduce guidance in relation to end of life care, stating that the number of visitors at any person’s bedside should be limited to one close family contact
After receiving this reply, Mrs D raised concerns specifically relating to the end of life visiting policy. She felt that the Care Provider had “inconsistent policies across its homes” and complained to the LGO. She also told the LGO that she was concerned the Care Provider would not implement the proposed improvements into practice.
The Care Provider told Mrs D that its Home managers made decisions based on the individual circumstances and apologised that this resulted in inconsistent policies.
What was found
The LGO stated that there was no fault in the Care Provider having different visiting policies in place across its Care Homes. The LGO highlighted that the Guidance states “local policies should be developed and these should be based on balancing the benefits to residents against the risk of visitors introducing infection. Home managers are entitled to make these risk assessments and reach different conclusions based on the circumstances in their home, including for different residents at different times.”
The LGO considered that the Care Provider’s acknowledgement and apology for its poor communication with Mrs D and Mr M in relation to their visits was sufficient. It also apologised for mislaying Mrs F’s bag, which the LGO stated was sufficient, especially as the situation had been remedied.
The lessons learned review stated that it was not in Mrs F’s best interest to stay outside for a long period of time in relation to Mr M’s visit. However, in response to the LGO investigation the Care Provider had since considered that it should have allowed Mr M to go inside.
The Care Provider stated that the reason it had not permitted earlier inside visits because it did not consider Mrs F only had a short time left to live. If it had considered so, it would have allowed an end of life visit for two people for an hour indoors. However, the LGO stated that from the 19th August, after discussions with Mrs F’s GP, she was regarded as needing to receive end of life care and medication. Therefore, the Home was aware that Mrs F was at the end of her life. The LGO stated that the Care Provider was at fault for not facilitating an indoor end of life visit for Mrs D and Mr M from the period between 19th-21st of August.
This fault led to a significant injustice as they missed an opportunity to spend time with Mrs F before she passed away.
The LGO only recommended that the Care Provider apologise to Mrs D and Mr M.
Points to note for professionals, councils, people who use services and their carers, advocacy providers and members of the public
This complaint highlights the sadness experienced by families wanting to spend time with their loved ones who lived in care home settings at the height of the pandemic in 2020.
The complaint itself featured several concerns about the way visiting had been handled for Mrs F by the care home provider. The LGO’s jurisdiction extends into looking at the actions of privately funded care providers.
The LGO did find some fault with this provider. It makes sense that a care company can have different visiting policies for different homes, as different homes often vary in how they are managed, the physical environment and the nature of the care given. This wasn’t found as fault in this complaint.
Had the provider taken the right approach here, Mrs F would have been able to spend a whole hour with her family members inside the home. She had struggled with external visits and had two episodes of fainting. The required risk assessments needed to be undertaken to reflect the situation at that time, and had the provider acted correctly with this, that final visit would have been able to take place.
The ready acknowledgement by the care home of its failings and its commitment to improving which it showed in the follow up to the draft report was no doubt significant to the LGO’s decision not to recommend any further remedy.
The existence of Government Guidance during Covid-19 gave the impression that homes were obliged to follow what the Government said. In fact, the Guidance left the position hugely unclear, and in some council areas the council itself as the commissioner laid down some rules, having taken advice from public health colleagues. In other areas the homes just did whatever their insurers told them they should do, and chaos reigned.
The position (in contract or the law of negligence) is that care home managers need, and are entitled, to make these risk assessments and reach different conclusions based on the circumstances in their home, including for different residents at different times. That is part of their duty of care, and is unavoidable in the context of caring for people in a group setting.
Guidance on care home visiting arrangements changed throughout the period covered by this complaint. The April 2020 Guidance said family and friends should be advised not to visit care homes, except next of kin in exceptional situations such as end of life. The regulations did not ever prevent that. It said that visitors should be limited to one at a time to preserve physical distancing and alternatives to in-person visiting should be explored. That did not derive from the regulations.
Further guidance was issued in July 2020, which set out the broad principles on which local policies should be based. Among other things, it advised:
- taking into account the extent of the harm that will be experienced by the resident from a lack of visitation or whether the individual is at the end of their life
- balancing the benefits to residents against the risk of visitors introducing infection;
- limiting visitors to a single constant visitor per resident, wherever possible;
- reducing risks via visits to communal gardens, window visits and/or drive through visits;
- encouraging visitors to keep personal interaction with the resident to a minimum.
CASCAIDr hopes that the enquiry into the government’s communications strategy during Covid will highlight the disingenuousness of its own Guidance.
The full Local Government Ombudsman report of Private Medicare’s actions can be found herehttps://www.lgo.org.uk/decisions/adult-care-services/covid-19/20-007-431