Care homes and mental health during COVID-19

‘Care homes are a microcosm of society: everything is inflamed, especially with mental health’

Ahead of our roundtable discussion on the impact of COVID-19 on the mental health of care home residents and staff, we spoke to three professionals who have worked in care homes throughout the pandemic. Interviews by Jayne Finlay, Ayden Wilson and Flo Greatrix

Dramatherapist in a private care home

I always think that our care homes are a microcosm of society; whatever state the world’s in, it’s amplified in a care home. Everything is inflamed, especially with mental health where everything goes from 0-100 anyway, even without a pandemic. It’s made those things, which were already there, become 100% worse.

A few themes have started to pop up: loneliness, feeling trapped, claustrophobia. We would have been out with the residents three or four times a week, but that hasn’t been able to happen for a very long time. People whose interests are football matches – they would have been going every other week, and that hasn’t happened. They’re not able to have their cinema trips. The whole social wellbeing part of their mental health care has been swept from under their feet. So obviously there was going to be a fallout from that, and it hasn’t really let up.

Also, people notice everyone’s business a lot more. So with regard to people passing away in here, there’s a lot more ‘closed-in-ness’. I’ve heard a lot of people coming to me or other care staff and saying: ‘That person’s died, am I going to die in here? When do we get out?’

Where I was dealing with these issues before, it’s kind of doubled itself over the course of the last year. It feels like a pressure cooker and people’s mental health is just bubbling up and up and up, but there’s no way to let that out. What people need is to get out, to see their families and their friends. Those are core things in the hierarchy of needs, and all of a sudden those things are gone.

There’s no way for me as a mental health professional to bring that back to them – all we can do is try to de-escalate and comfort and help to keep people’s mental health as best as it possibly can be. So we’ve had to try and change our way of wording things because we can’t say, ‘This is good, you have this to look forward to’ – because they don’t any more. We’ve had to try and find different ways of navigating mental health work because life has changed.

I know from talking to people in other care homes that morale is very low. If a staff team are feeling low, you are impacting the whole atmosphere of the place. We have to go in and provide the atmosphere, especially in mental health where there can be such a heavy energy. To combat that atmosphere is hard enough each day, without your own mental health and morale being low. It’s hard to keep up that level of care when your own mental health has been jeopardised as a result of the pandemic.

At the start of the pandemic, I know through conversations that care home staff felt overlooked and completely forgotten about. It felt like the world was really appreciating the NHS, and they absolutely deserve that praise and recognition. But care workers are still frontline workers trying to keep everyone safe, and there just seemed to be no kind of voice for us. That was a hard few months.

Some sort of thankyou or acknowledgement about how hard we worked to keep people safe, and how our personal lives have been affected, would be amazing. I think care workers and care homes have felt very invisible throughout this until quite recently. The only thankyou that has happened was the fact we were prioritised to get the vaccine.

It does feel like there’s this massive disconnect between CEOs, policymakers, government … and that’s the gap I’m trying to bridge. Every email I send, I tell them: ‘You need to listen to us, because this is happening down here, so this should be influencing how you make decisions now.’

Advanced Nurse Practitioner in a community rapid intervention team

Two words to describe my experience – horrendous and proud. Proud because I have been able to work and contribute; horrendous because when COVID-19 first started, I’ve got elderly parents and my dad had Alzheimer’s. I just remember being terrified of giving them COVID. That was in the early days of March; you didn’t quite know how terrible it was. I remember it was so stressful.

In the early days we had FFP3 masks, long-sleeved gowns, double gloves, the works –but within a couple of weeks that just went. I remember being horrified because they were sent to hospitals (of course they needed it) but we were given a surgical face mask and pinnies and gloves; it was inadequate, yet even now the guidance is that it’s okay. I would say that 90% of my team got COVID.

For me personally, my dad had a fall and had to go into a care home, where he contracted COVID and died. It’s affected me hugely. We weren’t able to see him; that was hard. But at the same time, being able to go into care homes then and now, and being there instead of family members – I feel quite privileged to be in that position in a place instead of a relative. It’s affected everybody, hasn’t it?

We have an incredible team; I can’t stress that enough. The team supports itself even though we’ve had to change our working practices. We used to all come into base, there was camaraderie, and that just disappeared over night. Everything went remote; our meetings and daily huddles took place on Teams. That was a huge change.

Our team WhatsApp group has been a valuable source, when I look back on it. You have comments from team members –  ‘I wish I could be cloned’; ‘I’ve never cried’. It really got people. In the care homes when people stopped visiting – we were in there with dying people, and their visitors and relatives were outside. I’ll never forget that. So we’re inside with the relatives who are dying, and the relatives are waiting outside the window. That really destroyed a lot of the team.

I don’t think there was face-to-face help when I came back after my dad died. I was put forward for emotional wellbeing sessions but they were quite full at that time, so in the end I didn’t bother accessing them. I think there is a delay in one-to-one support, but there is plenty of support out there, to be fair. We support each other, we know when somebody is just not right, and the management are very supportive if we need to take time. There are a lot of websites available that we can access, too.

Personally, I was driving to work this morning in tears because on Radio 4, they were talking to someone who had just gone to see their mum. It was really emotional to listen to that. I just feel [the vaccines] came two months too late for my dad. It’s just such a shame.

Care Home Manager

It has not been too traumatic at work recently. At the beginning, we had cases of COVID-19 in our care home and we lost people, and it was stressful trying to maintain staff morale. But since we managed to get the virus out of the home, it has been easier.

I think we are [receiving enough support]: every week I get an email from local government with updates to tell us how many cases there are in the area – I feel like we get the right, helpful information. And we get fantastic support from our local councillor, who rings every two weeks. We also have PPE coming out of our ears!

But the information coming from central government is not always helpful. Most recently, the announcements about the reintroduction of visitors placed big expectations on us to organise these by 8th March.

Also, I don’t think our experiences are being accurately reflected in the media. There is a portrayal that we are a protected bubble that can’t be touched, and it was the fault of care homes that the virus spread widely. When you are in a place with poorly people, of course it will spread quickly.

More recently, the reflections regarding visits are not accurate. We have to ensure that one designated person only visits; it must be supervised with that person wearing full PPE. Families expect to be able to spend the whole day with people, but half an hour is more realistic given the organisation required. Problems arise in particular with the one designated person rule. In reality, families don’t get on, siblings don’t get on, and everyone is trying to be that ‘one person’. I have implemented a rule whereby I have to receive the name of the designated person in writing, and if the family can’t decide who comes in then no one can, as it’s not our job to manage that.

Outside of work, it was hard when lockdown first happened: I was paranoid about bringing COVID-19 into the home so I stopped my kids going out and put restrictions on everyone in my family. My friend took her child on a UK break in the summer and I saw how much healthier they seemed afterwards. Then my husband got COVID-19 over Christmas so we also had a period of self-isolation. Now I am fully ready for the rules to relax.