Care homes told to label residents as Do Not Resuscitate

do not resuscitate, elderly
© Chormail

A recent report found that care homes were given blanket orders to label their elderly residents as Do Not Resuscitate, without asking family

Social care staff remain on the frontlines of a months-long battle.

Throughout this pandemic, there have been reports of staff living with their patients to prevent potentially fatal contamination. A group of nurses created make-shift PPE from bin-bags in the absence of substantial provisions. In March through to April, there was a migration of COVID-positive patients into care homes. Throughout, nurses experienced wage problems if they succumbed to the virus themselves and distanced for the well-being of their residents.

“It is clear from this survey that the care home workforce has faced very challenging issues,” said Professor Alison Leary MBE, Director of the International Community Nursing Observatory (ICNO). “Many have felt unsupported and their wellbeing has suffered.”

COVID-19 positive forcibly returned to care homes

A survey published today by the Queen’s Nursing Institute (QNI) found that 21% of care home staff reported receiving residents from hospital who had tested positive for COVID-19. Hospitals were refusing to provide treatment to some residents, so healthcare teams were left with no ethical choice but to accept the resident back.

A substantial 43% of respondents reported receiving residents from the hospital with an unknown COVID status during March and April 2020, because testing for the elderly begun on 15 April. Care homes has been labelled as “unlikely” to be impacted at the beginning of the COVID-19 pandemic, with no guidance from the UK Government toward limiting public visitation.

Whilst COVID entered the UK in late January, this statement about care homes was only withdrawn on 12 March. This created a window of several weeks in which visitation was still possible.

MP Liz Kendall, speaking in May about the slow response in aiding the social care sector, said: “Ministers have been too slow to tackle the problem in care homes.”

She went on to ask Health Secretary, Matt Hancock, about the decisions taken about care homes in the early stages of lockdown. He highlighted two funding injections, the £3.2 billion in March, and £600 million for general infection control, pointing at the acquisition of “regular information returns” to “better prepare” the social care sector. She further asked why there was no test requirement until 15 April for “the very group most at risk”, which Hancock did not answer.

Over two months later, this research raises further concerns about the impact of COVID-19 on the social care sector.

Staff told to label residents DNR

The Do Not Resuscitate order (DNR) is a code that legally asks a healthcare team to let a patient die, aka not attempt to restart the heart if it stops.

Usually, choosing to have a DNR calls for a lengthy conversation with loved ones and a consultation with a doctor or nurse. The NHS recommend that “your wishes” are at the centre of the decision. If the patient is unable to do that, then the next of kin is allowed to interpret any known personal wishes and “make a decision based in your best interests”. The decision is innately personal, and requires a lot of thinking. The decision is highly subjective, with the individual patient deciding their own fate based on their unique perception of their future.

In the recent QNI report, it was revealed that a decision had been made at a high-level, asking UK care homes to automatically label all their residents as DNR. This move comes after the release of COVID-positive residents back into these close-knit communities, and happened at the height of the pandemic.

There is online speculation that this was done to free up hospital beds and space, during the peak of the COVID-19 fatalities. Disabled activists are highlighting the negative perception of vulnerable groups, suggesting that the blanket DNR would never have been commissioned for a group of able-bodied people.

Anonymous healthcare staff said that they found the “blanket DNACPR” decision to be “challenging”, ethically, and professionally. This DNR decision was made for elderly residents without any discussion with the patient, their families or even care home staff who know them. This blanket DNR decision came from doctors or clinical commissioning groups, who had no way to interpret the wishes of a patient they did not know.

There were almost 30,000 more care home deaths between March and June this year, than there were in 2019 according to ONS figures. Two thirds of these deaths were attributed to COVID-19, but with the lack of testing until April – the certainty of who died from the virus and who didn’t is difficult to establish.

The blanket DNR revelation raises new questions for the APPG on Coronavirus to investigate in their ongoing cross-party examination. Outside of COVID-19, it raises deep-rooted questions for how policy-makers view elderly and disabled patients.

Individuals whose families were impacted are calling for a public inquiry.

Reactions to the DNR revelation

Christine Cusack explained how her elderly father was asked to make a DNR agreement while medicated beyond a logical thinking capacity:

Gregory Mansfield, a disabled lawyer working in disability justice, described his experience of DNR and the assumptions that have been made about his wishes:

Rachael Parry describes the ordeal her family experienced, when doctors called to confirm a DNR that was not medically necessary:

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