Date: 15/05/2020 12.30pm
In my last post, I talked about our early thinking on visitor access to our homes, in anticipation of the Government announcement on 11th and 12th May of its COVID-19 Recovery Strategy. I’m grateful for all the emails I have received from family members with reflections and practical suggestions for how the current blanket prohibition on visiting aside from in the case of terminal illness, might be eased. As you’d expect, we’re taking advice from a number of respected sources to make sure that any proposed changes are measured, prioritise the safety and wellbeing of residents and take account of our team members and you, as family members.
Our plans are, of course, linked to our progress both overall and home by home in relation to outbreaks of COVID-19 infection. I am pleased to report that the progress I noted in my last post has continued, with only a very small number of possible new infections in residents being reported. We have received a small number of positive test results from residents who have been entirely well throughout the pandemic, with no symptoms or signs of infection. The public health advice on their level of infectivity has been vague, so we have taken a precautionary approach and assumed that asymptomatic residents with a positive test result are infectious and instituted all of our usual infection control measures accordingly.
The testing programme remains fragmented across the country with some homes accessing tests for residents and team members relatively easily whilst elsewhere test kits are in very short supply. We have been able to share test kits between homes in some areas which has helped. The Government’s Recovery Strategy states that all team members and residents, whether symptomatic or not, will have been offered a test by 6th June and a new online portal for booking tests by care homes opened on Monday. We are hoping this will help. Knowing the status of residents and team members, particularly as there may be further asymptomatic positive tests, is important to inform decisions around safe visiting.
Testing residents and team members once is helpful, but prevention of future outbreaks requires a sustained testing programme, with our team members being tested on a frequent basis, such as weekly. We are actively lobbying for this and I will update you as we learn more.
The Recovery Strategy notes that the “Government expects all care homes to restrict all routine and non-essential healthcare visits and reduce staff movement between homes, in order to limit the risk of further infection.” With this in mind it’s important that infection risks are effectively mitigated.
Therefore, as and when we do open individual homes again to limited visiting, we’ll be operating in a very different way. We’ll continue to minimise any risk of infection by following our safety protocols both before, during and after any visit.
The decision on limited visiting will be made in relation to the status of individual homes and you’ll be contacted by the General Manager in writing, when the time is right, with specific local arrangements. Visits will be organised only by prior appointment, for initially a single visitor for up to a maximum of one hour. Where weather permits, visits will take place in the gardens with two metres social distancing, otherwise, visits will happen only in the resident’s room. Initially, we will welcome adult visitors only (aged 16 and over).
The protocol for visiting will include screening on arrival, temperature checking, hand washing and the donning of both gloves and a fluid repellent mask, which we will supply, and two metre social distancing.
We’ll also ask that you don’t bring any pets, food or drink on to the premises during your visit.
I hope that these measures, along with those outlined in the leaflet will help you understand the visitor protocol and the measures we will be putting in place to maintain the health of our residents. We’ll review the protocols regularly and adapt as the risk environment indicates.
As always, please do not hesitate to get in touch with your local General Manager if you have any questions.
Dr. Natalie-Jane Macdonald, CEO
Date: 1/05/2020 10.00am
This week I’d like to update you on our progress in managing COVID-19 infections within our homes, the situation on testing and our early thinking on how we approach the likely loosening during May of some elements of the Government’s social distancing measures.
Analysis of all of our Sunrise services indicates that outbreaks of possible or actual COVID-19 infections appear to have now peaked. Whilst there are a small number of new residents experiencing respiratory or other COVID-19 type symptoms for the first time in a few homes, these are reducing in number and the majority of residents are now gradually recovering.
All of our infection management measures remain in place and are being applied with the same rigour; we continue to carefully monitor the situation on a daily basis.
As you will have heard and seen in the media, the opportunities for testing have now increased and we are pleased that we will soon be able to ensure testing for all residents, symptomatic and non-symptomatic, and for all of our team members. As has been the case throughout the pandemic, the news is somewhat ahead of the reality. And the arrangements are not uniform across the country. Your local General Manager will contact you in due course therefore in relation to testing of your own family member.
You will also be aware of the active public debate on how and when the national social distancing measures should be reduced or lifted. We are beginning our preparations ahead of some likely loosening of the restrictions during May.
We have this week introduced two new infection control measures in anticipation of the fact that team members may soon be interacting outside work with more people, on public transport and the like. We are supplying each team member with masks to wear travelling to and from work, and outside work as appropriate. We are also now using masks when providing care directly or within two metres of residents who are in homes or sections of our homes where there are no symptomatic residents. Our purpose is to further reduce the risk of infection inadvertently being brought into the home from outside. This supplements the increase in testing of our team members.
We are also acutely aware that even with frequent telephone calls, use of iPads and so on to provide regular contact with loved ones, the continued extremely limited visiting arrangements and enforced isolation are frustrating and dispiriting for many of our residents and many of you. Whilst we want to protect all of our residents and avoid the risk of a second wave of COVID-19 infection in any of our homes, our residents are not prisoners. We are currently investigating protocols that we could put in place to enable greater visiting and movement within the homes, without diminishing the effectiveness of our infection control measures. We’ll share our thinking and plans with you in due course and we would welcome your perspectives on this to inform our decision making.
I’d like to thank the many of you who have written with messages of support and praise for our local teams. They are all shared with our team members and they really do help sustain morale and team spirit.
As always, please do not hesitate to get in touch with your local General Manager.
Date: 23/04/2020 4.00pm
As social distancing measures continue in the UK with the additional protection for vulnerable groups I wanted to provide an overview of how Sunrise are faring, to supplement the more specific local information which your General Manager will be sharing with you.
Our teams remain focused on protecting residents through careful screening for symptoms and signs, prompt isolation of residents to prevent spread and consistent use of infection control measures, including hand washing, increased cleaning, use of PPE and associated measures. We risk assess the situation in every individual home on an ongoing basis and the measures we apply will depend on numbers of residents and team members affected, where residents are located and the professional advice we receive from our internal clinical experts and external health professionals.
The general public health guidance on infection management has been consistent, but there have been adjustments to particular aspects which we follow carefully, and adjust our practices accordingly. The design of our homes with ensuite rooms makes infection management easier than in some other care homes.
We recognise that being isolated to one’s room is burdensome for residents and most are finding this the most frustrating aspect of the restrictions. It is however, one of the most important measures to contain infection. Isolation in a home which has two or more residents with symptoms must continue until 14 days after the last resident starts to experience symptoms. Therefore, the number of days in isolation may be significantly more than 14 days.
Our teams are doing everything they can to support residents during this period and I must ask for your support and forbearance also. We’ll lift isolation and other restrictions as soon as we can where they are in place, consistent with best practice in infection management.
We continue to be particularly careful regarding residents returning from hospital and this is now being more effectively supported by the NHS with mandatory testing of all patients for COVID-19, prior to discharge.
Testing remains limited, despite what you may have heard on the news. Our team members who are off work or self-isolating are now being invited for testing, but the centres are often far away and can only be accessed by personal vehicle, so this is limiting uptake. We continue to press for testing of our residents who have symptoms but again this is patchy. Our measures however are the same, whether or not there is a positive test result.
If you have any questions, please do not hesitate to get in touch with your General Manager who will provide more detailed information on the current situation locally.
Date: 16/04/2020 4.30pm
You’ll probably have seen and heard at least some of the extensive coverage of care homes over the past few days and the announcement by the Secretary of State for Health at the daily Government press briefing, on Wednesday 15th April. I would like to reassure you that the tone and content of the media coverage does not reflect the situation in Sunrise.
I’d like to update you on some of key areas where I’m sure you’ll have questions.
Personal Protective Equipment (PPE) supply and usage
We remain well stocked with all items of all PPE that we need – masks, gloves, aprons and visors, as well as equipment which we need more rarely – and we have sufficient supplies to see us through the duration of the pandemic.
As well as using PPE in a home for residents who have symptoms suggestive of COVID-19 we are also using PPE when delivering care and other services within two metres of all other residents in that home. This therefore applies to personal care, assisting our residents who need help with eating, when delivering medication and when providing one to one activities at a resident’s bedside or chair, as examples. This is intended to minimise the risk of spread of the infection from one resident to another.
I hope that these measures reassure you, when you are not able to visit as usual, that we are taking every appropriate infection control measure to safeguard your loved one.
I am extremely proud of the commitment and fortitude of our General Managers and their teams. Whilst we have had a number of team members absent with symptoms of COVID-19 many of them are now recovered and back in work. We have a number of other team members who have been advised to self-isolate, at home, to protect their own health during the pandemic.
The extra strain this has presented has been addressed by team members stepping in and covering for colleagues, some rapid recruitment of new team members and some use of agency workers too. Despite the challenges, I do not believe we have compromised on the standards of care being delivered. In addition, by all pulling together, despite the isolation, we are trying to provide stimulating activities and entertainment wherever possible.
I have had a number of emails from family members concerned that new residents coming in from NHS hospitals may inadvertently bring COVID-19 into the home. We of course have existing residents who have been unfortunate enough to need a hospital stay and when they are ready for discharge we want to welcome them back. In every case we expect a COVID-19 test to be carried out and the result available, prior to discharge. Every discharged returning resident is cared for in isolation, irrespective of the result of the test, for 14 days.
We are, in fact, receiving few enquiries from NHS hospitals asking to discharge patients to our homes and we are being extremely cautious in acceding to such requests. As I said in my previous post, our prime responsibility is to the wellbeing of our current residents and that comes before everything else.
COVID-19 infections and testing
As you may have heard the availability of testing for both residents and team members is now improving. This is good news. We are already seeing across a number of our homes team members being invited to attend for testing. We are also anticipating increased availability of testing for our residents who have symptoms. As the care sector is large with many thousands of homes, we expect this to gradually roll out over the next couple of weeks.
In the interim, our infection management protocols will remain the same.
The tests being offered will tell whether the person has the infection at the time of the test. They are not antibody tests, which tell whether someone has had the infection previously.
Our current status
We have a number of homes where there are small numbers of residents who have experienced symptoms of possible COVID-19 and a number of homes where we have so far had no evidence of possible infection. The vast majority of those with symptoms are making a good recovery. We have also had some residents with symptoms who have tested negative for the virus.
In all cases where our residents have symptoms we have received timely and excellent support from local primary care services and public health protection teams. Most of our GPs are running virtual ward rounds and we are very pleased with the individual attention our residents are receiving. There have been no issues in arranging transfer to hospital for the small number of residents who have had symptoms requiring hospital intervention.
Our teams provide care under the clinical leadership of our Care and Quality team who offer expert clinical advice.
If you have any questions please do get in touch with your local General Manager.
Date: 08/04/2020 9.00am
PPE and Infection Prevention and Control
Further to my post last week I wanted to update you in relation to our supply and use of Personal Protective Equipment (PPE). I also want to set out the approach we’re taking to manage potential outbreaks of COVID-19 infection. This contains quite a lot of detail but I want you to have full sight of the measures we’re taking to protect and care for our residents during the COVID-19 pandemic.
We remain well supplied with all types of PPE, including masks, gloves, aprons and eye protection. Our future supply is strong and we do not envisage any shortages. The recent coverage in the media of some other care homes does not reflect our situation.
The Public Health bodies updated national guidance for use of PPE on Thursday 2nd April and our policies on PPE utilisation comply with that guidance. We’ll continue to review both national and international evidence and guidance to inform our policies on PPE utilisation as we move forwards.
In relation to potential outbreaks of COVID-19 we’re adopting a rigorous approach.
If the home has a single resident with symptoms or signs consistent with COVID-19, the individual resident remains in their room for all care. PPE is used in taking care of this resident.
If another or further residents have symptoms or signs, this is treated as if it’s a COVID-19 outbreak. This means that if the residents reside in close proximity to each other, the rest of household or floor where they live is isolated from the rest of the home. All residents within the household or floor are cared for in their rooms, whether they’re symptomatic or not. If the symptomatic residents are in different parts of the building such that an individual household or floor cannot be isolated, then we isolate the whole building.
We screen all residents for symptoms and signs on a twice daily basis, including checking their temperatures.
We use full PPE to care for all symptomatic residents. We segregate our team members such that we have a dedicated team to provide care to residents who have symptoms.
We include other specific measures to prevent the spread of infection, including enhanced cleaning of rooms and communal areas, and the use of disposable cutlery and plates for residents with symptoms and a usual in room tray service for other non-symptomatic residents.
The outbreak continues either until 14 days after the last resident becomes symptomatic, or, where testing is available, when affected residents have tested negative for COVID-19 in which case usual, non-COVID respiratory infection outbreak measures apply.
During the outbreak visits to the home are even further restricted. The only people permitted to enter are the team members and local management team, relatives visiting terminally ill residents (following protocol), health care professionals such as GPs and business critical contractors undertaking essential works on an exceptional basis.
As you’ll know testing for COVID-19 in the UK remains very limited. There‘s no testing for employees unless they’re admitted to hospital as patients, and there’s very limited testing in care homes. Where residents in care homes have symptoms, Public Health England may test up to five residents. Getting tests carried out also takes some time to both arrange and receive reports back.
To reassure you, our protocols are not dependent upon testing. We seek to limit the spread of infection by caring for all residents who have signs or symptoms that could be COVID-19 as if they do. Most of them will not be tested at any point. Many of them will not have COVID-19 but other respiratory illnesses.
We’ll continue with our rigorous and meticulous approach for as long as the pandemic lasts. Our objectives are to protect all our residents insofar as we are able and to provide the highest standards of care that we can. In so doing, we are thankful to our committed and hugely resilient team members and their local managers, who continue to work with compassion and kindness. I cannot commend them enough.
With best regards,
Dr Natalie-Jane Macdonald, CEO
Date: 01/04/2020 2.00pm
Supplies of Personal Protective Equipment (PPE)
There’s been considerable media coverage over the past few days regarding shortages of PPE within care homes. I’m writing to update you on the position within Sunrise, to reassure you that we’re well prepared and do not have shortages of vital equipment.
Our procurement director has been working tirelessly over a number of weeks to ensure we have all the equipment needed in order to protect team members and residents where there may be COVID19 infection present. Please be reassured that we’re working around the clock to make sure we have more than enough equipment for as long as the pandemic lasts.
A few examples illustrate the scale of the sourcing and delivery effort:
We’re therefore in a very strong position on equipment, with future planning also underway for any future potential outbreak with a pandemic kit per home to be in storage from next week.
Our General Managers and their teams are able to answer your specific questions about your own loved one. I hope this update provides reassurance regarding our preparedness in this vital area.
Date: 19/03/2020 4.00pm
In light of the increasing restrictions being announced by Government, our desire to protect vulnerable residents from the spread of the COVID-19 virus insofar as we are able, and many requests from families, we are with immediate effect, temporarily suspending all visits from relatives and friends to our homes, unless in exceptional circumstances. We do not take this decision lightly and we recognise that the decision will concern some people, but we do ask for your support.
If you feel your personal circumstances do warrant a visit, please contact the General Manager before you travel to the home.
Our intention is to follow Public Health England advice to determine when visits will return to normal. We will continue to do our very best to support residents to keep in touch with loved ones via other methods, such as phone and video calls, letters or emails in the short term.
Our General Managers are on daily calls with the Executive Team and our Contingency Planning Team where they receive up to date information and we make day by day decisions on all aspects of policy affected by the COVID-19 virus. In addition, we have the ability to answer questions from our homes via our help-desk team who are supporting colleagues. In this way, we hope to be able to keep you continuously updated on the situation and ensure our General Managers have the facts to answer your questions.
Natalie-Jane Macdonald, CEO
Date: 17/03/2020 4.00pm
I am writing to update you regarding arrangements in light of the new advice from the Government yesterday evening.
Thank you all for your great support to our team members and homes at this time. We appreciate very much your understanding and are grateful for your offers of help. It is clear that the situation is going to be challenging for a number of months and we all need to prepare for that.
We continue to ask you to restrict all visits to a minimum, unless your loved one is receiving terminal care or there are specific circumstances that mean we should put a different arrangement in place. In that case, please liaise directly with the General Manager. We will endeavour to be accommodating whilst not increasing the risk of infection to our residents.
iPads are available should you want to FaceTime your loved on and we will facilitate telephone calls as well.
As well as screening visitors for recent travel and symptoms we are likely to introduce regular temperature checks for all visitors within the next few days. Anyone with a temperature above 37.8C will be asked to postpone their visit.
Mothering Sunday is normally a day when we have many visitors to our homes and also residents leaving our homes to join family. We will not be holding any communal events this Sunday. We believe that though this is an important date in the calendar we need to continue with the same precautions as on other days. If you do want to take your mum to your own home for the day, please can you contact the General Manager as all departures and returns will need to be carefully coordinated. Similarly, any visits for Afternoon Tea within a resident’s room will need to be staggered and carefully managed. Thank you for your understanding on this.
As with any other respiratory illness if residents and team members in a home have symptoms suggestive of COVID-19 infection, the home will be closed to all visitors. Although the care sector is prioritised in terms of testing, it is in practice proving difficult to get prompt tests undertaken for the virus. We will therefore manage the situation as if the infection is COVID-19. Homes will be closed until the infection has subsided and this may be for 14 days or longer.
Assuring a full staff team
We want to ensure we have sufficient team members in all roles over the next four to six months. We expect the Government advice to isolate households for 14 days where a family member has symptoms, will inevitably reduce the number of our team members who are able to come to work.
We have therefore already launched an extensive recruitment campaign targeting people who are being laid off by airlines and hospitality sector and we are putting in place steps to induct new team members effectively and at pace so they can become productive as quickly as possible.
Each of our homes will be contacting family members and friends this week, seeking names of volunteers who can be available to help if required in the next few weeks. This may include helping with delivering teas, coffees and meals to residents in their rooms and assisting with entertainment.
Our General Managers and their team will endeavour to answer any questions which you have and they have access to our central team for anything that they cannot immediately help you with.
I will continue to keep in touch as the situation evolves.
Dr Natalie-Jane Macdonald, CEO
Date: 13/03/2020 4.00pm
Following the Government's decision to move the status of the UK from containment to delay, please see below steps we are taking to protect our residents from the impact of COVID-19.
It is expected that over the next few weeks the infection will continue to spread within the UK and it is likely that this will include spread to and within care homes. Sunrise are currently unaffected, but we are aware of a number of UK care homes which already have outbreaks of the virus.
We are taking every sensible precaution in screening our team members and ensuring that they stay at home if they are symptomatic or need to self-isolate. We are undertaking contingency planning for the time when many team members will likely be affected and off work so that we are able to continue to care and serve our residents well throughout the virus peak period.
It is estimated that the peak will be anything from 10 to 13 weeks away, so our measures need to be sustainable and proportionate.
If residents or team members in a home are infected the home will be closed, as we do for any other outbreak or infection, and the same measures will apply.
At the moment we are encouraging relatives and other visitors to reduce the frequency of personal visits. We are also restricting all other non-essential visitors into our homes to reduce the likelihood of infection being introduced that way.
I hope you will understand that we are not taking these measures lightly and they are solely in the best interest of everyone who lives in the home. The Government advice is clear about the need to protect the most vulnerable in our society where mortality rates are highest, which includes all of our residents.
We will be issuing separate advice in relation to Mothering Sunday and the Easter Weekend over the next few days.
Date: 13/03/2020 9.00am
The health and well being of everyone that makes their home at Sunrise and Gracewell is our foremost priority, and we have robust infection control procedures in place.
As such, and in anticipation of the government moving to the ‘delay’ phase of its national response, we are postponing or cancelling group activities with residents that involve contact with more than 10 external people. This includes events at the home and external visits. We are also investing in iPads across all of our homes so that family and friends can reduce visits and stay in touch with their loved ones remotely, and asking anyone who is feeling ill or has returned from category 1 or 2 not to visit until they have recovered or spent sufficient time in quarantine.
We have also been undertaking thorough contingency planning, and have been communicating regularly with residents, team members, family and friends since the outbreak began to ensure that everyone is aware of the measures we are taking to protect the all of the people associated with Sunrise and Gracewell.
Please follow official COVD-19 information and guidance provided by Public Health England that can be found here.
As our residents are all particularly vulnerable to the COVID-19 infection, we have taken the difficult decision to temporarily suspend all visits from relatives and friends, unless in exceptional circumstances. We do not take this decision lightly; reducing visitors into our homes will help protect the health and safety of residents which is our priority. Visits from healthcare professionals and for matters relating to health and safety continue with appropriate precautions.
Our intention is to follow public health advice to determine when visits will return to normal. We will continue to do our best to support residents to keep in touch with loved ones via other methods, such as phone and video calls, letters or emails in the short term.