Daily battle faced by those treating the elderly in nursing homes

Diary of a care worker: Daily battle faced by those treating the elderly in nursing homes during the coronavirus crisis is revealed in heartbreaking journal

  • Lindsay Marks, 39, – not her real name – is a senior care assistant in Lancashire
  • She has worked for four years at a home with 63 residents aged 55 to 98
  • Four have died of suspected Covid-19 while more are showing symptoms
  • Here she reveals the harrowing truth about what is going on in her care home
  • Learn more about how to help people impacted by COVID

Health Secretary Matt Hancock’s pledge for more testing for workers and residents in care homes has been welcomed by those on the frontline of the crisis. 

But many say their calls for more specialist training and more Personal Protective Equipment (PPE) are still being ignored.

Lindsay Marks, 39 – not her real name – has been a senior care assistant for four years at a home with 63 residents aged 55 to 98 in Lancashire. 

Around half have dementia and the home is a mix of privately funded and council-funded residents. 

In the past two weeks, four have died – three with suspected coronavirus – while more are showing symptoms. 

Lindsay Marks (not pictured), 39 – not her real name – has been a senior care assistant for four years at a home with 63 residents aged 55 to 98 in Lancashire (file image)

As of last Friday, there is now one confirmed case there.

Here, in excerpts from her diary, she reveals the harrowing truth about what is really going on in one of Britain’s care homes…

MONDAY

Four weeks into lockdown and we’re still appallingly vulnerable to infection. Latex gloves, thin plastic aprons and just four pairs of plastic goggles shared between all 15 staff is the only PPE we have.

It’s my turn to use the goggles. I wash them so germs aren’t spread from one carer’s face to the next.

My colleagues tease me, but there’s no point in wearing them otherwise. Sharing goggles: that’s exactly how the virus is going to be spread.

Hand gel has been strictly monitored by management after a couple of bottles ‘went missing’. In desperation, I’ve ordered some for myself from eBay.

For weeks we’ve been pleading for shoe protectors, gloves, theatre-style gowns, arm protectors, more masks and goggles. We are told there is a problem with supply. We’re relying on so many favours.

A friendly district nurse smuggled in a spare box of aprons, but told us to keep quiet about it. One of my colleagues considered ordering some overalls from a fancy dress shop but management said they didn’t fit the uniform code.

Today, when I arrive for my 12-hour shift, a delivery of thin, blue-and-white cotton ‘30-minute masks’ has arrived — so-called because they work for only half an hour. A fresh one is needed after each patient.

‘Yes but look. . .’ says my colleague, Lisa, placing the mask over her face and ears ‘they’ve got gaps’.

She’s right. The masks gape at either side. How are they going to keep the virus out? Still, I suppose it’s better than nothing.

‘How many have we got?’ I ask, hopefully. She rolls her eyes as she explains that we have only one mask per care worker, per 12-hour shift. You can’t wash them, you just have to wear them and hope for the best.

I reach for a mask and put it over my face. The elastic snaps; Lisa gives me another one. ‘That has to last you two days,’ she jokes.

You have to keep a sense of humour, but frankly I’m petrified. I’ve been a carer for 20 years and I’ve never been this scared. I’m being paid £8.70 an hour to put my life on the line.

The care home’s workers had to plead for shoe protectors, gloves, theatre-style gowns, arm protectors, more masks and goggles (file image)

And I’m scared for our residents — that I’ll infect them when I come in from the outside world; that they’ll be completely wiped out by the virus.

I fear for my husband Tony, too, and our two children, who are five and just two years old. I worry myself senseless that I’ll take the infection home to them.

But I crack on because I know I’m needed — and I have to earn money. Thankfully, Tony’s a postman, so he’s still in work. But our stress levels are ratcheting up daily. One of my close colleagues is tearful. ‘This place is going to be ravaged,’ she says.

The patients who have died of what I am certain was Covid — both men — have had the same symptoms: a fever, shortness of breath, coughing up black phlegm. 

We knew them well and had grown close to them. Of course we’re used to death, but the virus attacks so quickly and violently it’s terrifying.

Geoff, 76, was the first to succumb. Yet he was one of our fittest and strongest residents. One day he seemed fine, the next we found him on the floor of his bathroom, unable to get up. After that he deteriorated swiftly.

We checked on him every 15 minutes as his breathing became more laboured but — hard-pressed as we are — we couldn’t sit constantly by his side, and he died alone.

A week later, Brian, in his 60s, suffered the same symptoms and was gone within days. 

He, too, died alone. It’s heartbreaking but we just didn’t have time to hold their hands and sit with them until they had breathed their last; neither were their families allowed to say their final goodbyes. 

All we could do was make them as comfortable as possible.

Now Geoff’s best friend, Malcolm, is suffering the same symptoms. A few days ago a nurse came to visit and he was put on an ‘end-of-life’ plan. 

He’s probably only got a few days. Thankfully, two of our more experienced carers have volunteered to look after him until the end. It’s very brave of them. They have families, too.

GPs are no longer coming into the home. I haven’t seen one for weeks. Carers even have to use their own phones to call them so they can make their diagnoses via FaceTime.

But unless they actually visit, they can get it wrong. Last week, one GP told us to put a (non-Covid) patient on an ‘end-of-life’ plan because he was barely conscious. The next day, this same patient was up and about in his room eating breakfast. We couldn’t believe it.

The patients who have died of what Lindsay is certain was Covid had the same symptoms: a fever, shortness of breath, coughing up black phlegm (file image)

As care workers we’re on the frontline but no one is listening to us. I would love Matt Hancock to step into my shoes for a day to see what we’re up against.

Our residents cough all the time. One has a particularly aggressive form of dementia and is prone to spitting and scratching us. I’m terrified every time I have to go near her.

I try to minimise touching patients. I hold my breath when I’m near them. But how can you do that when you’re helping a 15-stone man go to the toilet or changing the incontinence pad of a bed-bound woman?

What worries us most is the lack of testing. Although we strongly suspect we’ve had Covid-19 deaths, none has actually been confirmed.

It wasn’t until Geoff died that we got our hands on four testing kits, two of which we’ve used on Brian and Malcolm. We’ve also tested another of their friends who is showing symptoms. We’ve posted them off, but who knows how long it will be before we get the results? I wonder if we ever will. It’s like fighting a war without any armour.

TUESDAY

It is now four weeks since families of our residents were allowed inside the home to visit. Occasionally we’ll find them standing outside their loved ones’ window having a conversation. 

We turn a blind eye — it’s good for the residents’ morale and it means they can still have ‘visitors’.

The residents with dementia have no idea about Covid and don’t have any idea that their families are no longer visiting. However, a few have been a little more confused by the fact we’re all wearing masks.

The residents I feel most sorry for are those who do understand what’s going on. They’re suddenly being told to stay in their rooms all day and not congregate in the TV room or the lounge. 

I’m certain isolation and confusion will kill some of them. Already, five have taken to their beds and are refusing to eat, despondent and ready to give up.

One of the hardest moments for me came when a 90-year-old resident died — from natural causes, we believe — just after lockdown. Her family, bereft by the lack of contact, had to say their last goodbyes through the window. 

Today, I’m at my desk when I hear a commotion on the lawn. Outside Edith’s room, members of her family are shouting at her through the window and pointing. 

I hear the words ‘This isn’t your room!’ and race round to Edith’s room to find Mary, an 80-year-old dementia patient who has no idea where she is or what she’s doing.

She’s wandered into Edith’s room by mistake, and Edith is clearly distressed.

Normally, this sort of thing would be a minor inconvenience. It happens all the time in care homes. 

But we’re on high alert now for residents mixing with each other, and it’s particularly worrying because Mary was admitted only two days ago from a hospital.

While her illness wasn’t Covid related, she may well be harbouring the virus, able to pass it on to other residents. Gently, I lead her out of Edith’s room and back to her own.

I don’t understand why — when we’re supposed to be locked down and relatives are not allowed in — we can be admitting new residents, particularly now we have suspected Covid cases. 

It’s as if we’re sending people to their deaths. But we can’t lock people up. We’re doing our best to make them feel comfortable in their own rooms.

Today I had a little bit more time and visited one of the patients who hasn’t seen her family for a month. I sat and chatted with her for a while and painted her nails. She seemed a bit brighter after that.

WEDNESDAY

One of our patients, Isabel, has a slight cough and I’m nervous for her. She’s reasonably fit and healthy for 75 but we’ll keep an eye on her. There’s little point calling an ambulance if things get worse. Ambulances only come to care homes in an emergency, such as a fall. But if someone’s health is declining, the doctor or nurse will merely make the decision to put them on an end-of-life plan.

As in any care home, we have residents with severe diabetes whose wounds need dressing because of circulation problems. In normal circumstances, district nurses perform these tasks. Now we’re seeing far fewer of them. One even refused to come in. She was petrified, which I found shocking. After all, it’s her job.

One of our patients is so ill with diabetes that his feet have turned black and he needs urgent attention. But the dressings and medication will be left at reception, and we’ve been told that we must deal with it ourselves.

I’m not qualified for this — and neither are my colleagues. It feels very unfair, and it’s putting pressure on me. By the time I get home, Tony has tucked the children up in bed. I strip off all my clothes in the kitchen and put them into a hot wash in the washing machine.

Then I creep upstairs without touching the banister and soap myself down for ten minutes in a steaming hot shower.

It’s my new after-work routine — my way of protecting myself and our family.

THURSDAY

My colleague, Fiona, has called in to say she’s self-isolating as she’s got symptoms of Covid-19. It means we’re two staff members down this week, but we’re all aware that it’s not an easy decision for her. 

She has a young child and a partner and, because there’s been no testing for us, there’s no proof she has the virus, so she’ll only get statutory sick pay of around £60 to £90 a week.

We’ve been told recently that there’s now a testing centre for care staff, but it’s an hour away and I don’t drive. We desperately need more, accessible, testing.

It got even harder for Lindsay when a couple of her colleagues started developing symptoms (file image)

Like me, Fiona is on the minimum wage and she works only three days a week. I feel sorry for her. Many of us have had mild symptoms but, unless we’re actually ill, we’ve been told that we have to come into work. 

About a week ago, I felt a bit wheezy and thought I’d lost my sense of taste, one of the symptoms of coronavirus, but I poured myself a glass of apple juice and could taste it. I assume it was just hay fever. But who knows?

FRIDAY

I arrive at work to hear that Malcolm — Geoff’s best friend — died in the night. Like Geoff, he was a strong, reasonably fit man, but this virus doesn’t seem to care about fitness levels.

What’s worrying is that we’re noticing similar symptoms in all the residents Malcolm used to sit with. I daren’t imagine what’s coming in the next few weeks.

Unbelievably, I’ve also discovered that the manager has allowed some of the residents to mingle again. 

Given everything we know I can’t believe it, especially as today we had the results back of the other resident we tested and it’s positive for Covid-19. Thankfully, he is showing signs of recovery.

While I stopped watching the news a couple of weeks ago because I found it too depressing, my husband tells me about Matt Hancock’s latest pledges and I could weep. 

It feels too little, too late. Hopefully, the fact that families can now visit dying loved ones will help ease their pain.

But I can’t see the PPE situation changing soon. The home’s management are off-hand, dismissive. We’ve been left in no doubt that if we want to leave, there’s the door.

Some of the staff have been told this week that if they miss even one shift and they can’t prove they’re ill with Covid they will be sacked. It’s no way to treat us when we are all doing our best.

But I resolve not to be beaten — yet. I’ve been touched by the kindness of some families and the local community. We’ve had chocolates and thank-you cards; a local takeaway brought pizza for the late shift, paid for by the local rugby club. Friends and neighbours have shopped for me.

I just wish the politicians and those in charge had shown an ounce of their care and compassion for those on the frontline, those of us in care homes — because the worst is yet to come.

I don’t think we’re even half way through this crisis yet. 

  • As Lindsay fears losing her job and livelihood, she has asked us to change her name and the location of her care home. Names of residents have also been changed.

As told to Jill Foster 

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