Hospital patients ‘should go to interim beds before discharge to care homes’

Hospital patients should not be discharged straight into care homes if a second coronavirus wave hits but should stay in interim beds to avoid infection spread, an expert has said.

Gill Livingston, professor of psychiatry of older people at University College London (UCL), said there must be separate “step-down” beds for elderly patients to help care homes stay free of Covid-19.

Asked if there was one thing she would want to see done differently in a second wave, she said: “I think we cannot discharge people from a hospital to a care home immediately, that we have to have some interim step-down beds, outside of care homes.

“We know that even when they are swabbed that these swabs are by no means perfect, with 70 to 80% sensitivity.

“And so people have to have an interim time before they go to care homes, so that hopefully many of the care homes will remain free of Covid.”

Prof Livingston was speaking in a panel on the impact of coronavirus on elderly people held by the Royal Society of Medicine.

It comes as another panellist said infection control in care homes has been “sub-optimal”, with a lack of guidance on how to safely isolate residents and insufficient testing.

Adam Gordon, professor of the care of older people at Nottingham University, said: “It’s very clear early in the pandemic, in fact, as far as early June, we were flying half-blind with regard to the care home sector, and that was no way to manage our highly vulnerable population.”

Care homes were told to group residents with suspected Covid-19 together but were not instructed how to do this, he said – a particular concern regarding patients with dementia.

He continued: “Even now, some three-and-a-half, four months into the pandemic, there is no specific guidance on how to allow people to wander safely through your care home from Government – care homes have had to rely upon guidance from third sector organisations in order to work out how to manage these sorts of residents.

“So there are a lot of ways in which the infection control in care homes was sub-optimal in the pandemic, and I think, really, we could have done a lot better.”

It was also noted that delirium may be the only presenting sign of Covid-19 in elderly care home residents, a third of which may not display the typical symptoms of the virus.

Prof Gordon said the only way signs of a second wave in care homes will be spotted is if regular and widespread testing, as opposed to existing pilots, takes place.

He said: “Because up to a third of care home residents are asymptomatic, the only way we will see the next wave coming in care homes is if we’re doing regular surveying and swabbing, and we quite urgently need some guidance and recommendations and resources from Government to support that.”