The government had insufficient focus on these very vulnerable elderly people. At least half of the corona deaths in the Netherlands up to September 2020 fell under this group.
This conclusion of the Dutch Safety Board (OVV) in the first report on tackling the corona crisis, presented on Wednesday, confirms what the sector itself has been saying for much longer: in the first phase of the pandemic, attention was mainly focused on the ‘cure’ – sector, hospitals. The basic principle of protecting the vulnerable was therefore mainly aimed at hospital patients. The ‘care’ sector, long-term care, was painfully overlooked by the government.
Older people’s associations and elderly care organizations experience the report as an acknowledgment of the criticism they already expressed at the time. ‘This research report confirms that the safety of healthcare professionals was not guaranteed’, says professional organization NU’91. ‘It is good that the Dutch Safety Board is putting its finger on the sore spot with regard to this painful mistake,’ responds Anbo for the elderly.
The Dutch Safety Board describes how the government paid too little attention to the protection of nursing home employees because of its focus on hospitals. They had to work without protective equipment and initially could hardly be tested. Even worse: if the continuity of care threatened to be endangered, they had to continue working with minor complaints. The residents of the nursing homes have become victims of this neglect.
No voice
In this first sub-report on the first phase of the corona crisis, from March to September 2020, the Safety Board describes how this could happen. In this report, the Dutch Safety Board looks specifically at how the government has dealt with nursing homes in this first phase of the pandemic.
In the crisis structure of the government, elderly care initially had no voice. While alarming reports were received from abroad early in the pandemic about how ruthless the virus could be among vulnerable elderly people in nursing homes, that sector was given too low a priority, according to the OVV. The experts in elderly care initially felt that they were not heard enough. The recommendation is therefore clear: in the event of a possible subsequent crisis, long-term care must be given a greater contribution.
Partly because of the chronic lack of protective equipment and testing possibilities in the first months of the crisis, the virus was able to spread rapidly through the nursing homes. Also because elderly people with dementia are hardly able to follow rules such as keeping their distance from each other. ‘Sometimes an elderly person would cough all over my face,’ said a carer to the OVV researchers.
The fact that this group of elderly people did not always show the usual symptoms of a corona infection made the situation even more unclear. If two residents in a ward were infected, the nursing home closed the ward, so that the elderly people who had not yet been infected ran a high risk of contracting the virus.
Visiting ban brought loneliness
As an emergency measure to contain the virus in nursing homes, the government imposed a visit ban on March 20. This indeed put a brake on the spread of the virus, but it had a major negative impact on the well-being of the residents. They could start to feel lonely. It led to a lot of grief among carers. ‘Nursing home residents were worse off than dogs, at least they are still walked’, a nursing home employee sighed to the OVV. Many care administrators also say with the care employees: such a closure of nursing homes, never again.
Uncertainty, fear, anger, confusion, the emotions alternated. The nurses were angry that they had to work unprotected. They feared that they were contributing to the spread of the virus. The fact that they could not always recognize a corona infection in their residents made them insecure at a time when testing was hardly possible. And they got confused by different rules that were being fired at them.
Meanwhile, some nursing home administrators got their protective gear from everywhere and nowhere; at veterinary clinics, beauty salons, farms. Nursing home workers worked with fireworks goggles and asbestos suits.
Former corona minister Hugo de Jonge does not agree with the conclusion that the government neglected the nursing homes in the first months of the crisis. The decision to close the nursing homes on March 20 was earlier than the plan to spread patients across the hospitals, he argues. And he came to that drastic closure measure not because of the shortage of testing possibilities and protective equipment for the nursing homes, but because of alarming messages from nursing homes in the south of the country. ‘From the start, there has been consultation with this sector,’ De Jonge wrote in his response to the draft report to the Dutch Safety Board in December. ‘The general lockdown measures were there to protect the weak, including nursing home residents.’
Insufficiently trained
The fact that the nursing homes were initially not well visualized was also because the sector is multifaceted, with large nursing homes and also small forms of living, the OVV sees. And also because there are all kinds of representatives on behalf of, for example, the elderly care specialists (Verenso), the employers (Actiz) and the employees (V&VN), who moreover do not always speak with one voice. Moreover, in recent years the emphasis in nursing homes has shifted from medical care to more emphasis on living comfort, the so-called de-medicalization of the sector. A pump with hand cleaning gel would then be experienced as less pleasant. Nursing home employees are insufficiently trained in infection prevention, according to the OVV.
The branch organization Actiz of the elderly care also says that it has drawn the conclusions of the OVV before, namely that too little attention was paid to elderly care. “As Actiz, we pointed out the distressing situations in nursing homes and the shortage of protective equipment and tests to the ministry early on in the crisis, but this was not immediately followed,” says Mireille de Wee, chair of the Actiz core group Housing and Development. Concern.