I, like many of you, I am sure, have been monitoring the updates as to advice and guidance on how to deal with the pandemic referred to as ‘coronavirus’. I had lengthy discussions with local authority colleagues on what this means from a DoLS perspective on Friday. To complete assessments for DoLS purposes assessors are expected to visit individuals in their care homes. But care homes up and down the country are closing their doors to non-essential visitors.
There are a number of issues here. Firstly, denying visitors is very definitely an interference with people’s human rights. However, the right to private and family life is a qualified right, and can be interfered with if it is in accordance with a lawful process and necessary and proportionate to do so. The protection of public health exemption may well apply in the current circumstances.
I have also had some interesting discussions about best interests in the context of these restrictions. There may, after all, be many residents of these care homes who would prefer to take the risk of infection for the sake of spending more time with their loved ones. I wonder whether those who have capacity to make such decisions are being offered other options. Given the pressure on all elements of the care system, I very much doubt alternative care arrangements are being discussed.
And what about those who lack capacity to make such decisions? It is even less likely that best interests discussions are being held, considering their past and present wishes, and the risks to them as individuals. For many people, they perhaps do not have to be held, if there are no other options.
For the care homes who ‘jumped the gun’ a bit last week, there was perhaps some shaky legal ground. Because perhaps there were alternative measures that could be taken. How realistic these were, I cannot say. Moving people who wanted to continue to have visits to homes that had not put in place these measures is unlikely to have been viable. In my area, I know there isn’t the capacity in the system to move people quickly, or in large numbers. And allowing visits for those who wished to take the risk would still be running the risk of exposing everyone in the home to the virus, including those who had chosen, or would choose, not to have visits.
This afternoon’s announcement will, I expect, be followed by updating guidance for care homes, that will significantly reduce the chances of legal challenge. It is one thing for care homes to take these decisions in isolation, but quite another for there to be national guidance to rely on in these extreme circumstances.
The idea of non-essential visits also gave me pause for thought. Many functions of the local authority, including DoLS are statutory requirements. Consulting with the person is enshrined in statute. And DoLS is an important protection of each individual’s rights. So from a legal perspective, visits by assessors would seem pretty essential.
But as one best interests assessor I spoke to pointed out, understanding of DoLS is not widespread amongst family members. And assessors already face questions as to who they are and what they are doing ‘interfering’ in their loved ones’ care. Imagine having to make that phone call in these circumstances. Family can’t visit, but this random person can go and ask a load of questions?! Not an ideal situation, to say the least.
So it seems likely that a lot of visits by professionals will be put on hold.
But I welcome more detailed guidance. It is worrying enough for frontline health and social care practitioners not to know what they are supposed to do. I can’t imagine how difficult it must be for the thousands of vulnerable people reliant on carer visits for their basic needs, worrying what will happen if their usual carer has to self isolate, or if carers visit when they have a cough.
Thinking about self-employed carers commissioned through direct payments, with limited contingency arrangements is, frankly, enough to give me cold sweats. I imagine phones ringing off the hook as people scramble to arrange cover for sick carers, ensuring that meals, medication and personal care are all provided. In some of the rural areas our authority serves, this is going to get tricky fast.
Scary times for a system already stretched to its limits.
Now my authority does offer working from home arrangements. I generally work from home 2 days a week. But we purchase licences for the software that enables that to happen. And we only have so many of them. During severe floods, snow etc, I often receive emails asking me to please log off now so that essential services can use the licences and server capacity. I expect the same will happen in the next few days.
Which will give me more time to post on here. I am terrible when I am at a loose end, so expect to hear more from me.
In the meantime, current guidance for care homes and other placements is available here: https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance
In case it isn’t obvious from the fact I still haven’t identified the authority I work for, the views expressed on this blog are my own opinion and not the opinion of that local authority