What do you do when in a nursing home ward for psychogeriatric elderly, so dements, theres a corona outbreak? Do you isolate the infected residents of the uninfected, even if that means you have to lock them up because they wander and walk around?
Or do you not do that with the risk that uninfected residents are at risk of getting corona as well? As a result, they may become seriously ill and may die. Healthcare provider Mijzo was confronted with that dilemma.
The company has 26 locations in the area between Breda, Tilburg, Gorinchem and Den Bosch. There are 3500 people working and an additional nearly 2500 volunteers. Today, a total of 172 of the more than 3000 residents were infected with SARS-COV-2 at the 26 larger and small locations of the company.
At some locations, the number of infections is high, above 20. In the brand new nursing home De Riethorst in Geertruidenberg, the building has only been in use for three months, an outbreak started almost two weeks ago.
“ In the last weekend of November, we had the first two infections in the psychogeriatric ward. This quickly rose to twelve, twenty and forty”, says Chairman of the Executive Board Mireille de Wee, also director of the branch organisation ActiZ.
“ Now, except 2, all 55 residents in the psychogeriatric department have been tested positively.” Two residents have died in the meantime. Specialist in elderly medicine Astrid Cloquet says that the number of deaths may still be increasing. “But we do see that the infected elderly tolerate the disease better than during the first wave.” That may have to do with the fact that it was barely tested at the time.
What to do?
Testing for the coronavirus is a major and difficult for the (heavily) demented residents. “Our employees come fully packed in personal protective equipment. And then they have to stick a cotton pad deep into someones throat and nose.”
The residents do not understand what is happening to them. Coronary rules dont tell them anything. They sit together, do not keep a distance and, in many cases, wander or walk around. Eighteen employees, including the location manager, have become infected.
“ If you have one infection in a psychogeriatric department, it will soon be difficult,” says De Wee. “To begin with, you always find out too late and then the choice is that people can walk freely or are you going to lock them up? Thats very violent.”
The nurse doctor tells about the dilemma the staff faced:
The Riethorst has set up a cohort department where the infected residents stay during the day. Subsequently, the family members of the (still) uninfected residents were discussed. They were given the choice to temporarily accommodate their family member at home, to temporarily isolate their family member in their own room, or to allow their family member to retain their freedom of movement.
Wrong or wrong
“ Some of the family members chose to maintain the freedom of their family member. Everyone is in their final phase of life, and they thought that freedom was the most important thing. In a number of cases, family members chose to place their family member in individual isolation.” None of the people involved chose to temporarily take their family member into their home.
Isolation of a resident does not provide certainty that the resident did not already catch the virus. “Apart from the two deceased residents, we now mainly see clients with fatigue and decreased appetite. We will see how this develops in the next few days,” says De Wee.
As a nursing home, you can never do this right, she says. “Incomprehensible that you do not isolate mother, says one. Incomprehensible that your “mother” in her final phase of life deprives her freedom and imprison, says the other. They are really very substantial dilemmas.”
There are also “best what” complaints. “Especially for caregivers and nurses, this is very difficult,” says De Wee. “They are on the front line every day and are confronted with misunderstanding. Tolerance decreases.”
“ The staff would like it differently, but usually have little time to talk to family members properly. Its really awful. Ive never seen anything like this before,” says De Wee.
“ The residents are not sick. Theyre demented. Do you have to sedate them to prevent them from wandering around? They might die from that. At the Riethorst, clients can always leave their apartment because freedom is of paramount importance. Do we have to change that head-on?”
According to De Wee, other nursing homes have had to deal with this problem before, but the dilemmas that come with it have never been openly raised.