During the corona pandemic, the difficult situation of nursing homes has worsened dramatically. Rapid tests should help against the many infections and deaths. But they bring new problems.
By Sandra Stalinski, tagesschau.de
The smell of cookies and fir branches, singing songs together and reading the Christmas story aloud – what is normally part of Christmas in nursing homes will have to be canceled in many places this year. About a quarter of all German nursing homes are currently affected by corona outbreaks – with serious consequences.
In Berlin, for example, more than every second person who died from corona was a nursing home resident. In Schleswig-Holstein it was almost 89 percent. In order to better protect this particularly vulnerable group, there are now rapid tests. Up to 30 of these antigen tests have been available per nursing home resident and month since December; the costs are borne by the federal government. But that doesn’t solve the problem. Because who should do these tests?
Test obligation for employees and visitors
The ordinances of most federal states now provide for a test requirement for employees and visitors. In Berlin, for example, the staff has to test themselves twice a week, visits are only allowed by one person per day for an hour – and only if they can prove a negative corona test. The residents are also usually tested at least every 14 days. According to the Robert Koch Institute, the tests should be carried out by medically trained personnel. But “the nursing staff cannot cope with this task”, says nursing home operator Bernd Meurer, who is also president of the Federal Association of Private Providers of Social Services (bpa). “They are already going beyond their limits.”
In a home with 100 residents, there are roughly as many employees – kitchen, cleaning staff, administration included. If the staff are tested twice a week and the residents once, that’s 300 tests a week, making 1200 a month. Meurer calculates that it would actually take one or two more full-time employees to just take care of the tests.
There is a lack of staff for tests
But there is no such additional staff. Even before the pandemic, there was a nursing emergency in Germany, the homes have been competing for the same skilled workers for years, and numerous positions are vacant. “And now there is one regulation after the other and everything is dumped at the nursing homes,” says Meurer. The staff can usually test themselves and nowhere is it explicitly stated that the nursing homes are responsible for testing the visitors. But in practice there is hardly any other way to do it. “Many of our visitors are relatives of residents, who are often around 80 themselves,” says Claudia Appelt, spokeswoman for Caritas Altenhilfe. They often don’t even know where to do such a quick test.
Appelt is – just like Meurer – willing to continue to allow visits. The rapid tests are in principle a good thing. But don’t think through to the end of how this should work. “There is enormous pressure on the facilities,” says Appelt. “We’re collapsing,” says Meurer, who likes to use more drastic words.
Meurer: “You can’t close the homes”
And if there is also a corona outbreak in a home, it no longer works. That was the case five weeks ago in one of his nursing homes. At that time, 35 percent of the staff had to be in quarantine. He was only able to keep operations going because a business partner who runs another nursing home could help out with staff. “But what if you can’t find someone to help out?” Asks Meurer. “You can’t close the homes.”
And once an infection is in a home, it is difficult to contain. Often 40 percent of residents have dementia, explains Appelt. “It is difficult for them to adhere to hygiene regulations because they do not understand it at all.” And everyday work becomes even more difficult for employees because they have to constantly put on and take off protective clothing, disinfect objects and be extremely careful not to carry the infection from one to the other when looking after infected and non-infected people. And yet – it cannot be prevented entirely.
Calls for help from all sides
In addition, there is the psychological stress on the employees who are afraid of being infected, explains Meurer. Because they see that colleagues have been infected, sometimes with severe courses. “You can’t bow low enough to these people if they keep coming to work.” That is not a matter of course.
Calls for help can therefore be heard from all sides: The Bavarian Minister of Health Melanie Huml (CSU) asks all nursing staff who are currently not working in nursing to register for voluntary support. This “care pool”, which already existed in spring, is now to be reactivated. There are also similar models in other federal states, such as Hesse and Berlin. Diakonie boss Ulrich Lille calls for a “real reform of long-term care insurance” in order to counter the shortage of staff. According to the media, the German Nursing Council calls on politicians to declare the state of emergency and increase the lack of staff for the tests in the facilities. For example, by armed forces, by the medical service of the health insurance (MDK) or aid organizations.
Berlin: Twelve mobile test teams for 300 nursing homes
Bpa President Meurer is also calling for personal help. With the outbreak at his nursing home five weeks ago, he felt left alone. “Of course, I asked for the Bundeswehr paramedics, MDK personnel and medical students who were always mentioned,” he says. But nobody came. They were needed in the health authorities, they said.
Such aids are already available in isolated cases. In Berlin, for example, there are mobile test teams that are supposed to support the nursing homes, the Berlin Senate announced on request. Far too few, however. 12 test teams for 300 Berlin facilities. That is not enough back and front.
Appelt: “Christmas should be celebrated anyway”
And so the institutions try to help themselves. Especially since Christmas is approaching and there is the firm will to celebrate this festival with the residents despite the restrictions. “We made a call to our administration staff to see if one or the other could help over Christmas,” says Caritas Altenhilfe spokeswoman Appelt. Relatives are also written to and asked for support. Visits should definitely be made possible, even if that means that the homes would have to test the visitors.
Hope for relaxation brings the announcement that the first vaccinations can start between Christmas and New Year’s Eve. However, it will still be a while before all nursing home residents are vaccinated. And the fear is already now that a lot will be stuck to the homes again. The residents or their carers must have signed the declaration of consent and bring them to the vaccination appointment. To do this, a medical consultation would have to take place in advance. Who should organize this? Not clear.
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