The contract, from Trafford Council in Greater Manchester, outlines how eligible care homes will receive COVID-positive patients within just 2 hours of the patient being identified by the hospital as ready for discharge.
It also sets out terms for the “Rapid Discharge” of patients from hospital, and states that “some of these patients may have COVID-19, whether symptomatic or asymptomatic.”
A leading clinician warned it could become “commonplace” for hospital patients carrying COVID-19 to be discharged into care homes in England this winter, despite the controversy it caused in the early months of the pandemic.
Professor Adam Gordon told Channel 4 News that discharging patients from hospital to care homes was “accelerated and escalated” in the early months of the pandemic and that it could happen again in line with the latest UK Government guidance.
UK government guidance updated on September 16 reiterates that care homes in England should be prepared to accept COVID-19 positive patients from hospitals.
“As part of the national effort, the care sector also plays a vital role in accepting patients as they’re discharged from hospital, because recuperation is better in non-acute settings.
“Some of these patients may have COVID-19.”
The guidance also states that care homes will not be forced to admit COVID-19 positive patients.
In Scotland, patients should test negative twice before being discharged from hospital to a care home.
Earlier in the pandemic tests were not required before discharging patients from hospitals to care homes.
The latest data from the Office for National Statistics is that there were 15,501 COVID-19 related deaths in care homes in England and Wales up to 4 September.
A worker at a national care home provider (who asked not to be identified) told Channel 4 News there was “pressure” from local authorities to take patients, including those carrying the virus.
“They are aiming now for patients to be out of hospital into a care home within a few hours from the decision to discharge them. That process used to take about a week.
“We have contracts with local authorities for block beds and you have to have a very good reason to reject a referral.
Ethically and operationally it’s difficult to refuse a patient who’s arrived in an ambulance at the care home door as many could die from the back and forth.
“There is an expectation and pressure to accept all patients.”
The insider said current problems with testing in the UK meant care homes could not know whether the virus was circulating in the home after accepting COVID positive patients.
“When you’re bringing COVID positive patients into a care home many will die. We have strong procedures to prevent the spread, but this virus is extremely contagious.
“We are relying on the testing system to help keep our residents and staff safe.
“We have staff and vulnerable residents who are being put in danger. Care homes may not be safeguarded and no one in Government seems to care.”
Professor Adam Gordon, of the British Geriatrics Society, has been running a “red zone” COVID ward in a hospital during the pandemic and says infection control precautions taken in hospital present a challenge for care homes to replicate.
Professor Gordon said: “It can be very difficult to isolate people with COVID safely. And it’s a really quite significant burden to place on care homes to take that responsibility when they perhaps haven’t been able to see the patient and aren’t quite sure what their care needs will be at the point of discharge.”
“Care homes are not hospitals. They are designed to be homes, and, in many instances, care home staff are not healthcare professionals who in the past have had really in-depth training in infection control.
“If you were to be absolutely belt and braces about this, you might choose to isolate patients in an NHS setting until such time as they were confirmed to be COVID negative.”
Professor Gordon warned that under the current guidance it would not be unusual for COVID positive patients to be discharged from care homes into hospitals:
“The last time around we saw the hospital system under pressure and part of the response of that was to try to accelerate and escalate discharge into care homes.
“If we see similar pressures on the hospital sector this time around then it will be commonplace under the current guidance that people who are COVID positive will be discharged back into care homes.”
A spokesperson for Trafford Council said: “The discharge of patients from hospital is a carefully co-ordinated process in line with national government guidance.
“At all times, the health and wellbeing of the person being discharged is our primary concern and, if they are discharged to a care home, we make sure it is one that meets their health and social care needs.
“We appreciate that there is a quick turnaround but our contracts reflect the national requirements to ensure people are discharged safely and quickly. The alternative to doing this would be to leave the person in hospital. This would mean that the person’s recovery may take longer in an inappropriate setting, leaving them at higher risk of infection while also preventing seriously ill people being admitted to hospital to receive critical care when they need it.
“It is also in the contract that care homes have the right to refuse to accept a patient – and no patient is transferred to a care home without discussion and agreement of the care home. It would be totally against our values simply to turn up at a care home without the care home’s prior agreement. It would also be against the interests of both the care home and the person.
“It is also important to note that we insisted from the start of the pandemic that any patients ready for discharge were tested for coronavirus beforehand to reduce the risk of infection within the community.
“The care homes in Trafford who provide the Rapid Discharge to Assess service have been extremely supportive throughout this pandemic and we are very proud to be working alongside them to ensure our residents are well looked after at all times.”
And the Department for Health and Social Care sent us a statement in response saying “our priority is to ensure that people are discharged safely from hospital to the most appropriate place, and that they continue to receive the care and support they need”.
And it goes on, “No care home will be forced to admit an existing or new resident to the care home if they do not feel they can provide the appropriate care.”
Watch the full report on Channel 4 News at 7pm.