The painful consideration in nursing homes: elderly people with dementia should no longer wander

Demented elderly wander. This is because their brains no longer understand the here and now; they look for their mother, for their parental home, for their bicycle. And sometimes the demented person walks to relax: walk, walk, walk.

But wandering is not possible if you are infected with the new coronavirus, nor if you are infected presumably are infected.

If you don’t understand that, because you’re demented, the door has to be locked. And if you get angry about that, because you don’t understand it, you will be sedated. Although everyone in nursing home care avoids such measures for as long as possible, they can sometimes not be prevented during a pandemic, says geriatric specialist Nienke Nieuwenhuizen, chairman of the professional association Verenso. “They are painful tradeoffs between the rights of the individual [om te dwalen], the right of the group of vulnerable residents of the nursing home [om niet besmet te raken], and the law of society [om verspreiding te beperken]. ”

Also read: Half of elderly people with dementia in Rotterdam nursing home died

Lock up. No visit. Double pneumonia. Insufficient protective clothing for staff. And a lot of uncertainty, because corona tests are missing. The biggest dramas of the new coronavirus take place in the hospitals, but just as well in the nursing homes On Wednesday, 4,160 residents were already infected (or suspected) and at least 389 died. Much more than appears from the figures of the RIVM, because these only the tested people count in the mortality rates.

Not tested for weeks

But nursing home residents – elderly people who are too weak or demented to take care of themselves – were not tested for weeks, while the epidemic was already underway. “Nursing homes were told ‘no’ by the local GGD if they wanted to have a resident or carer tested. You are not entitled to a test, they said, ”says Nieuwenhuizen.

Verenso keeps track of who they think from mid-March that has Covid-19. They do this in the two large electronic patient files, of Nedap and Ysis, that use nursing homes. Nieuwenhuizen: “We can now easily recognize the clinical picture. This was initially difficult because older people cannot always tell what they are bothered by. And the elderly usually don’t get a fever because their immune system is less effective. ” And if you did not have a fever, you were not eligible for a test for a long time.

Tested in the morgue

Some deceased nursing home residents were tested afterwards, in the morgue, says Jeroen van den Oever, director of Fundis, a large nursing home in South Holland. “At least then we knew that person had Covid-19 and that family and staff had to be isolated.”

For weeks in the Netherlands the standard “did not test, unless”. The shortage of test options weighed in the government’s strategy for how to deal with the corona crisis.

The Ministry of Health, Welfare and Sport (VWS) left at the end of March NRC knowing that the lack of testing was not an urgent problem. “The test infrastructure is in order. There is enough manpower to test, ”the department wrote in writing. Minister Hugo de Jonge (VWS, CDA) wrote in a letter to the House of Representatives: “Since the test policy in the Netherlands has so far been partly geared to the available capacity and the expected need for tests, there has been no question to date. shortages of test kits. ”

The cabinet did change course at the end of last month. On March 31, De Jonge promised a broader test regime. But health workers read the new criteria this week and were disappointed. It makes little difference; they are still hardly eligible for a corona test.

If health care workers have Covid-19 symptoms, they should stay at home. And if that is not possible due to staff shortages, they have to continue working, but with masks and gloves, until the test result is there.

But you can also be contagious if you don’t have any symptoms yet? Nienke Nieuwenhuizen: “We assume the scarcity. The GGD only uses the test for people who are more likely to have it; namely when they have symptoms and are needed in the workplace. “

In the back of the row

The nursing homes are also in the back of the row when distributing protective equipment (mouth masks, glasses, aprons) and medicines. Jeroen van den Oever, of Fundis: “It is not transparent on which grounds VWS distributes the masks and aprons. We just don’t know. ”

While that distribution key – which the sector has been waiting for for weeks – is very easy to devise, says Nienke Nieuwenhuizen.

Also read: If your chance of survival is small, you will not end up in intensive care in the Netherlands

Three or four mouth masks should be distributed around each Covid-19 patient or suspect. So that caregivers can go to that patient protected three to four times a day. “It’s about the patient, not where it is: here, at home or in the hospital. But now hospitals are at the forefront of the distribution. ”

VWS has sought advice from experts on this ‘prioritization issue’, Minister De Jonge wrote to the House of Representatives on Tuesday evening. He expects to have that next week. In addition, he wrote, the “new testing policy” also provides an opportunity to determine relatively often and quickly whether or not someone has COVID-19. “

Are cohort wards in nursing homes not a solution? It is more difficult to organize cohort units (infected patients among themselves) in a nursing home than in the hospital, says Anneke van Strien, a doctor in nursing homes at The Hague Sapphire. “In the hospital, the patient only has a bed and a cupboard, you can move that to a cohort ward where only Covid-19 patients are located. Someone lives in a nursing home. So if you want to bring the Covid-19 patients together in one department, it’s a big move. ” But it has to be, she says. Because there, in a cohort department, the elderly can walk and wander among themselves.

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