A question of trust. How coronavirus has weakened the public’s confidence in care homes and how care providers can rebuild it

Nathan Hollow

Over recent months the coronavirus pandemic has impacted many industries in unprecedented ways, but none more so than care homes. More than 14,000 coronavirus-related deaths have occurred in English and Welsh care homes to date (23rd June 2020), with a further 2,000 in Scottish care homes.

Thankfully, the number of care home residents infected and dying is declining across all regions, and many operators are reporting that the number of deaths in their homes is returning to ‘normal’ levels.

From the ‘frying pan’ of one crisis and into the ‘fire’ of another

Whilst this is undoubtedly good news for families, and welcome respite for hard working and courageous frontline carers, the major challenge care home operators now face is how to rebuild occupancy and the financial sustainability of their business. Four Seasons, one of the largest operators in the UK, recently reported that their occupancy had fallen to 79.8%, down around 10% from pre-COVID-19 levels. Other operators who have been affected by the virus are likely to have experienced a similar decline – in part linked to residents passing away and in part due to a significant fall in new placements as homes are ‘locked down’ –  leading to warnings that over 1,000 care homes could collapse financially as a result of COVID-19.

A key challenge in rebuilding occupancy will be in restoring the reputation of care homes and the care sector and investigating whether this has been impacted by coronavirus. Research suggests the appeal of care homes has taken a big hit, with Policy Exchange and IPPR reporting that 31 per cent of people were now less likely to seek residential care for an elderly relative than before coronavirus.

This is no surprise when the sector has faced a torrid time both operationally and at the hands of the media. Mainstream media reporting on coronavirus cases and deaths in care homes has been relentless, and overwhelmingly negative. Blame has been shared by both providers and the Government – a blog topic in itself – but with headlines like “30 Covid deaths at one care home in Oldham” and “Care home deaths account for 40 per cent of UK coronavirus fatalities is it any wonder that the appeal of care homes has declined significantly?

In fact, I struggle to think of another sector which has suffered from such sustained and high-volume negative media reporting, barring perhaps other major crises like the BSE crisis of the early 1990s and the impact that undoubtedly had on the appeal of British beef. (Please tweet me with any other examples).

When thinking about how critical a moment this is for the care sector, it is important to consider whether the decline in the appeal and reputation of care homes is a short term phenomenon or a material change in the public’s mindset. If coronavirus – and the headlines – went away, would care homes regain some of their pre-COVID-19 levels of attraction? Is the coronavirus death rate alone driving this decline, or is this masking a deeper fear amongst the public, perhaps around quality and cleanliness, that coronavirus has simply exacerbated and brought to the fore? With rebuilding occupancy being critical to the financial sustainability of the sector, what can care homes themselves possibly do to win back to confidence of their local community?

What does the public really think?

To explore this, PLMR undertook some research looking at the views of people aged over 55, which is the age group most likely to be making a care placement decision for either a parent or spouse. Our sample size is limited (250 respondents completed the full survey) and the research was completed via a market research tool, rather than by a pollster, meaning we view these findings as indicative of the views of this vital age group, but not academically robust.

First, we set out to establish whether our sample group had experienced a decline in the appeal of care homes. They had, and far more steeply than the IPPR’s research, perhaps reflecting that we were only looking at an age range where care is a more realistic prospect. The results of our survey revealed that 50% of respondents were ‘much less likely’ to consider a care home for an elderly loved one than before coronavirus, with a further 20% being ‘less likely’.

We next wanted to see whether this decline was mirrored by an increase in the popularity of home care, the main alternative for those who need professional care. Here, the results were most mixed, with 40% of people ‘less likely’ to seek home care, whilst 32% were ‘more likely’. Despite the lack of headlines focusing on home care, it seems that the overall appeal of receiving professional care from an external (non-family) organisation has taken a hit, perhaps due to fears around carers spreading the virus, however unfounded those may be.

Returning to the topic of care homes, we then asked why respondents were more or less likely to consider a care home. Unsurprisingly, the most popular response was the fear a loved one would catch coronavirus (37.3%), followed by media reporting on care home deaths (22.5%) and that other care options seemed better (22%). Notably, 10% of respondents expressed concern that care homes might go bankrupt. This poses an interesting communications challenge for the sector, given that it has long needed funding reform and has recently seen an explosion in costs driven by responding to coronavirus meaning this funding reform is now more urgent than ever before. How to campaign for more money whilst appearing financially secure will be a tricky communications tightrope for the industry and particularly larger operators.

Turning to how to fix this, we asked what would increase the likelihood of a respondent considering a care home. We presented a range of options, and they could choose as few or as many as they liked, whilst also offering their own.

The results were quite clear, with 38.6% of people noting a charity run care home would be a preference, followed by a third of respondents noting Government endorsement would help. Perhaps taking a lesson from John Gummer’s famous hamburger photo op during the BSE crisis, we now need Care Minister Helen Whatley and Health and Social Care Secretary Matt Hancock to be seen in and around care homes, publicly backing them as a safe place for the public’s loved ones, including their own.

Around a quarter of people felt positive testimonials from people receiving care (28.4%), or from their loved ones (22.2%), would increase their likelihood of considering a care home, whilst a fifth of people (19.9%) wanted greater oversight and regulation to instil confidence.

We then gave respondents the opportunity to provide their own answer for how care homes themselves (as opposed to systemic change) could become more appealing. There was a big range of answers provided, but key themes were about demonstrating cleanliness, having more staff, having greater transparency around pricing and profit, and increasing the training and skills of their care teams.

Finally, we asked a couple of broader questions to help us understand whether the decline in appeal was a short-term phenomenon or more entrenched. We first asked whether coronavirus no longer being an issue, perhaps due to a vaccine, would change people’s views. 56% of respondents said it would not make a difference, whilst 32% suggested it might make them ‘a little more likely’ to consider a care home.

In our last question we asked which words or phrases respondents associated with care homes. Pleasingly, the top result was ‘community / companionship’, selected by nearly 40% of people. However, we quickly moved into negative territory with 36.6% of people selecting ‘poor quality’ and 18% selecting ‘dangerous’.

How should the sector move forward?

Whilst this research was indicative rather than academic, given the small sample size that focused on one age group, there are several important takeaways.

Firstly, the research suggests that people’s view on care homes may have been materially shifted by the coronavirus crisis, and that this is not a short-term phenomenon that can be resolved simply by the media moving on to focus headlines elsewhere. Fair or not, people are now more fearful that their loved ones will be at risk within a care home setting, both from coronavirus and from ‘poor quality’ care. The way the media has reported the impact of coronavirus on care homes has a large part to play in this, with anyone who has read a great number of articles noticing that care homes are very rarely presented as the “victims” of an invisible new virus that is both difficult to control and disproportionately affects the clientele. Instead, there is an undercurrent that suggests care homes could or should have done more. As one journalist put it to me, “if you have infection control procedures in place, how has the virus affected your home?”

I don’t share this view and I think it speaks to the lack of scientific understanding amongst many journalists and the desire to boil down complex topics with shades of grey into black and white headlines. Commentary from grieving families has only exacerbated this as they (naturally) seek to place blame.

Beyond this, it is clear that care homes can and should take action to rebuild their reputations and the trust the public place in them. Demonstrating preparedness for any second wave will be key; so too will be showcasing that they are clean and safe. Talk of having ‘an infection control plan’ in place will only get you so far if you later need to admit that half of your home has coronavirus. Simpler words and phrases that the average, non-clinical person understands must be deployed to greater effect, but so too must reiterating that this virus can be asymptomatic in a large minority of people.

Furthermore, we know the public believe there are issues around staff training, regulation, and transparency on pricing. All three are within the purview of the provider to more clearly communicate, whether that is in the media, perhaps through celebrating staff training milestones or regulator reports, or in direct communications through your website or when speaking to families. This is particularly crucial if you are raising fees or charging a one-off surcharge in response to the financial costs of responding to coronavirus.

Finally, the most powerful advocates for any care home are the residents and families already attached to it. Whilst the 16,000 people who have died from coronavirus whilst living in a care home is a tragedy for each affected family, it is important to remember there are more than 400,000 people living in care homes. There will be hundreds of thousands of families whose loved one was kept safe, well and entertained throughout lockdown because of the unwavering commitment of their carers.

You don’t need to talk about coronavirus to overcome the negative impact it has had on the reputation of the care sector, but you do need to remind people more vocally than ever before of the overwhelming good that care homes bring to the lives of older people in the communities they serve.

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