Q&A with Samuel Maierovits, Managing Director at Hudson Healthcare

Pitkerro Care Centre in Dundee was ravaged by an outbreak of COVID-19 last month that resulted in the tragic death of several beloved residents and a treasured member of the nursing staff. The grief-stricken care home faced a barrage of unwelcome publicity due to the spike in deaths and a complaint to the Care Inspectorate that was not upheld. Thankfully, the home has now gone through the peak of the pandemic, several residents who tested positive are recovering well, and staff have been buoyed by the heartfelt support of residents and their relatives.

In an exclusive interview, Samuel Maierovits, managing director of Hudson Healthcare, that runs Pitkerro and three other UK care homes, tells Lisa Thomlinson about the loss and learning that has come out of this grim experience.

Q. We understand that this is an incredibly tough time for care homes and their staff. Please can you give examples of how your staff are going above and beyond at this time?

A. Those working in the care sector didn’t need a pandemic to show us how heroic our staff are. That said, I’ve been blown away by how effectively they’ve adapted in the best interests of our residents. There are two themes to how staff are going above and beyond: supporting our residents, and supporting one another.

The staff are going above and beyond for our residents. It is such a challenge providing care where residents are isolating in their rooms and carers are wearing PPE, but the staff are making it work. Video calling for relatives is taking place daily so that residents can keep in touch with their loved ones. The staff are also keeping up all sorts of activities to keep residents entertained and occupied, from cupcake decorating competitions to bingo. In a time where the residents are not able to see their actual families, staff are stepping up to really fill the gap as best they possibly can. It’s incredibly heart-warming and effective.

There are also a few ways our staff have supported one another. The first is through practical support. Where staff have been self-isolating, we’ve been quick to ensure they receive the support they need. This has included delivering food and medicine to their houses, which has only been possible because our healthy staff are playing their part. The second is emotional support. It’s so hard providing high quality care in this environment – not just because of the shift in delivery, but because their work is constantly under the media and public spotlight. Staff have had one-two-one and small group support sessions, making sure they’re aware of the most recent government guidance as well as receiving practical support during these difficult times. I’ve found that the support they provide one another is just as valuable as the official support they get from us and the authorities, which is a testament to how care homes really do operate as families.

Q. We are extremely sorry to read media reports of recent deaths of residents and a nurse at Pitkerro. How have your family-run business and staff coped with this sad loss in the eye of such publicity? What are you doing to support and reassure residents and relatives at this time?

A. The entire Hudson Healthcare family were devastated by the passing of one of our staff members over the Easter bank holiday weekend. She was wonderfully compassionate, extremely hard-working and much-loved by all.

We have an enormous responsibility to our staff and residents, and their families, so it’s only right that we’re held accountable. Unfortunately, a lot of the publicity we received was based on misinformation and misunderstandings of the guidance. What’s got us through those extremely difficult days is the overwhelming support we’ve had from our staff and residents’ families. I’ve lost count of the positive calls, Facebook messages and emails we’ve had over the past few weeks. Those with a personal connection to the Home have recognised the heroic efforts of all our staff. The daughter of one of our former residents, who sadly passed away in recent weeks, even wrote an open letter to the Dundee community alongside one of our members of staff, talking about the amazing work being done by the staff at the Home. That, alongside all those messages of support, really has kept us going.

That said, we can’t be complacent. We’re very fortunate that our residents’ relatives are understanding and supportive. We try to keep them updated as often as possible, writing almost weekly or as and when there are important updates. They can also call anytime to get updates on their loved ones or the Home more generally. Early on we introduced regular video calling opportunities so residents can keep in touch with their loved ones, and a number of families have also popped by the home to say hello to residents through the window.

Q. What has been the scale of the impact of COVID-19 on your business?

A. We’re fortunate that only one of our homes has had an outbreak of Covid-19. Whilst that has, of course, been an enormous challenge, the other homes are managing very well so far. At Pitkerro, where there has been an outbreak, the signs indicate that we might be past the peak; and our staff have done an incredible job keeping residents and one another as safe as possible.

Whilst we won’t be complacent, things are also looking increasingly positive. Most of our staff at Pitkerro have self-isolated at some point or another; they’re returning to work or have already returned. The number of residents showing symptoms has dropped drastically in recent weeks, and several residents who tested positive are showing good signs of recovery.

Q. How well prepared would you say Hudson Healthcare and the care home sector in general was for a pandemic? What contingency plans did you have in place and who advised you?

A. We were well-prepared for Covid-19. We began introducing measures before they were required by the government, which is why in most cases our homes were able to get ahead of the virus. We also began procuring PPE from early March across our Homes, meaning our stocks have always been healthy and provided in line with the official guidance.

One thing this crisis has taught me is the value of communicating effectively. We’re in a clinical business, so there’s no doubt that we need to get our clinical decisions right. That said, the majority of people aren’t clinicians – including residents and their families. Being able to communicate clearly to them, and indeed the public, is vital, especially during a crisis. We’ve worked closely with our communications agency, The PR Office, for a number of years; their professional advice has been extremely valuable, especially in recent weeks.

Of course, as well-prepared as anyone was for the virus, there’s always some things that are out of our hands. We’re doing our very best in the circumstances, and we’re committed to continuing to do so.

Q. When the pandemic struck and the country went into lockdown, how much initial support do you feel the Care Home sector received from the Government and NHS? There has been a lot of discussion about the fact that the Care Home sector was largely ignored in the early days of the pandemic and left to battle on alone. What more could the Government and NHS England have done to mitigate the impact of COVID-19 on your residents, staff and business? Were they a forgotten community in your view?

A. We’re not interested in pointing fingers or assigning blame. We know that everyone is doing all they can to deal with this situation, including the Government. What’s important is that everyone works together to address these challenges.

We’ve enjoyed a positive relationship with the authorities, including local authorities, Public Health and the relevant regulators. All of them are doing their utmost to support us throughout these difficult times. What I would say is that the sector has had very little say over what the guidance is or how it’s communicated to the public, and this has been a key challenge for us. In terms of PPE, we were proactive in sourcing what was required privately, rather than waiting for the Government; other homes and providers weren’t so lucky.

The divide between Health and Social Care, and extreme underfunding of the latter, has been a political ‘hot potato’ in the country for many years. I think the current crisis has made it clear how equally important both are to society’s overall wellbeing. I would hope that this crisis will have helped policymakers understand this and once and for all find a solution to the long-term problem of Social Care being underfunded. I am hopeful that one of the profound positive changes the Covid-19 crisis will have had on UK society will be the respect we have towards the elderly amongst us and how we care for them.  

Q. What infection prevention and control measures do you have in place to keep your staff and residents safe at this time and to protect them against spread of the virus? Do you have any initiatives or solutions to share with other care homes?

A.The most important control we put in place across our homes was ensuring that staff self-isolated if they displayed any symptoms at all. This has included staff being tested for fevers before and after every shift, as well as completing an oral health check with a senior colleague. In recent weeks, we have also ensure that staff are able to get Covid-19 tests so that we are certain that they are safe to return to work.

Likewise, residents have had their temperatures checked every day, with carers also completing a health check. We have a very precise care plan system that means staff are notified of any residents displaying symptoms and/or that have tested positive for Covid-19. This means that the appropriate PPE and procedures can be in place all of the time.

The units within each home have been isolated from each other since early March; each with its own staff team, rest areas and changing facilities. This means that should an outbreak occur, we can more stringently lock down individual units to curb the virus’s spread. It is very likely that this had a major impact on limiting the impact of Covid-19 at Pitkerro Care Centre.

Q. Do you have adequate access to PPE and testing of staff and patients? What is your view on the situation surrounding these two issues?

A. We have had adequate access to PPE throughout this period. However, this is partly due to the fact we have sourced PPE directly through private providers, rather than waiting for support from the authorities. We know other care homes have not been so lucky.

As for testing, the guidance has restricted us to some extent. Early on, we had very good access to testing for both staff and residents. This has continued for any home where there was no outbreak. At Pitkerro, where there was an outbreak confirmed, residents were not able to access testing under the official guidance; although staff have had good access to testing throughout this period. The guidance has changed in recent days, but at the time it resulted in it being difficult to track precisely which residents were falling ill due to Covid-19, and which residents were ill due to other causes.

Q. What advice would you give to other care home managers and staff about how to cope with the practical and emotional aspects of the pandemic? How are you looking after the health and wellbeing of your staff and residents?

A. Communication, communication, communication.

I can’t stress enough how important it is to communicate; with each other, staff, residents, relatives, regulators, commissioners, suppliers, the general public and so on. Early on, we set up daily management meetings over video conference between home managers and head office management. Sharing ideas across the company and different geographical locations was very effective in helping us stay a step ahead of the situation all along. More importantly, the group sessions at times felt like group therapy sessions where everyone facing similar challenges was able to support each other. Realising this, we extended the concept to group staff sessions within the homes to help share important information, talk about anxieties and share ideas. Regular stakeholder letters, daily Facebook posts and resident Skype video calling all made relatives feel closer than ever despite the lockdown and no visitors. Daily contact with regulators and commissioners helped share important information both ways, reducing potential anxieties from the unknown.

Q. How have you coped with a constant barrage of criticism in the media and online as well as a report to the Care Inspectorate? What advice would you give to other care home operators who may find themselves in this situation?

A. We take transparency very seriously. As such, we have responded to every single request for a comment from the media, and are regularly posting on Facebook to keep the public informed.

Our belief is that misinformation is best challenged through information and evidence. That’s why we have taken steps like publishing a timeline of events which outlined exactly when decisions were made relating to Covid-19. The immense support we’ve received from residents’ relatives and our staff has helped us get through the most difficult times.

The report to the Care Inspectorate was a shame, but we were confident that it would not result in any serious issues. This is because we have been working very closely with the Care Inspectorate throughout this crisis to ensure we have followed the guidance every step of the way. Whilst they have to respond to every report thoroughly and equally, there is an understanding that we have been doing all that is required of us and more. The Care Inspectorate recently informed us that they were not upholding any of the allegations made against us.

I’ve learned a huge amount from this experience, as I’m sure many of my colleagues have too. Firstly, I think it’s extremely important to be self-reflective and self-critical. It’s because we so forensically looked through our decisions that we were able to confidently say that many of the allegations made against us in recent weeks were false. In some small instances, we did make mistakes; again, by being self-critical, we were able to hold up our hands and apologise.

Tied to this is the importance of being transparent. We have maintained open communications channels since the start of the crisis. We have absolutely nothing to hide; this makes our residents’ relatives more comfortable, and also means our staff can get on with the job. I’ve found that getting ahead of a crisis is as important as dealing with it.

Q. Have you adopted any particularly useful digital tools or technologies to support your care homes during the pandemic and going forward, for example, to support resident to communicate with their families or with GPs and other clinicians during lockdown?

A. We have made good use out of video calling technology, such as Skype. This has meant that residents can keep in touch with their loved ones, and many medical appointments have also been able to continue in this way. Many of our residents have family that live far away. I expect that video calling will be a more prevalent feature of care delivery moving forwards, even if/when society returns to normal.

Our care plan system, Person Centred Care, was implemented from last year, but has proven to be particularly effective during Covid-19. It can track a resident’s care in outstanding detail, meaning care delivery can be truly personalised. This has been vital in ensuring staff know exactly what care residents need.

Q. What do you think the long-term impact of COVID-19 will be on your business and the Care Home sector as a whole?

A. One positive impact of Covid-19 will be how the public at large respects the work done by care providers. Our staff are so moved when the British people come out to applaud them at 8pm every Thursday. I’m an optimist and really do think this recognition will continue for the long-term.