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Managers at ERS ‘play it safe’, restricting access to families for a little longer

Managers at the Elderly Residential Services are “playing it safe” and have no immediate plans to allow access to relatives of residents who have spent over eight weeks in total lockdown, Clinical Director Dr Antonio Marin said yesterday, as he urged families to continue making a sacrifice for the wellbeing of their loved ones.

Gibraltar’s care homes have been closed off to visitors from the start of the response to the Covid-19 pandemic and are likely to be the last element to be released from lockdown even as restrictions in other areas are eased.

Strict measures put in place, including staff screening and protective steps inside the homes, have so far shielded the most vulnerable members of the community, but there is still a need for maximum caution.

Appearing alongside the Minister for Public Health, Dr John Cortes, Dr Marin said this access for relatives would be reviewed by the Health Ministry, the Director of Public Health and the Civil Contingency Ministry over the coming weeks, but the outcome of those deliberations depends on trends in the wider community.

The virus has an incubation period of 10 to 15 days, and with de-escalation measures currently taking place the situation will have to be reviewed after that period has elapsed, he said.

“For now, it is too early to take a decision,” Dr Marin said.

“The first lockdown was in the nursing home and we believe that the last one to come out of the lockdown should be the nursing home.”

“But we all acknowledge what the family and friends are going through, it is a difficult time.”

“But looking at the numbers, although it has been a sacrifice, we have a good output.”

“I think the sacrifice should continue for a few more weeks and I think we should play it safe.”

Testing for Covid-19 continues at ERS after three residents contracted the virus, and over the past two months 13 symptomatic swabs were carried out while these residents were transferred to the designated isolation unit, Dr Marin said.

All 13 tests returned a negative result and there have been no further cases in any of the homes.

Meanwhile staff members have also tested negative for Covid-19 with 90 swabs carried out at Mount Alvernia, 75 at Hillside, 25 at John Mackintosh Home and 10 at Bella Vista so far.

“We will continue with our staff screening and any suspected case will be swabbed and advised to self-isolate pending results,” Dr Marin said.

The death rate in ERS has also fallen in comparison to last year, with 10 deaths recorded in April 2019 and six deaths recorded last month.

The total average of deaths from January to April 2018 and 2019 were a total of 56, and in comparison to the same time period this year, the number has fallen by 40% to 34 deaths.

Dr Marin said there is a high life expectancy in the nursing homes, with the average age profile for deaths at 86.7 years for men and 90.3 years for women.

The causes of deaths were dementia, cancer, stroke, cardiac arrest, sepsis and peripheral vascular disease, and all tested negative for Covid-19.

Over the past two months since the ERS has been converted into a medical unit, a total of 41 episodes of medical interventions were carried out which would have previously been seen by doctors at St Bernard’s Hospital.

Last year 20 residents were transferred to the hospital for care in the months of March and April, with a total of 130 days of bed occupancy.

This year 22 emergency cases were treated in the medical unit at ERS, freeing hospital beds, Dr Marin said.

“We have noticed that, even in acute cases, the incidence of delirium has significantly reduced,” Dr Marin added.

“This is mainly due to the fact that they have been treated in their own environment, but it is also due to the increment of the nursing workforce in order to provide continuity of care and the necessary cover for those nursing staff self-isolating while waiting swab results.”

Dr Marin said a discussion will have to be held between the GHA and the ERS to look at a future different model of care for the elderly.

“The figures show that things can be done in a different way,” Dr Marin said.

“We all know that the hospital is not built for the frail elderly and we know that it can sometimes cause more harm than benefits.”

Dr Marin said moving medical services up to the ERS facilities has contributed to “reduced pressure” on the hospital, adding: “We have seen an increase not just on life expectancy but also on quality of life.”

“There have been fewer incidents of falls and less incidents of delirium, and patients are quite well controlled and, perhaps in the future, we should consider moving the hospital to the nursing home and not the other way around.”

Meanwhile Dr Cortes said Gibraltar is “very well provided”, with enough empty hospital beds available for over 1% of the population of Gibraltar.

Dr Cortes read out yesterday’s figures, adding that a total 9.5% of Gibraltar’s population has been tested for Covid-19.

Of 3,104 swabs have been carried out and 143 test results are pending.

Of the tests carried out, 2,713 individuals tested negative for Covid-19, meanwhile 11 out of 144 confirmed cases of coronavirus remain active.