Every now and then the day job creeps into this blog. A few weeks ago I wrote about how COVID guidance of a ‘one size fits all’ variety doesn’t work particularly well when considering someone’s mental wellbeing. This is particularly true where the person concerned has a learning disability. [More of that here, if you are interested].
Given the ever shifting sands upon which Government guidance is being built upon, it is perhaps not surprising that not everything is as straightforward as it appears.
During the week commencing 11 May 2020, one of the tenants that we support received a ‘shielding letter’ in respect of COVID 19. The letter was dated from the previous week, several weeks after the initial coronavirus ‘lockdown’ was implemented by the Government. The reason for receipt of this letter would appear to be as a result of his having had significant health conditions since birth, which place him in the ‘high risk’ category, should he becoming infected with the virus. Allied to these long standing health concerns, he is diagnosed with ADHD. Medication, allied to routine and structure, have benefitted him enormously, and have ameliorated a lot of his more challenging behaviours.
He lives in shared accommodation, and requires round the clock support both indoors and outside. At present he is sharing the property with one other tenant. Since the lockdown commenced, (and indeed prior to that), he has undertaken a daily walk, supported by staff, in the vicinity of his home. Self-evidently, any change brought about by restricting his movement is likely to significantly undermine the progress made in respect of his behaviours.
It is perhaps worth providing some context. The housing estate on which he lives is at the edge of a rural area, with significant amounts of green space on the estate. The walk that he undertakes is a loop of approximately 30 minutes duration, and utilises the green spaces. The likelihood of him encountering other residents is limited. There is also sufficient space on the roads/pathways for staff to ensure that a two metre distance can be maintained should the need arise. Staff confirm that he looks forward to this daily activity. It helps him to break up the day, burn off excess energy, and most importantly provide him with a purpose and routine.
There is sufficient evidence to indicate that he lacks the mental capacity to make informed decisions about the best course of action to maintain his wellbeing, and in particular strategies which could benefit his mental wellbeing. Confining him to his home, and preventing him from undertaking his daily walk would be significantly detrimental to his mental wellbeing, and poses a far greater risk to him than that posed by a supported walk in the community as described above.
In addition, we need to consider the impact that not being able to benefit from regular walks would have on his co-tenant, and indeed the staff supporting him. His level of agitation would significantly increase, he would be more likely to exhibit noisy and aggressive outbursts. His sleep patterns would once again become disturbed, as would those of others staying in the house. This will undoubtedly have an impact on the mental wellbeing of those sharing his living space. In short, confining him to the house after several weeks of a well-established routine during these difficult times, is likely to undermine all of the progress made by him to date.
Self evidently, we cannot apply both, which highlights the real difficulties involved in moving from he abstract to the real…
You might want to reflect on your own ‘decision’, before reading on…
So let’s look at the current risk management strategies in place.
- Staff are already following guidance in respect of PPE and social distancing to keep tenants and staff safe. This guidance is informed by the ongoing communication which emanates from CQC, (who regulate our activities), the Local Authority and Central Government.
- We are already working with a tenant elsewhere who is living in shared accommodation and has received a shielding letter. There are already processes and procedures in place which can be implemented within this individual’s home immediately. These cover routine processes for cleaning communal areas and strategies for maintaining social distancing in communal areas.
- We operate a cluster system of staffing within our supported living services. This means that staff are ordinarily drawn from a small proportion of the total staffing complement. This has been implemented in order to minimise footfall and therefore reduce the risk of infection.
- Monitoring of all tenants’ general health and wellbeing by staff is a matter of routine and good practice.
So, given all of the above. To continue to walk…or not?
Short version…we continue with supporting him to walk, having consulted with the family, the local health authority, and the local social services. There are sufficient other strategies in place to ensure that we can still protect him from COVID infection. A ‘best interest decision’ taken on his behalf during these difficult times, for the reasons detailed at the beginning of this narrative.
Oh…and one more thing. We appear to be becoming quick to ‘judge’ others’ behaviours and actions during these difficult times, without necessarily understanding the full story…