It’s not easy being pin-sharp and relatively young in a nursing home. James, 73, was a meteorologist before he retired and has advised governments all over the world. When he and his wife, who both suffer from severe arthritis, felt obliged to stop living independently last year, he wasn’t ready to be wrapped in cotton wool: “We warned them when we came in: “no one calls us ‘darling’.”
James likes to keep himself informed. He reads the news every night on the computer in his room: the BBC, the Belfast Telegraph (“for a slightly different perspective”) as well as his local paper. But since the coronavirus outbreak, he’s been struggling to establish what’s going on in his own care home.
I first started talking to James in mid-March. I’d been reading reports of care homes banning visitors and wondered what life was like behind the lines (not realising that the whole of Britain would be put into lockdown a few days later). I asked around to find someone in a care home who would be willing to speak about it and I was put in touch with James, a wry man with a faint East Anglian twang. I’ve never met him in person, so I don’t know what he looks like. When I asked he told me he had a rosy face from spending too much time working in countries with plentiful sunshine and cheap gin. I’d expected someone in his situation to sound fearful about contracting the virus, eager even, for more protective intervention. But James came across more like the Winston Smith of residential nursing: “Little doubts are niggling us and I don't want to ask too much in case I get told I’m too inquisitive,” he said, making an ominous reference to falling “foul of the authorities”.
The home James lives in is a modern building in East Anglia that resembles a pleasant mid-range hotel. It’s generally well-run and he likes the people who work there. But the sense of powerlessness that everyone struggles with when a novel infectious disease rampages through the world is magnified when you’re completely dependent on paid carers. In the absence of official communications, James has relied on conversations with individual staff members to make sense of the growing number of changes going on around him – missing parcels, the sudden appearance of masks on the carer’s faces. Some will stop and make an effort to communicate what’s going on, he explained, others “will say ‘don’t worry about it, dear’, pat your head and go away.”
James was unsettled by the opaque way that new restrictions were introduced. He only found out that there was a new policy banning non-family visitors, when a friend was turned away at the door. Around the same time, one of his carers mentioned in passing that staff were having their temperatures taken before being allowed in. “We have not had any official communications as to what we’re doing and why we're doing it,” he complained.
While coronavirus deaths in hospitals are gradually starting to decline, the disease continues to sweep mercilessly through Britain’s elderly care sector. The latest figures from the ONS show that a third of all coronavirus deaths in England and Wales are now happening in care homes. In Scotland and Northern Ireland it is more than half. It’s hard to confirm the exact death toll across the country as so few people dying outside hospitals are tested. An analysis by the Financial Times estimates that around 11,000 more people than normal have died in care homes since coronavirus hit the country.
James’s home has so far been spared, but even if the pandemic is brought under control, it is likely that institutions such as his will have to remain in isolation for much longer than society at large. He will not be able to see his children or any of his friends. The care-home staff are preoccupied. They’re mostly local women, with families of their own to worry about. With some having had to go into precautionary self-isolation and others dealing with the fallout of the lockdown on their own lives, it has felt like those who are there don’t really have time to chat. “You can hear them talking among themselves,” James said. “They’re very concerned about their families…finding time to go to the shops, finding anything in the shops, which of course we’re shielded from.” In our most recent phone call, James’s loneliness was palpable: “I would dearly love a conversation with someone from time to time,” he told me.
The atmosphere in the home – never exactly electric – has become even more desultory. Nearly all the diversions its 30-odd residents had before – the church service, the travelling library, the visiting musician who’d lead singalongs – have been snuffed out by the lockdown. Some residents simply slump in front of the TV next to the dining room as it blares out 24 hour news (“it’s just depressing”). It’s hard to find the opportunity to speak with other residents. James’s closest friend has taken to staying in her room since the visitor ban in case she misses a phone call from her son. James and his wife are now the only ones who take their meals in the dining room.
James started running a monthly quiz on Wednesday afternoons when he first arrived in the home. The questions were on history, mainly: which novelist wrote “Bleak House”? Who discovered penicillin? It got the conversation going at least. When he tried to do it a few weeks ago however, the quiz was a wash-out. Death and infirmity had already been chipping away at the participants before the coronavirus outbreak, and with no visitors to bulk up the numbers, it was no longer really viable. “We were always scraping the barrel a bit in having enough members of the lucid community around”, he said ruefully.
Even after he gave up on the quiz, James thought he might try and start a discussion about the current situation with his fellow residents. He checks statistics on the spread of coronavirus every day, and thinks the media are making it seem more terrifying than it actually is (“it’s not the bubonic plague”). Handicrafts sessions are still being offered once a week, and James went along to one recently with the hope of starting a group conversation while people knitted. When he got there he found that someone had put on a CD of wartime songs, and he couldn’t bring himself to compete with “Pack Up Your Troubles”.
Unable to have a proper conversation in the home, James has been trying to engage in public debate. He had a letter published in a local newspaper, and wrote to his MP politely urging him to think about whether the restrictions were just. “Since the precautions have been in place, I have wondered about the balance between advice, direction, and curtailment of civil liberties and human rights,” he wrote. “I now feel that this fine balance has been tipped towards the latter.”
He has also been trying to find out whether other care homes in the area have had outbreaks – he’s been reading the local press, asking his son if he has heard anything, and quizzing the carers in his home. The management eventually confirmed that other local institutions had been affected, though, as James noted, they didn’t inform the residents of this, instead sending an email to their next of kin.
James doesn’t worry about getting ill himself: it’s much like worrying about a bullet with your name on it in a war. What he does worry about is whether the home will be able to keep operating if the lockdown carries on for a long time. He’s also worried about being able to pay for it. He and his wife were in the process of selling their house to secure their place in the home, but the buyer dropped out and the housing market is now frozen. “What the hell will we do?” he asked. In the early hours of the morning his worries get to him. “I try not to get too depressed about it,” he said, “which isn't to say I don’t get depressed, but I try not to show it.”
When the peak of the infection was approaching and it was unclear whether hospital resources could cope, NHS staff began preparations to make decisions about whose life was worth preserving. Politicians trying to restart the economy will have to choose whose way of life to prioritise. Reports have suggested that one option being considered is to keep people over 70 in isolation until a vaccine is available, while restrictions on the rest of society are lifted. The prospect of blanket age-based restrictions has stoked fears about the impact of prolonged isolation on a huge swathe of the population. It’s a cold calculation, easier to make when people like James are not part of the conversation.
On Mothers’ Day this year, one of James’s friends at the care home got a visit from her son. He didn’t enter, but chatted to his mum from the doorstep. It cheered her up. It cheered everyone up. A few days later, the staff decided to help some of the residents go out into the garden. They sat in the spring sunshine. “The daffodils were coming out, there was lots nesting, and lots of small birds hopping around and twittering,” James recalls. “It was lovely to get outside and get fresh air.”•