Why do we need nursing homes for the elderly

Retirement and nursing homes in the corona crisis"There must be no social isolation"

The massive restrictions on public life in Germany are having an effect: The number of new COVID-19 cases reported every day is falling. That is why the federal and state governments have agreed on a very cautious relaxation of the restrictions. The fear of another steep increase in the number of infections is great, especially since the death rate continues to rise. Which is partly due to the fact that there are more and more outbreaks in nursing and old people's homes.

All articles on the topic of coronavirus (imago / Rob Engelaar / Hollandse Hoogte)

Therefore, in connection with the loosening that has now been decided, the federal government is proposing special protection for nursing homes, senior citizen and disabled facilities - but without completely isolating those affected socially. An approach that the President of Diakonie Deutschland, Ulrich Lilie, welcomes. To do this, however, enough protective masks, protective clothing, gloves and disinfectants would finally have to be available, said Lilie in the Dlf interview. With around 500,000 employees, Diakonie is one of the largest operators of nursing homes in Germany.

Absolute shortage of protective clothing

Silvia Engels: Angela Merkel's somewhat cryptic announcement that nursing home residents should be specially protected, but not socially isolated - is that practicable?

Ulrich Lily: Yes, that is a sentence that I liked a lot. Because last week there were also statements from Prime Ministers who talked about "the old ones" who now need to be protected, and that actually meant that they should keep holding back. That’s a different accent now, that’s going in the right direction. "Protected, but not isolated" said the Chancellor, because that is not ethically justifiable, because old people, the very old and people with multiple illnesses - these are the people who live in the inpatient facilities - are social beings. Without visits, the reality in such inpatient care facilities really looks very different. I think we now need a sense of proportion and the right order and then also have to consider how we can make inpatient facilities accessible again.

(Imago) Seniors and the coronavirus - "Locking up makes you sick"
Older people are considered to be particularly at risk from the coronavirus. Most nursing homes do not allow visits because of this. A condition that many sufferers find counterproductive. Some warn of the consequences of isolation.

Angel: How could that work? Because at the moment we have the situation that there is often no access for visitors at all, and external visits for residents to the senior citizens 'sport or to the senior citizens' café are not possible either. What can you do here?

Lily: There are already different solutions. In the federal states it is handled differently that, for example, relatives are allowed to come for an hour. I think it will be about, first of all, that we really protect these facilities - that is our real problem at the moment - really sensible, by finally having protective masks, protective clothing, gloves and disinfectants available in large numbers. as we urgently need them. All of our facilities all over the country still reflect the fact that there is an absolute shortage of supplies, in some cases catastrophic conditions. We have to improve that now.

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When we have that, I think we can gradually develop things. There are already very nice new models: windows, window dialogues, walks at a distance. You can imagine different things, and I think we now need a new creativity that has to be combined with something like a corona etiquette. That means that we also need a culture of mutual respect and solidarity, including between generations.

"We need something like a corona etiquette"

Angel: But the challenges increase when, for example, the schools reopen step by step. If the contagion rates there may also rise again, that can mean for the nursing staff in the homes that have school-age children that they themselves become much more risk-bearing. Shouldn't these nursing staff then, consequently, be excluded from access to the homes?

Lily: It will be fine. Infected employees are of course not allowed to work with residents. That is why the most important thing is that we really have protective clothing that is sufficient, also that people can protect themselves in their private surroundings. I think we basically need three things now. Again: we need something like a corona etiquette. During these days I have often thought of the whole AIDS campaign. That's when we learned how incredibly demanding it is to change people's behavior. And I think we now have to do a lot more public relations education and prevention so that children learn to deal hygienically with such things, but so do their parents. Then a lot can be prevented - the area of ​​prevention and education.

Then we finally have to get to the point where everyone is properly equipped with protective masks and protective clothing. Gloves play a big role, disinfectants. Then you can imagine that you have locks, cleaning stories, and then we will certainly need a lot more tests. We then finally have to know which people are really infected and which are not. Even that is still a very big problem in the area.

(Picture Alliance / dpa / Monika Skolimowska) Visiting bans - "Many relatives fear an increase in dementia"
It is bitter for residents of nursing homes not to have any more visitors during the corona crisis, said Ulrike Kempchen from the BIVA Pflegeschutzbund im Dlf.

External impulses are important

Angel: But all of what you are rightly asking for now, more tests, more protective clothing, affects precisely those areas that are so scarce at the moment. That means that the residents have to prepare for further weeks in strict seclusion because the conditions that you demand are simply not there?

Lily: I fear that we will certainly have to continue making all efforts up to the date mentioned in May, but also have to live with the fact that we still have to live with closed facilities. Until then, we must now do what is humanly possible to finally ensure at the federal and state level that these materials are really available to employees and residents, but also to visitors.

Angel: What about the acceptance of the residents, the relatives and the employees, but also the acceptance of the residents for these tough measures? From time to time one hears voices that the short lifespan that the residents still have should not be "wasted" on these restrictions. Are these voices increasing?

Lily: These voices are increasing. Anyone who knows such an institution knows that she simply lives off her daughter bringing the cheesecake, and of course not only for her mother, but for the entire ward. Then they drink coffee together. That means that social life depends crucially on the fact that impulses come from outside, that creativity arises, that events are organized together. Older people are no different from us. They also need address and contact.

At the moment, all of this is concentrated on the already very stressed employees who, by the way, are doing a heroic job these days. I would really like to emphasize that again at this point. These are really the everyday heroes in these institutions, especially when they still have small children at home that they then have to look after. But then they carry it out and that's why it's only an interim result. We have to think more about it and I am also sure that we will find sensible solutions, as we are now with the opening times of shops.

The younger ones must show consideration for the older ones

Angel: Nevertheless, experts warn against making old people's and nursing homes too much publicly accessible again. You have asked for protective clothing. But don't you and the residents fear some kind of two-tier freedom of movement after all? The younger ones will be allowed out at some point, the older ones not?

Lily: That is exactly what must not happen, and I really liked the Chancellor’s vote that she said that it was not ethically justifiable. There must be no social isolation. We have to take care of that and then maybe the younger ones have to show consideration for the older ones. I could also imagine that we would set up protection zones around such stationary facilities, where we say there are times when people can really go for a walk together, can go out, and the others take care of the elderly care facility in nearby.

There is also one around the corner from us. I would have no problem staying inside for two hours and saying, now they can get out of here with their relatives and can make good use of this time, walks at a distance or other things. We'll think of something together. I say we have to develop a Corona etiquette, which really also means a culture of mutual consideration and solidarity.

Protection is a priority

Angel: Mr. Lilie, towards the end of the conversation we still have to take a look at the current security situation in your homes. You have already had severe, fatal corona infections that infected many home residents. The best-known example is the Hanns Lilje nursing home in Wolfsburg, where 38 residents have died so far. How is the situation there and what is the situation in other homes?

Lily: Last week I was able to speak to the home manager again. So they really did everything - once to really separate people from one another, to build in all sorts of forms of security, locks and other things. You just have to know: The Hanns-Lilje-Haus accommodates people, some of whom live with severe dementia. These people in particular are of course particularly at risk because they simply do not have the ability to discern their behavior due to their illness, do not understand why they are no longer allowed to do certain things. That means you have to explain everything over and over again.

In addition, these are the groups that are naturally frightened to react to changes. That makes things incredibly difficult. And once a virus rages in a house like this, it's really hard to contain it. Again: protective clothing, disinfection, gloves, protective masks, they would have been helpful back then. Then the virus would not have gotten that far. That clearly has to be the priority now.

Statements by our interlocutors reflect their own views. Deutschlandfunk does not adopt statements made by its interlocutors in interviews and discussions as its own.