"In Ehpad, it's chaos, we have to do bush medicine"

• At the Four Seasons Ehpad in Bagnolet, all the staff are mobilized to take care of the 65 residents of the establishment.
• But two caregivers have just tested positive for Covid-19 and several residents show symptoms of the disease.
• Prohibition of visits, isolation of probable cases, confinement in a room: the Ehpad makes every effort to stem the spread of the virus. Measures that weigh on the morale of residents, which must be protected at all costs.

Tears strangled his voice. Exhausted, angry, desperate, Laurent Garcia does not want to falter. "You have to hold on, you have no choice," explains this health executive, who heads the staff at the Les Quatre Saisons nursing home in Bagnolet (Seine-Saint-Denis).

There, everything threatens to miss: masks, gowns and staff, while the coronavirus is already present in the establishment. Only the goodwill of the staff knows no limits. But for how long ?

What is the situation in your Ehpad?

It's complicated, unmanageable to tell the truth. We do what we can with what we have, that is to say, not much. We are a small establishment, we have 65 residents. We have been sounding the alarm for over a month, because we see the coronavirus wave coming, and we do not have what it takes to fight. We know that we are going to take it head on, because today, we are suffering from the authorities' lack of anticipation, and I do not have the means to properly protect residents and staff.

Many Ehpad, including yours, testify to the lack of means, and in particular the lack of protective masks. What about the Four Seasons?

We count everything. At the moment, we have masks, but not enough to last very long. At the start, we didn't see the shortage coming. Before the epidemic spread, we allowed masks to be given to families who came to see their loved ones. I had placed a large order, and at that time, we thought there would be no supply problems. Then my supplier told me that he had nothing left, that he could not supply us. This is where the visits stopped.

Today, the masks are distributed to caregivers in a dropper. We manage everything over the water: masks, staff, we do not have the slightest visibility. We received surgical masks, but no FFP2, and only enough for a few days. For the rest, we don't know. The protocols communicated by the Regional Health Agency (ARS) change every day, we are left to ourselves, and completely lost.

Do you have cases of coronavirus among staff and residents and how do you manage them?

Two health care workers reported symptoms and were arrested. We have just received the results: they are positive for the coronavirus. Fortunately, long-term contractors have been mobilized and ready to take over.

Today [the interview was conducted this Thursday], twelve residents are placed in solitary confinement for suspected coronavirus. But we are not certain that they are Covid-19 positive, because obtaining screening tests for residents is almost impossible. We have set up a Covid-19 unit within the establishment where the suspected cases are isolated, but they have not been detected.

In practice, only one caregiver is seconded to take care of residents likely to be contaminated, to save masks and overcoats. We are forced, for lack of staff and for the safety of these residents - who have many cognitive difficulties - to lock them in their room. It is something violent and painful for everyone, residents and caregivers.

An Ehpad is a place to live, not a hospital. Today, we are reduced to bush medicine!

Have you taken any additional steps to prevent the spread of the virus?

Obviously, visits to the nursing home have been prohibited for a few weeks. And in addition to the creation of a Covid-19 unit, we decided to tighten the containment: since Wednesday noon, meals are no longer taken collectively, residents eat alone in their rooms. And it's hard for everyone, the residents did not hide their dissatisfaction by learning the news. And it is also difficult for staff to manage, especially in terms of logistics. The first breakfast in the room lasted until 3pm! It was chaos.

All this breaks our hearts a little more, but we have no choice, we organize ourselves as best we can to protect residents. The Ehpad must be operated with only six carers, a nurse, two persons in charge of maintenance and two persons in charge of room service. But everyone puts their hands in the dough for everything, to keep it going.

How do residents experience this isolation, alone in their rooms?

Honestly, for them, it's horrible to live. They were already cut off from their families, and today, they no longer even have the conviviality of meals shared all together. Psychologically, it's very hard, especially since the staff are too overwhelmed to give them more time. We can't wait for them to end the containment.

So we try to maintain the link with families, by phone, or by Skype, with our tablet, to make them feel the presence of their loved ones despite everything.

In this context, how is staff morale going? How do they stand?

They are really afraid: fear for the residents' health, fear for themselves, fear of bringing the virus home and infecting their families. Fatigue, moral and physical, accumulates. Every morning, during the staff meeting, the anxiety comes out, caregivers come out in tears because the nerves are cracking. So everyone is crying a heavy blow, and oddly, it relieves a little.

And we hang on to little things: we write words of encouragement and thanks. And every day, all the staff come together for a photo that we post on social networks. It's not much, but it's a symbolic moment, which reminds us that we are a close-knit team. And that helps us keep a smile on our face.

Photo of the day
No slogan pic.twitter.com/eKpIQ5TJXN

We really do what we can to support our teams pic.twitter.com/nOPLvsCSE4

If serious cases were declared among the residents, what treatment is planned?

The hospitals of the department are saturated, there is no longer any place for resuscitation in Seine-Saint-Denis, and very old people with multiple diseases are not anyway priority today in hospitals. So if serious cases occur, they will not be treated in the hospital.

If the case arises, we will give the best possible support. But we cannot afford a resuscitation unit, or even a palliative care unit. You will be able to provide comfort care, place on oxygen and administer morphine drugs to relieve pain. However, we will not be able to allow a dignified and surrounded end of life because we do not have enough staff. Here we are.

And this Thursday evening, we learn that a resident, who was doing very well this morning and who was not identified as a probable case, had a sudden fever spike and is currently in respiratory distress. The team is with her to help her the best.

The families of the residents must be extremely worried… Have there been requests to remove residents? And is it possible?

They are terrorized, panicked. They constantly call us to take news of their loved ones. And fear losing a parent or grandparent in these conditions, who would die alone without having seen his family.

Two girls contacted us to take their mother home, because the risk was unbearable for her. And I acceded to their request: their mother is alert, and will be better by being surrounded by hers. Even if these recommendations are backwards, how can we not understand their fear and their desire to protect their mother? Other families would like to do it too, but when it comes to a very dependent loved one with Alzheimer's, it is very complicated for families to manage.

How do you feel about this coronavirus crisis in nursing homes today?

In the midst of this chaos, I am grateful every day for the involvement of the staff, who are sparing no effort and mobilization to take care of the residents.

However, today I am angry. I like my job, but I cannot afford to do it in decent conditions for both staff and residents. So this crisis, when it is over, it should not be forgotten, so as never to have to relive it again. It's inhumane.

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• Containment
• The elderly
• Health
• Covid 19
• epidemic
• Coronavirus
• Ehpad