s the lockdown rules loosen, friends and family members of our nursing home residents, who have been so supportive through this crisis, are nurturing hopes of a relaxation in our visiting policy. It was on 17 March – only 11 weeks ago, though it feels like a lifetime – that we decided with the heaviest of hearts to close our doors to almost all visitors. When the country went into lockdown that decision seemed a prudent, if painful one; the home is normally full of the laughter and joy of up to 30 residents and their visitors, who are usually such an important presence. Deprived of their company, many of our residents have become more anxious, confused or both, in spite of our best efforts to maintain connections using technology. By the end of March, 16 out of 58 staff members were isolating because they or a family member was sick, or shielding, meaning it has also been a day-by-day struggle to make sure we have had enough people on duty, not to mention supplies of food and personal protective equipment (PPE). Thankfully our local authority has provided support on all fronts, which helped us through the most turbulent initial weeks, and we’ve since managed to find new suppliers and recruit new staff alongside those who have been able to come back to work. We have watched the devastating consequences of the virus in other homes with horror. Our own numbers make painful reading, with 11 deaths in as many weeks, but we think we have actually been lucky; most of those have been the culmination of a long illness, or new admissions to us from our local hospital for end-of-life care. Initially only three residents were tested so we won’t know for sure – and we try not to drive ourselves crazy wondering – but, although one of those three positive patients has sadly died, the other two, including a lady in her 90s, appear to have made a full recovery. The rollout of the promised weekly testing of all care home residents and employees is painfully slow. Our first full set of tests arrived on Sunday 17 May, with a 30-hour window of opportunity to carry out tests before the prearranged collection; miraculously we managed to test 72 people, including all but three of the staff who weren’t on duty over those two days. When the results arrived two days later, a resident and a member of staff – neither of whom had experienced any symptoms – had tested positive. By chance, that staff member hadn’t been at work for a few weeks, but it brought home how important testing is, and how badly we need to repeat it regularly. Disturbingly, we still have no idea when that will be possible. Current guidance states that the PPE that staff wear will protect them from transmitting the virus, and we can only hope this is the case, because our converted premises, which give us a lovely homely atmosphere, make social distancing impossible – even if two people washing and dressing the same resident could keep two metres apart. The guidance at least means we won’t lose half the staff team as the result of a single positive test – as the PPE is supposed to protect us – but given how Covid-19 has spread in other homes, all the PPE and infection-control processes in the world don’t give us confidence that if we have another case, we will be able to contain it. And that is why, despite the easing of restrictions, and the government’s seemingly spontaneous last-minute decision to allow the “extremely vulnerable” to leave their houses, we are not yet comfortable with even the most socially distanced of visits. The only piece of official guidance, issued to care homes on 15 May, advises that face-to-face visits should only take place at the very end of a resident’s life, and under strict conditions (no more than two visitors, no kissing, PPE to be worn). It hasn’t been updated, leaving homes to navigate this minefield for themselves. Portsmouth has had lower infection and death rates than many parts of the country, but as people start to mix we know that the local infection rate is likely to go up, making it more likely that any visitor brings more than they intend with them. It is a short step from there to another outbreak in the home, and we can’t count on being so lucky next time. So for the time being, we are keeping our doors closed and trialling meetings between a resident inside the conservatory and a visitor outside who will be able to see and speak to each other through the glass double doors. We are also puzzling over how to provide chiropody, and when hairdressing and worship can resume in the home. In spite of the severe symptoms some of our colleagues suffered, we have for the most part stopped worrying about becoming ill ourselves. Protecting our residents feels like our most important task. It also feels like an impossible one. • Robin Hall is administration manager at the Home of Comfort in Southsea, a charitable nursing home, and secretary of the Hampshire Care Association