AS DANISH SOCIETY REOPENS DURING A TIME OF CORONAVIRUS,
ARE THOSE RESPONSIBLE FOR LOOKING AFTER THE NATION'S ELDERLY
SCARED
OR PREPARED FOR WHAT MAY LIE AHEAD?
By Jacob South Klein
and Andreas Würtz Adamsen
Photography: Jacob South Klein
Boasting a quality provision of healthcare considered to rank amongst the best in Europe, the Nordic countries are commonly thought to look after their citizens well as they enter old age.
However, following the emergence of COVID-19, and with Sweden (a nation ajudged to be first for treatment of the elderly by the UN as recently as 2013) left to bitterly count the human cost of a terrible death toll in their state care homes, some have also naturally begun to question the safety of elderly care in neighbouring Denmark.
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As of June 8th 2020, 208 deaths out of Denmark’s coronavirus toll of 589 have been from confirmed cases in elderly care homes.
Now, four Danish carers share their own experiences of life in a care home whilst the pandemic has spread more severely elsewhere - offering a unique insight into how coronavirus has changed the day-to-day lives of residents, the measures put in place to prevent disaster, and their reservations for the future with the responsibility that lies on their shoulders.
Ultimately: are elderly care homes in Denmark as safe as the public think they are?
Charlotte,
Aarhus Midtown
Nicolaj,
Southern Denmark
Rebekka,
Aarhus North
Marie,
Stenslundcentret, Odder
Precise locations have been used wherever possible, however some facility names have been omitted upon request in order to protect those who are vulnerable
"Starting the job in the middle of a pandemic was certainly interesting"
A Changing Role
Charlotte Gøtstad Sørensen is a nursing assistant who is on placement at an elderly care home in midtown Aarhus, Denmark.
“I’ve only been working here for six weeks, so have no idea what things were like before coronavirus. Starting the job in the middle of a pandemic was certainly interesting”, she says with a nervous laugh.
“I didn’t really know what to expect before coming here - I didn’t know if we had any coronavirus cases in the home or not, or even how the current staff were protecting themselves.”
Nicolaj Laue Juhl has been in the care industry for longer, although his job is slightly different: “I do home care for older people in southern Denmark, cleaning and helping them to shower, administering medicine and food, things like that.”
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“But when coronavirus came, the rules that were given to me changed, so that I now can’t clean and have to minimise my time spent in someone’s house.”
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“It’s a whole new way of working, and it’s created a conflict in my head - people need more than I’m giving them, but I’m not allowed to give it to them”, he ruminates.
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“The rules make sense, but it’s difficult for me and my colleagues to live up to those rules - when your time in an older person’s home is cut from normally around twenty minutes down to only five, it’s hard to accept that and not do more, from a human standpoint.”
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“When you see they are lonely or they need to have a conversation - especially when no-one’s calling them on the telephone - you would love to be there for a longer time.”
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“But because of the rules, deep down we know we have to be careful. That was even more the case right at the start of the outbreak, when nobody really knew how bad it was going to get.”
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Like Charlotte, Rebekka Rygaard Kusk also provides care at a facility in Aarhus: “I started here last summer, and before that I was at another care home elsewhere on a permanent nightshift contract, so I have experience of how things were pre-coronavirus.”
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“We used to come into much closer contact with residents, eating and doing activities together. Once the virus hit, all the residents had to stay in their rooms all day, and the common area wasn’t being used at all - that was very different.”
“I’ve worked at the same care home in Odder for over two years”, confirms care assistant Marie Hougaard.
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“Things have changed quite a lot in that time - for example, the protective clothing we’re wearing now because of the virus is really different to what I’m used to.”
"we weren't wearing anything protective at the start"
Staying Equipped
Marie elaborates further: “We all have long plastic aprons and gloves to wear when we’re in close contact with residents, and if we’re up close, like shaving people or brushing their teeth, we wear a visor, too.”
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Visors represent part of the new normal for Charlotte as well. “There were some questions at the beginning about whether we were going to run out of the visors or not, but it hasn’t turned out to be a problem, so that’s a positive”, she says.
“I’ve been hearing about the supply issues with the protective gear in other homes but we haven’t had problems like that”, affirms Marie.
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“We have a lot of stock, but then again, we’ve only started using it in the last few weeks now that Denmark is reopening - we weren’t wearing anything protective at the start.”
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“So we had our own responsibility to protect ourselves and others.”
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In March, the Danish Medicines Agency launched the ‘Denmark helps Denmark’ campaign, urging authorities, companies and others to report it if they have excess equipment or ideas on how to procure more.
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The Danish Government then cemented this action in law by issuing two dedicated executive orders in an effort to guarantee a reliable supply of protective equipment.
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As for guidelines issued by the authorities, whilst appreciative, Marie acknowledges that the system is imperfect.
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“In the houses, there are pieces of paper on the walls with all the guidance from the health authority listed - but sometimes a situation comes up unexpectedly that there isn’t any guidance for.”
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“We had to come up with rules for relatives to visit dying residents ourselves, for example.”
Plastic medical visors (pictured above) have formed a crucial part of a Danish care worker's toolkit, but early issues surrounding supply had to be resolved.
The evolutionary nature of the guidance from the authorities is a factor that Rebekka is eager to draw attention to.
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“The regulations on what we have to wear has changed throughout - it used to be that we could bring our usual work uniform home with us, wearing it to and from work”, she says.
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“But then they stopped letting us do that, and instead we had to keep our clothes at the facility.”
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“We also had to be very conscious of keeping our own clothes in a bag, and not carrying it around the building as it could be contaminated, too.”
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Scarcity of equipment is also a problem that Rebekka has witnessed first-hand.
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“It was difficult to get hold of certain protective gear initially - we normally use a lot of gloves anyway for preparing food, but then we were told to stop using them in the kitchen and to stockpile them for more important things other than cooking, in case we ran out”, she recalls.
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“Then about a month ago, each employee and nursing student in our local region got their own visor.”
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“Especially at the start of the pandemic, I was worried about low stock levels for our equipment. I don’t think the public was that aware of the stock issues for us.”
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“We had some very limited supply, and we were told by our bosses that more could be ordered if needed, but I wasn’t so sure about that - they were being wary of the quantities we were using, asking us to clean our goggles each time we used them.”
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“But I guess nobody knew how long coronavirus was going to be around for, so perhaps it’s understandable that we were being so conservative.”
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“Plus, the health authorities have been efficient with the guidance they’ve given us - they made a website for all co-workers so that every day you’re able to log on and get the latest coronavirus updates and information.”
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“For example, they wrote on there about two or three weeks before we were given our protective visors that they had been ordered.”
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However, Nicolaj is more critical of the support he has received from those above him.
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Voicing his frustration, he comments: “Actually, I think the health authorities made a poor decision at the start, because they weren’t making the visiting home care staff (like myself) wear protective equipment”.
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“The healthcare workers in the care homes and hospitals were wearing visors or masks from the almost the beginning, but we were only told to use hand sanitiser back then.”
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“But now the authorities have reversed their decision and we must wear masks and gloves, too. The strategy has turned around, but it’s come a bit late in the year.”
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“I don’t really understand why we were the last to be protected when we were coming into such close contact with people from day one.”
"It's been clear to see some of the residents becoming depressed"
The True Cost Of Isolation
Nicolaj seems to be impressed with how closely some he visits are monitoring the progress of the pandemic from indoors.
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“Fortunately for us, some of the older people I visit are well aware of how things are from reading their newspaper - they know how badly the virus has spread elsewhere.”
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“That makes it slightly easier to justify being with them for a shorter time”, he says with a bittersweet expression.
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However, not everyone shares that same level of awareness, Rebekka adds: “Of course, a few of our residents have dementia, so you can tell them “oh, you need to wash your hands before you come in here because of the virus” and they’re like “…what?”, even up to five times a day.”
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“Then again, some of the residents are always glued to the news all day, so they know everything that has gone on.”
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“Some of the older people asked me to keep my distance, but others were still super touchy, because they didn’t really understand the situation. It’s very difficult to know how to deal with that”, she admits.
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“Others were just curious to know what it was like for me to go outside.”
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“You can tell that they’re still not getting the level of social interaction that they used to, which I think is quite sad.”
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“I think it was very tough back when they couldn’t have visitors - they only had us and their own room. Sometimes they could wave out of the window to other residents. Otherwise it was just themselves.”
Like Rebekka, Charlotte also contests how much those in her care know about the development of the pandemic, or how extensively the virus has affected other countries, such as Sweden nearby.
“A lot of the residents are suffering from dementia and aren’t at all aware of the virus situation in Denmark, let alone in other countries.”
“The only thing that appears different for them is that we’re wearing a visor, and some of them aren’t even concerned about that”, she chuckles sadly.
“But the residents that aren’t suffering from dementia are very engaged and up-to-date with what’s in the news - it’s hard to gauge the overall mood because of how different each person’s individual health and awareness is.”
She laughs: “The more concerned ones will always comment on my visor and tell me “remember to wear it!””
“Of course, they have a good reason to be concerned because a lot of them would not survive coronavirus”, Rebekka says with her tone hardening once again.
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​“One thing that’s different now is that relatives aren’t able to visit like they used to - although for some residents with dementia, they might not have been able to remember when family visited before, so in that way it’s strangely not that different of an experience for them.”
Residents are allowed outside at this care home in Aarhus, with visitors also permitted. Not every home has yet reopened in this way.
Echoing the thoughts of the others more directly, Marie has serious misgivings regarding the mental health of residents. “It’s been clear to see some of the residents becoming quite depressed - a lot of them have Alzheimer’s or dementia, and a lot of what they enjoy comes from touching or being around relatives”, she observes.
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A joint study in April this year found that the COVID-19 pandemic is likely to have unseen negative health consequences for psychological well-being in Denmark, beyond those caused by the virus physically. However, the mental impact on older Danish citizens is yet to be specifically documented.
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“Some of them don’t speak a language anymore, but when they see their grandchildren or their wife, they feel some kind of connection or love. The lack of contact and closeness is upsetting for them.”
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“We have six separate houses of ten residents, and normally they’re able to join in with activities between houses - we had dancing sessions and choirs, for example. But that’s not allowed to happen anymore”, Marie says wistfully.
"I'd heard horror stories about police finding bodies in European care facilities similar to mine"
Shared Anxieties
The early sense of dread at what might have been on the horizon is evident in what everyone recalls from the initial shutdown of Danish borders back on March 13th.
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“The first few weeks of the Danish lockdown, I was very worried - I didn’t really know what was going on and was keeping my distance from people outside of work much more than usual”, Rebekka remembers.
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“The guilt of accidentally bringing coronavirus into the care facility would have been unbearable.”
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“Plus, I’d heard horror stories about the army finding bodies in other European care facilities similar to my one.”
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Marie read the same grim reports: “I remember reading about care homes in Spain being abandoned by workers. They just left! I couldn’t understand it, that really shocked me.”
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Similarly, Charlotte admits to being apprehensive of what might have unfolded.
“I was very concerned at the beginning when we weren’t sure if we could keep the virus under control - I’ve known since February that I’d be working here, and as my start date grew closer, I was getting worried with all I was reading in the media.”
“But I’ve stayed very careful even in my own life outside of work. After all, I know I could have been without symptoms and still contagious if I caught the virus.”
Eventually that tension started to subside, Rebekka says. “Over time I started to calm down a bit, as I could see that it wasn’t developing as rapidly here in Denmark as I feared it would.”
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Rather than being overtly worried, Marie’s early days of the lockdown were instead punctuated by anger.
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“At the start of the lockdown I was actually quite angry at some of my close friends, because they were continuing to meet up and go out drinking together, which was selfish”, she says.
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“I said to them “you have to stop this”, because I work in a place where I’d have to witness the consequences of their selfish actions first-hand.”
"It might seem excessive but it's for the best"
Sterilising Chocolate (With Alcohol)
Reopening Denmark whilst simultaneously keeping the doors of some care homes shut has not come without a fair share of teething problems.
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Marie explains: “It’s so hard with the relatives, because they live in the reopened Danish society but can’t seem to understand that we still have rules in place at the care home. They think we’re the bad guys!”
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“We don’t make the rules ourselves, it’s each individual Kommune that sets them”, she stresses.
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A Kommune is the Danish equivalent of a city council or other local authority.
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“So for instance, we have a rule that allows the family to visit, but the resident in care has to stay in their room (with the top of their door unlatched) with the relatives talking to them from outside the building itself, from the garden. They can’t go inside the home.”
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“The families can also walk with their relatives in a wheelchair, but they must stay behind the wheelchair and not face each other.”
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“If relatives bring their grandparent a gift - like shampoo or chocolate or something - a worker first has to take it to a small room to sterilise it with alcohol, keeping it in there for two straight days before letting the resident have it.”
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“That might seem excessive but it’s for the best. We haven’t had a single coronavirus case in any of our Kommune’s care homes, fortunately.”
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Charlotte is growing accustomed to the rolling back of restrictions, although it is jarring for her at times.
“I’ve not been that concerned about the reopening, mainly because of how gradual it’s been and the order things have happened in. It’s not been too fast or dangerous.”
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“But it’s weird, seeing people in the supermarket standing so close together, when in the care home I have to wear a visor and keep two metres apart from everybody.”
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Rebekka’s care home is one of the few opening up, albeit with limitations in place. “It’s good that some elderly homes are starting to allow visitors again, including mine.”
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“At my facility, we have a nice garden where families and residents can sit together if they book a date and time in advance. For that to be allowed now is wonderful.”
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“Overall it’s great that things are starting to get moving again, for the sake of both the physical and mental health of the residents.”
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“Not being able to move around much or see other people was more and more damaging for them the longer time dragged on.”
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Compared to the others, Nicolaj is noticeably philosophical in his response.
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“I’m not too afraid of another potential wave of coronavirus, but I guess I’m also in the privileged position of being young and healthy”, he muses.
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“Actually, I’m more curious and worried about whether we’ll be able to give hugs and shake hands again.”
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“If older people are forced to think about the safety of meeting their kids and grandkids, then that’s quite heartbreaking really.”
"we've learnt a lot in a short space of time"
Rethinking Safety
When asked to consider the future of care in Denmark post-coronavirus, Marie remains stoic: “Looking forward, I think we’re ready for whatever comes next - we’ve established a new standard in the homes, with all the hygiene rules and equipment. It’s kind of our ‘normal’ now.”
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“Our home also has its own state-of-emergency plan just in case things get drastically worse. But one of my friends who is also a care worker in a neighbouring Kommune said they don’t have anything like that”, she cautions.
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Nicolaj considers how coronavirus has changed his personal outlook on care home work
Charlotte and Nicolaj share the same optimistic outlook.
“I think we’d be well equipped and prepared to handle a smaller second wave - we’ve learnt a lot in a short space of time”, Charlotte says.
Echoing her, Nicolaj concludes: “We’re so much more prepared now if we do get another round of the virus, with the experience of the last few months and how we’ve handled it.”
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Marie readily acknowledges that some homes are likely to be better placed than others in the current landscape.
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“We’re quite lucky in our Kommune in that our care is well-funded - at our home at the start of any given week, we usually have four or five workers to care for ten residents, which is a good ratio”, she says.
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“At other homes, I think it can be something like three workers covering fifteen residents. But of course it differs from place to place.”
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“I do think though that when we look back once the pandemic is in the past, compared to countries like Italy, Spain, Sweden, and the UK, our care homes in Denmark will have held up pretty well - and we’ll have made a positive difference for a lot of people.”
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It is apparent that each of these four Danish care home workers have been galvanised by their experience of the pandemic to date.
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Rather than wilt under the weight of expectation, their stories prove that they have the motivation and expertise to continue in the face of a demanding and unprecedented global health situation.
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“Until now I’ve never really seriously contemplated how safe our Danish care homes are, but after these six weeks here, I’m convinced they are - even at a time like this”, Charlotte summarises.
“In Danish we have the word ‘samfundssind’, or ‘citizen mindset’, and you can feel that more than ever in the care homes now.”
“Everyone is looking out for each other’s safety.”