“We heal, not in isolation, but in togetherness” – a role for the Care Home Care Coordinator?

Helen Cowan studied human physiology to PhD level at the University of Oxford. She then qualified with distinction in Adult Nursing and has worked as a nurse for 16 years in neurosurgery, cardiac surgery, elderly care, hospice care and clinical trials. She tweets @HelenCCowan

Resy Manalo, Lalaine Lopez Pesario, Gilbert Barnedo, Elsie Sazuze, Suzanne Loverseed and Karen Hutton are some of the care home workers who lost their lives during the coronavirus pandemic. Larni Zuniga, a care home nurse who ‘epitomised everything that nursing is about,’ died in April after spending 3 weeks battling coronavirus in the same intensive care ward as Boris Johnson. Between mid-March and mid-June last year, there were 35,067 excess deaths (those above the ‘expected’ number) among care home residents; at least 16,000 further individuals have died in care homes during the second wave of the pandemic.

How can healing even begin? The vaccine is being administered but the scars left by fear, fatalities and forced separation from families run very deep. Care homes need support - not soundbites, promises and inconsistent, ever-changing and opaque guidance from central bodies.

It is said that a journey of a thousand miles (which is what care homes face as they contemplate recovery) begins with one step. In strengthening links between care homes and general practice across Primary Care Networks, becoming, in a sense, the (often invisible) ‘thread that binds’, could the ‘care home care coordinator’ play a part? “Coming together is a beginning; keeping together is progress; working together is success,” said Henry Ford; “Alone we can do so little; together we can do so much,” said Helen Keller.

As a care home nurse shielding since the start of the pandemic, I currently work as a care home care coordinator and here are the ways in which I have been able to help.


Working with four surgeries and seven care homes (ranging from an 80 bed care home to a small convent and a private home where a handful of residents live alongside a family), I gather data on each of the 250 or so residents. Everything from their resuscitation status to when they last saw a doctor and which routine blood tests are due is included, acting as a visual reminder for the doctor of who is where and what is needed when.

Giving families the chance to share what matters most to their loved one with dementia is another important aspect of my role; having the time to listen on the telephone and co-create a shared narrative helps form a truly person-centred advance care plan. Relationships within the family and with the clinical team can also be strengthened, the process of care planning proving sometimes more important than the product, especially during such a time of enforced separation and sadness.


Medicines optimisation is important in the care home cohort; polypharmacy can increase the risk of drug interactions and adverse drug reactions, together with impairing medication adherence and quality of life.

Helping to arrange appointments between the pharmacist and care home nurse for structured medication reviews, I also act as messenger between the two. For example, after I had heard from a nurse of the ongoing struggle to administer apixaban twice daily at twelve-hour intervals to one frail resident, a decision was made by the pharmacist to administer once daily at lunchtime, during her brief window of wakefulness. Something, it was decided, was better than nothing for this particular resident; half a loaf being better than no bread according to the 16th century proverb.


The COVID-19 vaccine has now been offered at every eligible care home with older residents across England. Achieving this goal has not been easy. Inviting care home staff for vaccination in late December, I was surprised by the hesitancy, especially among some in BAME communities, and I was asked many questions and addressed many concerns, often still meeting with refusal. Keeping spreadsheets of residents’ consent or refusal to have the vaccine was another of my roles, working closely with families and care home managers as best interest decisions were made, sometimes in emotionally charged situations.

Planning for the second round of vaccines in care homes proved problematic, with inevitable movement of residents between homes making us realise that we were trying to hit (or rather vaccinate) a moving target. Within a single care home were recipients of different vaccine types on very different dates, with the data changing almost daily. Occasional COVID-19 outbreaks only added to the logistical challenge.


‘How did we end up turning our care homes into jails of enforced loneliness?’ asks one campaigner, who argues that, despite their heroics, ‘a paid carer isn't an intimate, can't be the memory, the gatekeeper, the beloved link to the familiar world’.

Distress, despair and heartbreak are rife among residents and families forced apart – and I can be a listening ear and an occasional advocate with my telephone calls, acting as a link in the broken chain, passing on requests for the “big little things” that make life more bearable. Whether it’s a call for a Communion cup or an appeal for a treasured teddy bear to be always close, each one is a reminder that, for the care home resident, as for the rest of us, ‘non est vivere sed valere vita est’ (life is more than just staying alive). Quality of life matters as much as quantity; let’s work together to retrieve what has been lost.



Thank you for such an interesting article. The role is not one that I am familiar with and it sounds so necessary. I wondered if it is a uniform role in all areas and who funds the role. There is a vacuum of help for self funders when they are faced with finding a care placement - is this role accessible to them? Health and Social Care is a failed, broken system held together by some very dedicated Carer’s and others who simply fill the gaps. People, we all, deserve so much better. This crisis has shone a light on many of the inadequacies, not least the attitude towards those needing Care support, in our society. We all must continue to insist that H&S is on everyone’s agenda and that someone is brave enough to create a whole new system.


Dear Helen Cowan thank you so much for this piece which resonates with me as Care Homes CNS based at Birmingham St Mary's Hospice.  We are in the process of providing 8 webinars for local care homes (some of whom have care home coordinators but where this role is very new and untested).  Most of the sessions planned so far will provide clinical education but a key theme throughout will be how staff can most effectively work with their MDT and have the most productive meetings.  We have a Care Homes Lead Pharmacist and two GPs form 2 of our local PCNs supporting this piece of work who, we think, with the care homes staff would all benefit from learning about your role and experience.  Would you please be kind enough and able to present at one of the sessions? It really is about getting the conversations going in this area and improving understanding around MDT working.  Please could you contact me at kate.palmer5 [at] nhs.net if you feel able to help?  We would be most grateful if you could.  The sessions are every Wednesday from 4th August between 1400 and 1530.

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