Social Isolation and Vulnerable Clients

Many of my clients are residents in nursing homes or live alone and receive care from family and friends on a regular basis. In the last few weeks, pandemic has led to many having limited or no contact with their friends, or family.

I have other clients who are clinically extremely vulnerable and who are in this situation because they have suffered a brain injury, spinal injury or have reduced mobility because of illness, disease or amputation. Others have significant mental health issues and are unable to care for themselves.

The government has identified clinically extremely vulnerable people as anyone in the following category:

1. Solid organ transplant recipients.
2. People with specific cancers:
   • people with cancer who are undergoing active chemotherapy
   • people with lung cancer who are undergoing radical radiotherapy
   • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
   • people having immunotherapy or other continuing antibody treatments for cancer
   • people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
   • people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD).
4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as Severe combined immunodeficiency (SCID), homozygous sickle cell).
5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
6. Women who are pregnant with significant heart disease, congenital or acquired.

Staying in contact with vulnerable people

As we all know, it has never been so important for such vulnerable people to maintain contact with family and friends. This can seem almost impossible in the current circumstances.

I have been taking time over the last few weeks to check in on my clients and to see how they are managing and to arrange further support wherever needed. One of my clients lives in a nursing home. She is partially sighted and prior to lockdown had a ‘buddy’ visiting her several times a week to keep her company and attend social gatherings within the nursing home with her such as quiz afternoon’s and music afternoons in the dayroom.

Prior to the buddy arrangement my client would spend all of her time confined to her room and she became isolated and lonely despite regular contact from her family. She also became depressed because of this and was prescribed anti-depressants. The buddy coupled with her medication lifted her spirits and gave her a sense of wellbeing.

The buddy can no longer attend the nursing home. I was worried that this would cause my client to feel isolated and lonely again, so as to maintain the contact, the ‘buddy’ now makes contact several times a week. The telephone calls are not long but just enough for contact to be maintained and to give my client something to look forward to again, several times a week.

Another vulnerable person I have contact with is tetraplegic and living in a care home and he maintains contact with his sibling in USA via video calls via an iPad with assistance of the care home staff.

We must find alternative ways for our vulnerable clients to engage with those who are important to them and provide them with support both physically and emotionally. If that means seeking an interim payment to purchase an iPad to enable them to Skype; WhatsApp or Zoom others so that they have continuity of contact.

When speaking to my clients I have been encouraging them to think about calling friends and family more frequently. Assisting them to look at their current mobile phone service and see if they can transfer to an alternative network; change contract; to ensure that their telephone calls are cheaper and they get a better deal for making more calls during this time.

Providing clients with useful online links guiding them to entertainment whether it be an old film or musical or a live stream to allow them to watch a theatre production, or a link to read their regular magazine or newspaper.

We are living in a very strange unprecedented times and we have to ensure that our client’s and their families are safe and well both physically and psychologically.

Stephanie Prior, Partner, Head of Clinical Negligence at Osbornes.