Residents are dying, swathes of staff are off sick and care home managers say they have been left to fight coronavirus alone as the pandemic sweeps across Greater Manchester.

Care home infections and deaths from COVID-19 are not included in the official figures released by the Government - but last week Prof Chris Whitty, the UK government’s chief medical officer, said that just over 9pc of care homes had confirmed cases.

However, Care England, the industry body, has said the death toll is already likely to have hit a thousand - with some homes suffering double-figure losses.

And as the crisis continues, so sadly will the impact on the most vulnerable in our society.

A report from the London School of Economics shows around half of all COVID-19 deaths appear to be taking place in care homes in countries including Italy, Spain, France and Belgium.

The pandemic comes amid massive shortages in care - with 122,000 vacant posts in a 1.4m-strong workforce. In Greater Manchester, there are estimated to be 3,200 vacancies among 64,000 care workers.

And that was pre-coronavirus. Before the workforce was further eroded by sickness and self-isolation.

The Alzheimer's Society has written to Matt Hancock, Health Secretary, after being 'inundated with desperate calls' as a result of the 'devastation' caused by coronavirus in the care system. They have demanded a comprehensive care package to support social care through the pandemic.

Meanwhile, through speaking to care home managers and staff in Greater Manchester, the M.E.N has learned:

Care home staff fear they are spreading coronavirus in homes and to their families because they can't get tested

Elderly patients being released from COVID-19 hospital wards to care homes risk bringing the virus with them

Care home residents are being refused hospital treatment

GPs are issuing Do Not Resuscitate orders to residents without consulting their families

Care homes are battling to source their own PPE, some forking out thousands of pounds to 'profiteering' firms

Work forces have been crippled by staff absence

Residents, many with dementia, are suffering in isolation without visits from loved ones

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The manager of a care home in Bury told the M.E.N: "We're not getting support, nobody is helping us, we can't get our staff tested.

"The way care homes have been treated is ridiculous - across the board. We've been told by someone in authority - I don't want to say who - that we could lose 20 per cent of our residents."

The manager said they had had four residents with coronavirus symptoms last week.

Because this was classed as an 'outbreak', the residents were swabbed by Public Health England, with positive results.

Two of those who tested positive have now sadly died.

The manager added: "We keep the residents in isolation but because we can't get the staff tested we don't know if they are spreading it.

"We are taking patients from hospital and we are told they have tested negative. But the ambulance staff drop them off saying they've been on COVID-19 wards and that could be how the virus is getting into homes.

"The government should be getting them, and staff, tested. We are looking after vulnerable residents here. Our staff are amazing but it's so hard for them. They are frightened to death."

The manager said there had also been cases where residents with 'suspected' coronavirus had Do Not Resuscitate orders added to their files by GPs - without consultation with their families.

The manager added: "Never in my 40 years in the job have I ever seen anything like this."

Another tragic - and unavoidable - consequence of the crisis is the isolation now suffered by many residents, the majority of whom have dementia.

"We are seeing them going down hill without visits from their families," they added.

Other care home managers have also spoken of their fears that coronavirus is being brought in from hospital wards, where staff are scrambling to free up beds.

A lack of testing for care home residents and staff exacerbates this problem.

Public Health England and NHS England lab testing is prioritised for hospitalised patients. Care homes only become a priority in targeted 'outbreak investigations' where two or more residents or staff show symptoms.

This sparks an investigation, which could in turn trigger a swab test. But these strict stipulations mean care homes are fighting the pandemic with one arm behind their backs.

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Rachel Hind is company director for Hind Care Ltd, which runs top-rated homes, Faversham House and Brookfield Nursing Home in Urmston, Trafford.

"We do not get any access to the tests for coronavirus - for patients or staff," Rachel said.

"This makes the management of care for our patients really difficult.

"We essentially really want to play our part in the overall response to COVID-19 and take as many patients out of hospital as possible but we are unable to tell if patients on discharge from hospital are with or without coronavirus."

When staff or their families develop symptoms, they are unable to access testing so are off for 14 days, further depleting the workforce.

Rachel is also struggling to source personal protective equipment, adding: "The are some suppliers who are clearly profiteering on the situation and charging exorbitant prices for PPE which is clearly immoral but we are unable to get the necessary equipment from any other source."

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Getting residents on to hospital wards for treatment has also become a challenge.

Andy Burnham, Greater Manchester Mayor, has insisted there is ‘no policy’ to deny hospital beds to care home residents and during a Downing Street press conference, Health Secretary Matt Hancock said there was no blanket rule for these patients.

Regardless of whether denying hospital care is 'policy' or 'rule', it does appear to be happening, according to reports from the front line.

Yvonne Timms, nurse at Faversham Nursing Home in Urmston, claimed care home staff and residents were being treated like 'second class citizens' when it comes to accessing hospital care.

She added: "We had a lady with heart failure who we were very concerned about but the doctor said if we tried to admit her to hospital she would just be sent home.

"We all care greatly about our residents - we are one big family. We know people in here are going to die but we don't want to give them any more risk factors."

John Evans is the director for Auden House care home in Audenshaw - rated Outstanding by the Care Quality Commission (CQC).

He says the 24-bed care home is 'just about keeping its head above water' after several staff members were forced to self-isolate with symptoms of coronavirus.

He currently has a manager in isolation, and two members of staff in hospital with suspected Covid-19.

"We are as much in the front line in terms of exposure as the NHS front line staff," John said.

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"I have got a resident who has tested positive for coronavirus and is in hospital. Luckily he was already in isolation because of a suspected chest infection and only tested positive once in hospital.

"None of our other residents are currently displaying symptoms. But we are not getting tests - none of my residents have been tested.

"Of course I would like testing to be available. What you know you can do something about."

John ordered thousands of pairs of gloves and masks at the start of the outbreak - but claims his bills have quadrupled as a result.

He said: "My staff are feeling very strained. It is very hard.

"My big beef is funding for social care. We have been banging the same drum for years. There is not enough money for social care.

"My staff are being paid relatively inferior sums of money, taking the exact same risks as frontline NHS.

"The whole system needs looking at. If we don’t get this out now it is just going to carry on.

"Social care has been knocked around like a football for too long.”

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As the UK's death toll passes 11,000, it's challenging to get a grip on how many more deaths are taking place in care homes.

That's because the government's figures, which although calculated with a lag due to reporting delays, are the most up-to-date, don't include care home deaths.

The Office of National statistics' (ONS) calculations do calculate care home deaths separately - but they are nearly two weeks behind.

So, for example, for the week ending March 27 - the most recent numbers available - the ONS recorded a total of 539 deaths from COVID-19, with 20 of those taking place in care homes.

On Tuesday, results for the week ending April 3 will be published. This will give an indication of how rapidly care home deaths are increasing - but that figure will still be 11 days behind the curve.

It means those fighting for more support for the care sector are learning the scale of the problem by listening to their communities.

Among them is Barbara Keeley, MP for Worsley and Eccles South and former shadow minister for social care, who said the social care system is being treated as an 'afterthought'.

Ms Keeley said she had come across cases in Greater Manchester where people living in care homes had been told they would not be admitted to hospital, regardless of their underlying health condition.

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In one Salford care home alone, there have been five deaths, she told the M.E.N, warning that the entire sector is being denied protective equipment and testing.

Ms Keeley added: "Our care staff provide vital support to vulnerable people day after day.

"We cannot leave them without the protective equipment and access to testing needed to keep them safe."

Calling on the government to roll out testing to social care staff and allow them access to community testing facilities outside hospitals alongside NHS staff, she added: "T esting patients before discharging them to a care home must be a priority.

"I have called for a coordinated social care plan from the Government which will protect both our vital care staff, and those they are working hard to keep safe every day."

Sally Copley, director of policy at the Alzheimer's Society, said: "The shocking reports of elderly residents having DNAR notices applied to them without proper consultation, combined with the rapid rise of coronavirus cases in care homes, is frankly terrifying."

She said 70 per cent of care home residents have dementia, adding: "We are receiving thousands of calls on our Dementia Connect support line from people worried about their safety and wellbeing during this pandemic – these reports confirm they are right to be worried.

"The Government and NHS England must rule out denying people critical care simply because of their age or their dementia.

"Care homes are central to the fight against coronavirus which means the government must also prioritise equipping them with the testing and Personal Protective Equipment (PPE) they need to protect their staff and residents.

"We are calling on the government to make it clear how they will ensure people with dementia receive the care and protection they need and to not abandon them during this crisis.”

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What the government say...

A spokesman for the Department for Health and Social Care said: "This is an unprecedented situation and we are determined to give the social care sector the support it needs to respond to coronavirus, including access to PPE and tests.

"We are working closely with Public Health England to monitor the impact on care homes, and we have delivered 7.8 million pieces of PPE to more than 26,000 care settings across the country.

"We have begun providing tests to key social care workers, and are working hard to increase testing capacity."

Care homes with two or more suspected coronavirus cases among staff or residents should report to their local Public Health England team, who will carry out a risk assessment and investigation before advising the home how to manage it.

This could include taking swab samples for testing, the Department for Health and Social Care has indicated.

The Manchester Evening News have contacted Public Health England for comment.

Anyone affected can contact the Dementia Connect support line on 0333 150 3456. The charity has also launched an emergency appeal at alzheimers.org.uk/emergency.