- Heatwave is a period of hot weather when temperatures remain abnormally high.
- During a severe heatwave the elderly and people with chronic diseases or disabilities may be at increased risk of ill health.
- Adult social care organisations should plan ahead to keep their service users safe during hot weather.
Everybody likes periods of hot weather when they can get outside and enjoy the sunshine.
As long as people follow advice to keep hydrated and protect their skin from too much sun, moderate heat does not usually create health problems. However, extreme heat, particularly if sustained over a period of time, can be dangerous, especially for the elderly and for people with poor health who are vulnerable. Risks increase considerably during a heatwave.
What is a heatwave, what are the risks, and what can adult social care providers do to keep their service users safe?
A heatwave is a period of hot weather when temperatures remain abnormally high. During heatwaves people can become very ill, particularly those with chronic cardiovascular conditions where the heat adds to the strain on the heart. The elderly are especially at risk, with mortality rates typically increasing as temperatures soar.
The effects of high temperatures are usually made worse by poor air quality presenting further risks to those with serious respiratory diseases or weak hearts.
The Met Office is responsible for forecasting heatwaves. It monitors temperatures in different regions of the country and passes on alerts if temperatures during the day or night rise above certain thresholds. These vary by region, but an average threshold temperature is 30°C by day and 15°C overnight for at least two consecutive days.
The heatwave plan
Concerned by the rise in mortality and hospital admissions during heatwaves, the government publishes a public health plan which it regularly updates. The latest version, Heatwave plan for England – protecting health and reducing harm from severe heat and heatwaves, was published by the Department of Health in 2015.
The plan is designed to raise awareness and provide information for emergency planners, for the public and for health and social care professionals. It alerts people to the dangers of extreme heat and encourages them to plan in advance.
The plan is based on four levels of warning:
- Level 1 is the minimum summer level requiring people to be prepared
- Level 2 means a heatwave is imminent
- Level 3 is issued when temperature thresholds have been exceeded
- Level 4 is issued when a prolonged hot spell becomes severe.
A major incident would be called in the event of severe or prolonged heatwave affecting sectors other than just the health service. Under these circumstances the plan requires local emergency planners to ensure an effective response, working with health and social care organisations, emergency services and local authorities to manage the crisis.
In a major incident the heatwave will typically not only cause pressures on the NHS and social care systems, it may also cause problems such as power or water shortages. Conditions may even threaten the integrity of health and social care systems and put more people at risk.
Similar plans are in place in other parts of the UK. In Scotland the Chief Medical Officer disseminates Safe Summer guidance. Adult social care providers should read the plan that relates to them and ensure that they are prepared before it gets hot.
Before the summer, adult social care managers should review service users’ care plans to assess which individuals are at particular risk and identify what extra help they might need. Older people, especially older women and people with chronic or serious illness, mobility problems, severe mental illness, those on certain medications (such as diuretics), or those living in accommodation that is hard to keep cool, may need extra care and support.
In a care home setting there is much that managers can do to mitigate the risk of a heatwave for their residents.
Recommended pre-planning actions to keep the home and residents cool include:
- ensuring that sufficient contingency plans are in place to cope with heatwave conditions
- checking that rooms occupied by vulnerable residents can be ventilated and kept cool – those living in top-floor accommodation may be at particular risk as heat rises
- checking that any south-facing windows, which let in most sunlight, can be shaded or protected with outside shutters
- ensuring that there are enough fans or air conditioning units available.
Managers are advised to have a ‘cool room’ ready that people can be moved to if necessary. They should also check that fridges and freezers work properly and that there are adequate supplies of cool drinking water. In the gardens, trees or leafy plants can be planted to provide shade and cool the air around buildings.
In the community, domiciliary care managers should liaise with other healthcare professionals such as GPs to identify service users at risk. A plan of care should be agreed. Services should work with relatives, carers and voluntary bodies to ensure that vulnerable service users are prepared.
Care home and domiciliary care managers should always take heatwave alerts seriously. They should monitor the threat during hot weather by checking the Met Office website or listening to local or national weather news via radio and television and take appropriate action according to the level of alert.
During a heatwave, staff should be alert to the specific symptoms of heat exhaustion and heatstroke. Vulnerable service users should be advised to keep out of the sun wherever possible and are likely to need additional support from care staff.
Care staff should keep curtains closed at windows exposed to the sun while the temperature outside is higher than it is inside. They should open the curtains and windows once the temperature outside has dropped. Service users at risk should be advised to stay out of the sun, keep hydrated, wear light, loose, cotton clothes, and avoid drinking alcohol and caffeine. Some may require their fluid intake to be monitored and recorded, particularly if they need help to drink. Some may require late-night visiting to ensure that they are well and are keeping cool.
In a care home those most at risk or those bothered by the heat could be moved to cooler areas of the home or a ‘cool room’ if provided.
Heat exhaustion and heatstroke
Care staff should be aware of the symptoms of heat exhaustion and heatstroke.
Heat exhaustion is where someone becomes too hot and may be dehydrated. The person loses water and salt from their body and starts to feel unwell. Symptoms include headaches, dizziness, nausea and vomiting, muscle weakness or cramps, pale skin, weak pulse and high temperature.
Someone with heat exhaustion should be moved to a cool place and should be encouraged to drink water. They should loosen their clothing and their skin should be cooled, such as with a damp flannel or a fan.
If symptoms are left untreated then potentially fatal heatstroke can develop.
Heatstroke is a medical emergency and can develop very rapidly. With heatstroke the body temperature becomes dangerously high. Loss of consciousness, confusion or seizures can occur.
If it is suspected that someone has heatstroke, staff should take the same actions as with heat exhaustion but should call 999 immediately.
Use the following items in the Toolkit to put the ideas in this article into practice:
- Checklist – Heatwave safety (care homes)
- Checklist – Heatwave safety (domiciliary care)
- Policy – Heatwave safety (care homes)
- Policy – Heatwave safety (domiciliary care)
About the author
Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care.