Underestimated deaths from COVID-19 in care homes highlight some distorted values underpinning our society Older people link the past with the present and give us our cultural inheritance. They've given their life's work, they've volunteered, they've cared for partners and family. Yet age discrimination is the most common form of discrimination in the UK. We need a cultural shift in the way we treat older people to ensure their dignity and care is person-centred rather than task-orientated. The public services that they use should focus on improving their expectations and feelings of self-worth. And this ageism extends to those who care for them – the care sector is often undervalued and overlooked in society. Much of the media attention on social care focuses on crisis and neglect, and care workers are perceived as having low status. Some care staff fail to receive the training they need to care for adults with complex needs, for example, people with dementia, and in the areas of safeguarding, the Mental Capacity Act (MCA), and the Deprivation of Liberty Safeguards (DoLS). Care homes are often crying out for more staff, and find that many leave soon after joining. The hourly pay for care workers is below the basic rate of most UK supermarkets. According to The King's Fund, those who have worked in the sector for 20 years often only receive £0.15p more than someone with just one year's experience. However, most care workers are deeply committed to their work, love the freedom it offers, enjoy working with the people they meet, and take pride in doing what can be a tough job. Care work for most is a calling and much more than a job. So when people who provide essential, practical and emotional support to our most vulnerable are so poorly paid, we surely have to question why? Public Health England figures, taken on 22 April for the week 13-19 April, reported that of the 682 confirmed cases of SARS-CoV-2*, 651 were in care homes. There has likely been an under-reporting of deaths in care homes. Staff and residents haven't had adequate testing. There is a delay in recording deaths. Death certificates might attribute flu, pneumonia, or even dementia as underlying causes of death – rather than coronavirus. Deaths occurring behind closed doors are an untold tragedy. The government needs to help care home staff. The residential care system needs to be resourced to meet the pressure to control this crisis. We need to protect our elderly and most vulnerable and those who work with them from COVID-19. We need reliable supplies of quality personal protective equipment, quick and comprehensive testing, and fundamentally give this sector much more support. Care staff are worried that if they have to self-isolate – either because they are ill or to look after family, then being off work for even a week can make it hard to make ends meet. And when they return it can be six weeks before they're paid. Some homes are offering on-demand pay to give them their money when they need it - before pay-day. Many have partners who have lost their jobs or are trying to manage on a reduced income because of the lockdown. It's especially worrying when there's an outbreak at work. Some are getting sick, and others are losing their lives. Rahima Bibi Sidhanee, 68, was a care home nurse at Grennell Lodge nursing home in south London, where she had worked for 20 years. Before that, she had been a midwife and nurse after moving to Britain from Trinidad in the late 1960s. She refused to retire so she could continue to care for others during the coronavirus outbreak, but died from the disease on 12 April. Her son Abu Sidhanee, 41, said: "She said the elderly people needed her and she actually started doing an extra shift. People were in need of her, and she was there." Caring for patients with COVID-19 can be deeply upsetting and take its toll on mental health. Some symptoms of trauma are feeling angry and irritable, anxious, low, drinking more alcohol, smoking, eating and having problems sleeping, and even burning out. Advocacy Focus works with many people in care home settings and works with many professionals in the care sector to secure positive outcomes for people. We have adapted our way of working to deliver advocacy in safe, creative, socially-distant and person-centred ways. We are working remotely, but others are visiting people when it is urgent and critical and safe to do so, all the while adhering to Public Health England guidelines. In this way, we are helping to improve the value placed on older people and ultimately helping them live the lives they want to live. Our befriending service, and Pen-demic Pals initiatives, are combatting loneliness in the community. Our team is encouraging essential advocacy referrals into our service during the current pandemic. We are watching how this situation is affecting care staff at the frontline and will support or signpost them to the right services if they need this after experiencing a traumatic event. This will give them the best chance to emerge stronger and able to continue to provide the care that many older people need and deserve. Underpinning all this is the need for a fundamental improvement by government and society in the way we value our older generation and the people who provide such essential care. * Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the name given to the 2019 novel coronavirus. COVID-19 is the name given to the disease associated with the virus.