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Oireachtas committee calls for 'immediate' action to protect nursing homes in event of Covid-19 second wave

The report was welcomed by Nursing Homes Ireland and the INMO.

THE LACK OF statutory clinical oversight of care in private nursing homes is one of the greatest weaknesses exposed by Covid-19, the Oireachtas Special Committee on Covid-19 has said. 

In a report, published this evening, the committee recommends that the Department of Health “urgently reviews” clinical oversight and governance in privately run nursing homes. 

Deaths in nursing homes accounted for over 50% of all Covid-19 deaths. At the peak of the pandemic, nearly weekly reports of new clusters, outbreaks and deaths in Irish nursing homes were a major source of criticism for the government. 

“The committee is strongly of the opinion that we need to strengthen clinical oversight of individual nursing homes, both public and private, by requiring a designated medical officer be appointed to each nursing home,” committee chairman Michael McNamara said in a statement. 

The report also calls for the Department of Health, alongside the HSE and HIQA, to develop a plan to ensure staffing levels and infection control are able to cope with any second wave of Covid-19. 

Other recommendations include asking the Department of Health to ensure regulations are robust enough to protect nursing home residents, while the members of the committee also suggest that no patients are discharged from hospital to any nursing home which fails to meet infection control standards. 

The report also calls for adequate stocks of PPE to be provided to all nursing homes in the months ahead. 

“We know, for instance, that the discharge of patients from acute hospitals to nursing homes has been tightened up through testing and isolation procedures, which is welcome. However, the fact that the HSE still facilitates the placement of older persons in a nursing home with known infection control risks is, in the view of the Committee, indefensible. This practice must end,” McNamara said. 

McNamara said that the committee will come to a decision in September on whether a public inquiry is needed into the scale of cases and deaths in nursing homes. 

Reaction

This evening, Nursing Homes Ireland CEO Tadhg Daly welcomed the report’s findings. 

“The report correctly finds the public health authorities were slow to respond to the threat posed by Covid-19 in nursing homes and engagement undertaken with our sector was not substantial or fully collaborative in nature,” Daly said in a statement. 

Daly, in a lengthy statement, added:

Our sector continues to ask why nursing homes were not a bigger priority in the preparations for the pandemic, why guidance was so slow to come and the purpose of the regulator’s latest report when it would have been better to come during the height of the crisis.  We hope the Committee will also get to the bottom of HIQA’s role on NPHET, which failed to focus on nursing homes at the outset.

“Government must now lead in assessing the challenges that present in terms of ensuring the staffing skill-mix and complement is available to meet the health and social care needs of residents in nursing homes who have high-intensity, complex care needs,” Daly added. 

The Irish Nurses and Midwives Organisation (INMO) welcomed the report, backing the call for better staffing levels. 

“The Oireachtas committee is absolutely correct in its recommendation on staffing. For decades, staffing levels in the Irish health service have been based on historical levels,” said INMO General Secretary, Phil Ní Sheaghdha. 

“A ward would have staff based simply on what they have had previously, rather than patient needs. Whether we are facing a second wave or not, Ireland needs to set staffing levels based on evidence, not history,” she said. 

However, one member of the committee called the findings “too watery”. 

Bríd Smith, a People Before Profit TD, said the findings need to be stronger when the full report is published in September. 

“We need to examine the fact that 80% of our nursing home capacity is run by private for profit homes which are not equipped to provide medical treatment and couldn’t adequately retain staff,” she said. 

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    Mute Darragh Bowes
    Favourite Darragh Bowes
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    Jul 31st 2020, 9:35 PM

    If they don’t have a plan by now, they won’t have one when the second wave hits.

    94
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    Mute Tiktok
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    Jul 31st 2020, 10:15 PM

    Its simple. Dont bring infected covid patients in to nursing homes like they did in March and April.

    77
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    Mute Paul Gorry
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    Jul 31st 2020, 10:52 PM

    @Tiktok: what does that even mean?(infected patients?ye mean sick people?that need help)I guess in your head it sounds like a nice quip to make and post it here. But the fact is your just MUPPET. And off no intellectual intelligence what’s so ever

    10
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    Mute Steven
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    Jul 31st 2020, 11:22 PM

    @Paul Gorry: infected covid patients = infected elderly nursing home citizens, y are u so mad lol

    31
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    Mute Paul Gorry
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    Aug 1st 2020, 12:06 AM

    @Steven: well Steven my mam died from covid in a nursing home early may. And i don’t blame anybody for that ie nursing homes, government, or whatever. Nobody knew what was going on or happening, and i take solice in that. So muppets like him that responded the way he did annoys me. Anyway hope now you understand why I am so mad. (I’ll leave out the usual LOLthat everybody seems to use).

    8
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    Mute Steven
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    Aug 1st 2020, 12:09 AM

    @Paul Gorry: im sorry to hear that but what the guy said above is true, infected patients were in fact shipped out to nursing homes, it’s a fact.

    22
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    Mute Paul Gorry
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    Aug 1st 2020, 12:46 AM

    @Steven: well i agree. But what nursing homes???

    3
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    Mute Thomas Sheridan
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    Aug 1st 2020, 6:05 AM

    @Paul Gorry: people did know. They only had to follow what was going on in Spain in the preceding weeks.

    9
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    Mute M J Flynn
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    Aug 1st 2020, 10:31 AM

    @Steven: in January the WHO told the world to check, and if necessary, improve Infection Prevention and Control because coronaviruses spread like wildfire in care settings. NPHET, the CMO and the Minister for Health ignored the WHO. That is the starting point of this scandal. These guys, our leaders, IGNORED the advice and the warnings and this has been covered up ever since.

    4
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    Mute Virus-free Turkey
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    Jul 31st 2020, 10:57 PM

    Oireachtas committee calls for immediate action… and then goes on 6 weeks holidays. Only in Ireland…

    62
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    Mute Tony Shaw
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    Jul 31st 2020, 11:38 PM

    The HSE hate the private nursing home sector and hung them out to dry in Covid-19 by sending untested residents out to them from HSE hospitals, taking their staff,not giving ppe priority.
    Over 50% of deaths in nursing homes.
    HSE high & middle management & Nphet hang your heads in shame for these avoidable deaths.
    0 deaths in prisons? Go figure.
    Don’t trust HSE not to do the same again.

    50
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    Mute workhorse of health
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    Aug 1st 2020, 10:44 AM

    @Tony Shaw: that’s ridiculous. HSE sent residents back to their homes if the nursing homes said they could isolate the resident for 14 days. And they didn’t ‘take’ their staff. Staff left homes because of the way they were treated there by owners not supplying PPE and HSE were employing staff far quicker than at normal times. If owners paid staff properly and treated them properly none of them would have left.

    4
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    Mute Neuville-Kepler62F
    Favourite Neuville-Kepler62F
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    Jul 31st 2020, 10:11 PM

    Surgical Face Masks … surgical masks not effective for aerosol borne virus.!

    This PubMed report  published in 2013, concludes that surgical masks are not good enough to protect from aerosol borne viruses. This might help to explain the high incidence of transmission of corvid19 among Health care workers, Care homes and in other high risk settings.

    https://pubmed.ncbi.nlm.nih.gov/23498357/
    Effectiveness of surgical masks against influenza bioaerosols

    Abstract: Most surgical masks are not certified for use as respiratory protective devices (RPDs). In the event of an influenza pandemic, logistical and practical implications such as storage and fit testing will restrict the use of RPDs to certain high-risk procedures that are likely to generate large amounts of infectious bioaerosols. Studies have shown that in such circumstances increased numbers of ordinary surgical masks are worn, but the protection afforded to the wearer by an ordinary surgical mask against infectious aerosols is not well understood. ….. “code for not proven effective”!
    —————

    {{{{
    IMO, Respiratory protective devices (RPDs) such as N95 or FFP2 (without exhale valve) or even 3 layer cotton homemade well fittted masks with metal nose pinch would be better protection against covid19 rather than ordinary surgical face masks which do not provide a good face seal in order to prevent infection via bioaerosols.
    }}}}

    20
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    Mute David Jordan
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    Aug 1st 2020, 12:52 AM

    @Neuville-Kepler62F: Wrong.

    SARS-COV-2 is mainly droplet spread, sometime aerosol. This study about you posted Flu is not relevant to SARS-COV-2.

    Droplets are larger than aerosols and do not usually travel as far, thus the 2 meter rule. There may be exceptions, coughed droplets can travel far in the still air of a stuffy room up to 12 metres! However, a simple cloth mask is sufficient to block these larger droplets.

    Here is a test subject with no mask v’s various types of simple cloth mask:

    https://www.youtube.com/watch?v=RkB0k81oNiI

    Wearing a mask dramatically reduces the distance droplets travel, even a cloth mask works.

    “We reiterate that although the non-medical masks tested in this study experienced varying degrees of flow leakage, they are likely to be effective in stopping larger respiratory droplets.”

    From:

    Verma, Siddhartha, Manhar Dhanak, and John Frankenfield. 2020. ‘Visualizing the Effectiveness of Face Masks in Obstructing Respiratory Jets’. Physics of Fluids 32 (6): 061708.

    And not only do Cloth Masks reduce the chance of infection, they also lower the number of inhaled virus. As result, if a person does end up infected, despite wearing a mask, they are more experience mild symptoms, as their is a dose response relationship between number of inhaled virus and illness severity, explained here:

    https://srconstantin.github.io/2020/06/02/Dose-Response.html

    Wearing mask is very important, as unlike previous pandemics or viruses, SARS-COV-2 is contagious even if there’s no symptoms, in pre-symptomatic and asymptomatic ill individuals.

    The isolation of only sick people is not enough to slow or stop the spread of this disease, because so many asymptomatic contagious people walk around not realising they are infectious. That’s why it’s important to assume that you are infectious and operate with a mentality that you are trying to not to give the virus to others.

    This is the mentality of polite east Asian countries, like Japan, who are more obedient to the group and are less individualistic. They all wear masks. Their COVID-19 epidemics are under control.

    14
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    Mute Neuville-Kepler62F
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    Aug 2nd 2020, 9:49 AM

    @David Jordan: Wrong.

    Aerosols DO carry virus, pollen, asbestos dust, etc. The RNA of a virus is irrelevant in its ability to travel in aerosol.

    Ordinary standard surgical masks do not adequately protect the wearer against aerosol transmitted virus because they have a poor seal as the research indicates. https://pubmed.ncbi.nlm.nih.gov/23498357/

    The death rate in Irish Care Homes and the world’s highest infection rates among Irish hospital staff is compelling.

    In May 2020, the guidance from the German Department of Health changed, to state explicitly, that “Studies indicate that the novel corona virus can also be transmitted through aerosols … They can remain suspended in the air over longer periods of time and may potentially transmit viruses. Rooms containing several people should therefore be ventilated regularly.”     

    French school rooms must leave the door and at least 1 window open to vent aerosol due to breathing, talking, laughing, singing, coughing, sneezing, shouting …

    Ask yourself this question.
    Which option would you choose to enter or place a family member:-
    A Care Home, hospital, bus, train, plane, meat factory, GP surgery, school etc 
     
    A. Where basic surgical masks are acceptable.
    B. Where only well sealed 3 layer cotton masks with nose pinch seal OR better are acceptable.
    C. Where only N95 (FFP2) masks are acceptable for ALL who reside or enter the setting. (exceptions can be made for special individual cases)

    I would choose option C.
    I would want to protect myself and others from potential aerosol infection and not rely on others wearing ordinary surgical masks to protect me!.

    The choice is yours. The WHO is too slow to respond.

    https://www.nature.com/articles/d41586-020-02058-1 

    1
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    Mute William Bryan
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    Aug 1st 2020, 7:36 AM

    Now they want to change nursing homes from social care models to more medical model of care, which I. My opinion would be a backword step, its their home, it should feel like home. We need a more blended model with more nursees working in the care homes but with a social care led ethos not sterile hospital styled wards rather than rooms

    13
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