THE HEALTH WATCHDOG received multiple allegations of outsiders entering nursing homes during the first two months of the Covid-19 outbreak despite visiting restrictions.

Further complaints were also raised about the quality of care given in nursing homes during the crisis, as well as the impact of visiting restrictions on residents.

The issues are detailed in a log of Covid-19-related complaints to the Health Information and Quality Authority (Hiqa) about the nursing home sector, seen by TheJournal.ie.

Between 5 March and 22 April, the authority received more than 170 complaints about the coronavirus outbreak in nursing homes.

Around half of these were released under the Freedom of Information Act, although the names of specific homes, patients and complainants were not disclosed for privacy reasons.

The majority of complaints express concerns over infection control measures, potential non-adherence to social distancing guidelines, the quality of care being given to patients, and the availability of personal protective equipment (PPE).

Others detail more specific issues, including where a staff member is alleged to have returned from an affected country without isolating, and the failure of a nurse to recognise symptoms in a patient.

In a statement, Hiqa told TheJournal.ie that all providers of nursing homes and their staff are required to know what the current public health and infection control guidance is in order to manage and prevent the spread of Covid-19, including the wearing of PPE.

Sinn Féin Health spokesperson Louise O’Reilly said the complaints highlighted the confusion that arose within the nursing home sector after the pandemic reached Ireland.

Nursing homes have been badly affected by the Covid-19 outbreak.

To date, there have been 257 clusters – defined as a location where two or more cases have been confirmed – reported in nursing homes, almost half of the country’s total.

More than half of the country’s 1,583 deaths from the coronavirus have also been among nursing home residents. 

“There are serious questions to be answered in relation to nursing homes and congregated settings,” O’Reilly told TheJournal.ie. 

Preparation questioned

Although issues relating to nursing homes are not unique to Ireland, there have been questions as to whether the government adequately prepared for the challenges the pandemic would present to the sector.

Early information on the spread of Covid-19 showed that older people were particularly vulnerable to the virus, and nursing homes in Spain and Italy were badly impacted when the pandemic reached them. 

However, HSE guidance on 17 March – more than two weeks after the first case of the virus was confirmed in Ireland – only called for “appropriate visitor restrictions in the event of a Covid-19 outbreak”.

It was not until 10 April that the HSE’s advice changed to ask families and friends to avoid visiting unless in exceptional circumstances. 

Complaints released by Hiqa show that the watchdog was made aware of concerns about visitors in nursing homes weeks before the HSE advice was issued.

On 18 March, one person complained about the number of people attending wakes being held in a nursing home, suggesting it was putting residents and staff at risk.

On 24 March, a complainant alleged that a staff member in one home had returned from Spain, where the virus had struck particularly badly, without quarantining themselves.

Three days later, another person complained that a resident elsewhere continued to receive visitors on a regular basis, despite a total ban on visitors in the home.

And on 6 April, another home was alleged to have allowed a building contractor to enter a unit where residents were living without washing their hands.

No social distancing

Many complaints were also made in relation to infection control, social distancing and the supply of PPE soon after the arrival of Covid-19 in Ireland.

On 5 March, two people cited issues with hand-washing in different nursing homes.

The following week saw initial complaints about infection control in nursing homes, an issue that was raised with Hiqa on 17 occasions between 16 March and 22 April.

On 8 April, one person told Hiqa that staff in a facility continued to work there instead of self-isolating if they showed symptoms of the virus.

The same day, another person told the watchdog they were concerned that a staff member in a facility was also working in a local supermarket, putting residents at risk.

Several complaints were also sent to Hiqa about the use of PPE in homes between March and the end of April.

The first of these was made on 18 March, when a complainant alleged that staff were not permitted to wear medical masks when working with residents who had tested positive for the virus.

Official guidance was later changed on 22 April, advising healthcare workers to wear face masks within two metres of a patient.

Further complaints dating from 23 March further alleged that social distancing was not being adhered to in some homes.

Impact of restrictions

However, many complaints to Hiqa also raised concerns about the impact of visiting restrictions on residents, particularly at the start of the crisis.

On 6 March, Nursing Homes Ireland introduced strict new visitor restrictions asking people to only attend homes in “urgent circumstances”.

Between 5 March and 7 April, the watchdog received 14 complaints in total about visitor bans and the impact it had on those living in nursing homes.

The welfare of residents in light of visiting restrictions also became an issue to complainants when the virus had spread further.

Several complaints were made about the well-being of residents after visiting bans were imposed, with complainants citing a lack of communication from homes about their loved ones.

One person on 30 March alleged that a resident was being neglected by staff and was missing meals during the crisis, while another on 8 April contacted Hiqa with concerns that a resident was being left in bed all day.

On 20 April, a different complainant raised concerns about a resident’s personal hygiene needs, and the poor management of their wound care.

Nursing home inspections

Asked whether these complaints had been followed up, a spokesperson for Hiqa said it is unable to investigate individual complaints, although it does carry out reviews and risk assessments of the information contained within them.

The authority said that although it does not comment on individual nursing homes, any information which could indicate a risk to residents is addressed with the management of individual homes on a case-by-case basis.

The authority also noted that it has continued to carry out inspections of nursing homes during the crisis, and that some of these have involved the assessment of facilities’ Covid-19 contingency arrangements.

Commenting on the complaints, Sinn Féin health spokesperson Louise O’Reilly said they showed the extent to which authorities had been made aware of concerns about Covid-19 in nursing homes.

“The level of complaints seems to indicate that these issues were being raised but there was no plan to address them, even though we were watching other countries who were ahead of us and who were experiencing these issues in their nursing homes,” she said.

“It appears that there was vital time lost and it remains to be uncovered what the impact of this time lost was on the spread of the virus.”