DESPITE THE CHIEF Medical Officer stressing that visitors did not bring Covid-19 into nursing homes, the body that represents the sector has questioned again the decision to challenge its call in early March to restrict visitation.
Nursing Homes Ireland (NHI) will today tell the Oireachtas Special Committee on Covid-19 that the National Public Health Emergency Team (NPHET) publicly challenged the NHI’s decision to restrict visitors to nursing homes, which was issued to its members on 6 March.
Tadhg Daly, CEO of Nursing Homes Ireland, will tell the committee that the organisation, which represents the private and voluntary nursing home sector, that Hiqa had made a decision on 10 March to suspend visits by its inspectors to hospitals, citing the safety and wellbeing of patients and staff.
Daly will also tell committee members that hundreds of discharges were facilitated from acute hospitals to nursing homes in the early days of the outbreak.
“This was despite refusal to test patients prior to discharge from hospitals to nursing homes and we know the extent of community transmissions,” Daly will say.
Speaking on RTÉ’s Morning Ireland today, Daly said that he didn’t “accept for a minute” that visitor restrictions were unsuitable in early March, emphasising that “up to 40% of cases are asymptomatic,” and that no one really knows exactly how the virus spreads in any setting.
Among the possible ways the virus is thought to have spread in nursing homes is through hospital discharges to nursing homes, staff members, or visitors to nursing homes. Dr Tony Holohan has said previously that visitors were not the cause of the spread of coronavirus in Irish nursing homes.
He also said that staff at nursing homes were given accommodation by the HSE if they had symptoms and needed to self isolate.
Daly said that millions have been spent on PPE, 60% of private nursing homes are owned by SMEs, Daly said.
The special committee, made up of 19 TDs, met for the first time last week. Over the next year it is anticipated it will assess the government’s response to the pandemic.
Daly says in his opening statement it was known early on that people in homes would be “amongst the most susceptible”.
Stories from overseas emerged early in the year regarding the devastating impact the virus had on older persons in residential care settings, states Daly, adding that in January NHI had begun its engagement with nursing homes to provide Covid-specific guidance.
In February “concerted engagement” was undertaken with the HSE to deliver specific Covid-19 education and guidance for nursing homes.
Guidance from the Department of Health to provide dedicated guidance for residential care settings was also sought.
On Friday 6 March, a decision to restrict visitors to nursing homes was made, which Daly states was informed by their nursing committee, which comprises of clinical experts representing nursing homes across the country.
It was a decision “not taken lightly,” says Daly.
At the NPHET briefing of 10 March, “the decision was taken to publicly challenge the
decision to restrict visitors as premature”.
“This is despite Hiqa, presented as the representative voice for our sector at NPHET, announcing that same day it would suspend visits by its inspectors to hospitals, citing the safety and wellbeing of people using services and staff.
“Two days later – 12th March – it cancelled inspections of all social care services.”
Chief Medical Officer Tony Holohan has previously stressed that officials do not believe, based on the data, that visitors brought this disease into nursing homes.
TheJournal.ie revealed earlier this week that Hiqa received multiple allegations of outsiders entering nursing homes during the first two months of the Covid-19 outbreak despite visiting restrictions.
Since the beginning of the outbreak, criticisms have been made as to why action wasn’t taken sooner to safeguard those living in nursing homes.
According to Daly the first specific guidance regarding nursing home care management was only issued on 23 March, weeks into the national emergency.
Throughout the public health crisis, private nursing homes not under public ownership, have raised concerns about the lack of funding available for the purchase of personal protective equipment needed in nursing homes.
The State has since stepped in to help provide this equipment to the private sector.
While the Department of Health eventually intervened, Daly says key State organisations left the nursing home sector and its residents isolated in those early days.
“The dismay will live forever with us.”
A number of mistakes were made, says Daly, including the insufficient testing of residents and staff and the mass shortfall of PPE.
He adds that there was also an aggressive recruitment of nursing home staff initially by the HSE. As the crisis emerged, a massive recruitment drive got underway for medical and healthcare workers to help in Irish hospitals – but as a result there have been criticisms since that such actions decreased the level of staff working in Ireland’s nursing homes.
Discharging from hospitals
Daly will also highlight the discharging from acute hospitals to nursing homes without testing at the outset of the public health emergency in March.
HSE boss Paul Reid said last week that there is “no evidence whatsoever” that Covid-19 infection spread into Ireland’s nursing homes by the discharge of elderly people into nursing homes in March.
However, Holohan said “the reality is any form of movement of people in and out of any setting increases the risk of transmission of this infection”.
“And if there’s movement of individuals in and out of nursing homes and longterm residential care facilities happening, that can increase the risk of transmission.”
Daly will tell the committee today:
“We were exasperated. The sector required a specific plan. We knew that Covid-19 disproportionately impacts on older people. The planning and focus was almost exclusively on our acute hospitals.”
While he said nursing homes had huge levels of experience in managing the outbreak of flu and norovirus every winter and have extensive experience and clinical expertise in implementing infection prevention control measures, the global pandemic was on a “different scale to any previously encountered in the sector”.
Daly will also tell the committee that lessons can be learned from the closer engagement brought upon by Covid-19.
“There is requirement for a better and more integrated working relationship between the State and our sector. The core focus has to be on meeting the complex health and social care needs of nursing home residents,” he concludes in his statement.
Reacting to the opening statement from NCI, Sinn Féin’s Louise O’Reilly stated:
“The whole statement points to a complete failure of the State to enact a structural plan for the nursing home sector, with the necessary financial and staffing resources, until late in the day.
“The document makes for very difficult reading, but it highlights many of the issues that the sector itself had raised for many weeks before the government intervened.”
Inspections by Hiqa
Also appearing before the committee today is Hiqa, the body that is legally responsible for the monitoring, inspection and registration of designated centres for older people, such as nursing homes, in Ireland.
Hiqa’s Chief Executive Officer, Phelim Quinn will tell the committee about the ceasing of inspections of nursing homes in March, which was also highlighted by Nursing Home Ireland.
“Whilst routine inspections were not initially possible, Hiqa has a process in place whereby all designated centres are formally contacted by an inspector on a regular basis to assess how they are managing in the provision of safe services to vulnerable service users,” he says in his statement.
He says inspections required to register new centres or to facilitate increased capacity have been expedited within days.
Hiqa has also provided information to the Department of Health and the HSE on those centres with a history of poor compliance with key regulations, as these services are at increased risk of a Covid-19 outbreak.
While the body is in charge of inspecting nursing homes, in 2018 it only inspected 76.4% of all 581 nursing homes.
Of the 581 homes, only 128 were fully compliant with the Hiqa regulations in 2018. This issue was raised in the Dáil last week by Fine Gael’s Fergus O’Dowd, who said that the percentage of compliance was down from 27% in 2017 to 23% in 2018.
Quinn will also tell the committee today that currently 80% of nursing homes are operated by private providers, despite being largely funded through the Nursing Home Support Scheme also known as the Fair Deal Scheme.
“The HSE did not know this sector. As a consequence, the infrastructure required by the HSE to support the private sector was under resourced and became increasingly challenged.”
In addition, the current model of private residential care for older persons has no
formal clinical governance links with the HSE, adds Quinn.
“Importantly, this means there is no national clinical oversight of the care being delivered to some of our most vulnerable citizens,” he says.
Quinn outlines that Hiqa initiated a number of interventions from 5 March, including the escalation to the HSE and the Department of Health on the risks and trends requiring a more coordinated national response.
On 18 March, Hiqa made a formal offer to assist the HSE in liaising with designated
centres, says Quinn, stating that this was in recognition of the fact that there was no established relationship between the HSE and the private sector.
Sage Advocacy, a group tasked with protecting and defending the rights of vulnerable
adults, older people and healthcare patients, will also tell the committee today that the impact of the outbreak on residents of nursing homes has been “frightening for many”.
The arrival of people in full PPE has been terrifying, particularly for those with dementia, the group’s chef executive Mervyn Taylor will tell committee members.
“Serious shortages of staff meant that there was little, if any, time to provide support to residents in facilities where many died. For families with relatives who were extremely ill or dying, the inability to visit or to even talk to their loved one by phone was a source of considerable distress and frustration,” says Taylor.
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