LAST UPDATE | 19 Aug 2020

A REVIEW OF the employment terms and conditions of healthcare workers in nursing homes should be carried out, according to a new report on the sector set to be launched today. 

With a combination of both short-term measures and long-term goals for the sector, the report stressed that the health system and nursing homes – many of which are privately owned – need to be more closely aligned. 

The 200-page report, which looks at how nursing homes responded to the Covid-19 crisis, offered a series of wide-ranging recommendations about how the system needs to change to cope with any similar issues in the future. 

The Nursing Homes Expert Panel, which compiled the report, was launched in the wake of the severe coronavirus outbreaks in nursing homes. 

Deaths in nursing homes accounted for 56% of all Covid-19-related deaths. 

’200 pages of wisdom’

The report was launched by Minister for Health Stephen Donnelly this afternoon. Calling it “200 pages of wisdom”, Donnelly said that the government would be looking carefully at the recommendations but acknowledged that the care of older people needs “systemic reform”. 

This report, he said, should be a key foundation for that reform. 

Donnelly didn’t commit the government to implementing all the recommendations of the report, admitting that some of it would be a challenge. 

However, he said that there were things – such as testing and infection control – that were either already in place or could be introduced immediately. 

He also promised to argue for more funding for the sector at the Cabinet table. 

“Some of the most pressing measures”, he said, “are already in place”. 

“There is some really revolutionary stuff in here,” Donnelly told reporters. “Some of that is complex, really important and I imagine, really expensive”.

An implementation group for the report will be established next week, but Donnelly also said that some of the more ambitious measures were matters for the government to discuss. 

“One of the things Covid-19 is doing, it is shining a light on the weaknesses in our society. We are seeing outbreaks in nursing homes, we are seeing outbreaks in congregated settings, we are seeing outbreaks in Direct Provision. We’re seeing outbreaks in workplaces where people are not paid a lot of money,” Donnelly said. 

Prof Cecily Kelleher, who led the review of nursing homes, stressed the need for “systematic reform” in the care of older people. 

“Many of the the people infected in this were the citizens and taxpayers who helped to create this State. We owe it to them now to have a healthcare system that is entirely fit for the 21st century.”

PPE

The report warns that it is “critical” that regional public health teams have all the resources needed to support local nursing homes and stresses that residents should continue being prioritised for testing. 

On the issue of PPE provision, a source of contention between nursing home owners and the HSE during the crisis, the report says that the system for ordering PPE “needs to be refined”.

It says that PPE should be readily available to staff, as well as appropriate training – with an “emergency supply” of PPE also ready to go in the event of a cluster. 

Staffing

The report makes specific recommendations on staffing, calling for a ban for the next 18 months on staff working in multiple nursing homes. 

It recommends that “adequate single-site employment contracts should be put in place to support this”. 

The recommendation will be seen as a response to one of the concerns at the start of the crisis that agency staff, moving between different nursing homes, might have added to the risks of spreading Covid-19. 

Donnelly told reporters that “this was something that could be considered”.

“We will start looking at it immediately,” he said, but warned that these were private sector contracts.

“It’s something that needs to be done with the sector,” he said. 

The report also stresses that occupational health and psychological support be introduced for all staff. 

Admissions

The document also recommends that people should only be admitted to nursing homes that reach sufficient infection control standards. 

A register of all nursing homes that have reached this level should be maintained by the Health Information and Quality Authority (HIQA). 

All new residents coming from the wider community or from hospital, the report finds, should be tested for the virus.

The report said stakeholders involved agreed that the pandemic “exposed the deficiencies in the system and the lack of an overarching governance structure” in the long-term residential care sector.

‘No absolutes’

When it comes to the next few weeks, Donnelly said that the “goal has to be that there is as much protection as possible for nursing homes”.

He declined to say that the government could be confident that nursing homes wouldn’t see the same kinds of outbreak in the months to come as occurred at the start of the crisis. 

“There are no absolutes,” he said. “I can’t say what’s going to happen in the future in terms of outcomes. What I can say is that nursing homes are better protected now than they were. And with these measures, will be better protected again.”

Response

Many groups have responded to the report, calling for immediate action in a sector that was vulnerable and in need of reform before Covid-19.

Tadhg Daly, the CEO of Nursing Homes Ireland, said: “The measures recommended to protect residents in our nursing homes must be a public health priority and must be in place across the country as we continue to live with Covid-19 and do all we can to protect residents in our nursing homes.”

He also said that “nursing homes should be part of a continuous spectrum of care of the older person within the wider healthcare system”. 

Dr Denis McCauley of the Irish Medical Organisation called the report a “step in the right direction”, but warned that “too often we have seen reports like these gather dust, and this cannot be allowed to happen now”.

Seán Moynihan, from the charity Alone, which supports older people, said that the “sector is disjointed, and a clear governance structure is urgently needed to bring nursing homes in line with overall healthcare in Ireland”.

With reporting by Orla Dwyer