We have been cautioned about the dangers of Covid-19 misinformation nearly as much as we have been told to wash our hands. A fact which is indisputable and has been abundantly clear from the outset is that Covid-19 has devasting impact on the older members of our society. Despite this, there has been an apparent lack of cohesion in planning between the Health Service Executive (HSE) and the Nursing Homes Ireland (NHI).
The scale of the crisis is alarming. It was reported recently that there were eight Covid-19 related deaths in one nursing home in Trim. Dr Jack Lambert highlighted on the Sean O’Rourke radio programme RTE’s Today the planning of the pandemic was focused on hospitals. Nursing homes were required to devise their own plans.
This disregard of older members of Irish society runs deeper than the current crisis. The Health Protection Surveillance Centre’s published a “National Pandemic Plan” in 2008. The aim of this plan is
“to provide timely, authoritive information on pandemic influenza, to provide clinical guidance for health professionals, and to provide public health advice for the public, public health professionals, and policy makers in the Department of Health and Children and other government Departments and agencies, all of whom will be involved in the response to an influenza pandemic.”
There is a notable absence of any mention of nursing homes or indeed any residential care institutions in this document. Our dismay only increases when one considers that this document was contingency planning for fear of an outbreak of the Sars Virus which first appeared in Asia in 2003. One of the most vulnerable groups in a flu pandemic outbreak are the elderly. The devastation currently happening in nursing homes was foreseeable.
An ad hoc approach by each nursing home, many of which have limited resources and few staff in reserve to replace those who a require sick leave is an inadequate response, in the extreme.
Nursing Homes Ireland have issued guidelines to their members, as follows;
“Providers should develop their own operational resilience planning. This will relate closely to plans which should already be in case in relation to any major incident. The distinction being that there may be factors limiting the ability of staff to travel to work if there is any instruction to self-isolate.”
“We are liaising with the HSE with regard to specific recommendations with regard to planning for COVID-19 and emergency measures to be undertaken and expect to circulate guidance imminently.”
The number of clusters of Covid-19 in nursing homes has grown from the mid-20’s in March to over 200 in April. It is inevitable that questions will be asked as to whether those nursing homes affected by the Covid-19 followed best practice. Questions must also be asked of the government as to the speed and nature of support provided to nursing homes.
According to Dr Lambert there had been an expectation on the nursing homes to find their own PPE, to organise testing, training and isolating of residents and clients in what is an already under-resourced environment where staff are getting sick.
Steps were taken by Minister for Health in early April to assist nursing home source necessary PPE but further urgent steps are required as the virus continues to spread. The delayed government intervention and lack of planning have exposed vulnerable residents of the nursing homes, the staff and their families to the virus.
