Covid-19 in nursing homes and what went wrong

At a glance: 

The frustrating tragedy of the deaths of residents in nursing homes in Ireland is that more could have been done to prevent the stop of the virus. Nursing homes were clearly identifiable as one of the most vulnerable groups before we had even one case of Covid-19 in Ireland. Three lessons can be learnt:- 

  • Lesson One: Nursing Homes need to be locked down earlier 
  • Lesson Two: Nursing homes Ireland need to have a seat on the State Health Crisis Team     
  • Lesson Three: Nursing homes need to be prepared and need funding to do it 

1,670 people have died from Covid-19 related illness in Ireland and nursing homes account for 927 victims or 55%; these figures are shocking when you consider that the threat to elderly people was known worldwide. 

Ireland has one of the highest Covid-19 mortality rates in the world among nursing home residents. The nursing home residents are a group that could and should have been protected. Mistakes were made and we need to learn from these mistakes in advance of a second wave occurring, so what are the lessons to be learned?  

Lesson One: Nursing Homes need to be locked down earlier 

If we go back to mid-February, Italy were reporting that older people are particularly vulnerable to this virus and this followed earlier reports of the numbers of people affected by outbreaks in Seattle Nursing Homes.   

In Ireland on 29th February 2020 we had the first reported case of Covid-19. It was not until 6th March 2020, that Nursing Homes Ireland issued a statement saying ‘visiting restrictions are now in place in nursing homes nationwide. No non-essential visiting, children, or groups will be allowed’. 

On 10th March 2020, the minutes from a NPHET meeting stated, ‘unilateral/widespread restriction of visiting to nursing homes, hospitals and healthcare facilities is not required at this time’. 

By 13th March 2020 the NPHET advice was to stop nursing home visits. If the nursing homes were locked down earlier the spread of the virus could have been controlled.  

Lesson Two: Nursing homes Ireland need to have a seat on the State Health Crisis Team     

Nursing Homes Ireland has no voice on the State’s Health Crisis Team. 80% of nursing homes in Ireland are under private control and as such Nursing Homes Ireland were not included in the discussions and State planning of control of the virus. The focus for the Government was not on nursing homes as the responsibility of the residents was up to the nursing home owners.  

It was on 13th March 2020 that HIQA sent a list of ‘at risk’ nursing homes to the Department of Health. The Department acknowledged the list but nothing was done.  

In the National Action Plan on Covid-19 published on 16th March 2020, there was only one mention of nursing homes which stated  ‘on an ongoing basis, accelerate appropriate discharge of patients [from acute services] to appropriate facilities, or with homecare support’. During this time the virus in the nursing homes was silently being spread as we see a peak in the transmission of cases in April.  

The issues that were arising in nursing homes at this time were not highlighted as the government was focused on the logistics around the hospital capacity in the event of a surge of infections. There needs to be clearer communication between Nursing Homes Ireland and the Government.  

Lesson Three: Nursing homes need to be prepared and need funding to do it 

Complaints to HIQA from staff working in nursing homes during this crisis reveal that staff had concerns on the following:- 

  • Transfers of patients from hospitals to nursing homes; 
  • No PPE;  
  • lack of staffing;  
  • Nursing home staff who had tested positive for Covid-19 but had no symptoms were asked to continue working;  
  • Untested staff who had symptoms of the virus continued to work; and 
  • Lack of infection controls within the nursing home.  

Nursing Homes Ireland CEO, Tadhg Daly, was seeking help from the Government during March to try and deal with these issues.  

This cumulated in a nursing home working group being setup on 18th March 2020. Nursing Homes Ireland were not on the working group, although HIQA, the regulator of Nursing Homes Ireland, was. 

It was only announced by Government on 4th April 2020 that a €72m support scheme for nursing homes was available. The seriousness of the delay in funding is highlighted when you consider that Ireland reached peak contamination of Covid-19 on 23rd April 2020.  

If the nursing homes were better prepared and funded to deal with the risks that were foreseeable perhaps the spread of the virus could have been contained.  

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