Dozen Covid cases in local nursing homes

As of June 30 last, there were six cases each in Cavan and Monaghan, five in neighbouring Leitrim, one in Longford, and 13 in Meath.

There were a dozen suspected or confirmed cases of Covid-19 infection each found at nursing homes in counties Cavan and Monaghan, according to the HIQA published report examining the impact of the pandemic on the sector nationally.

As of June 30 last, there were six cases each in Cavan and Monaghan, five in neighbouring Leitrim, one in Longford, and 13 in Meath.

The first confirmed case of COVID-19 in a nursing home in Ireland was reported March 13.

The report states that many nursing homes in Ireland have been fortunate not to have an outbreak of COVID-19 to date.

The HIQA published report however details the findings of recent inspections and HIQA’s interaction with nursing homes throughout the outbreak, and describes the experiences of residents, their relatives and staff.

At the time of the report being conducted, there were 576 registered nursing homes in Ireland, with approximately 32,000 residential places.

Nursing homes are operated by a mixture of private and voluntary bodies, and the HSE. Private entities are by far the largest providers in the sector, managing eight out of 10 beds nationally (80%).

While the average number of beds in nursing homes nationally is just over 56, they range in size from as little as nine beds to the largest centre which has 184 beds.

The newly discovered coronavirus that causes COVID-19 is an especially difficult one to manage from an infection prevention and control perspective, HIQA acknowledges, particularly in the context of residential care for older persons.

Between March 30 and July 3, there were 11 revisions to HPSC guidance. This required management in nursing homes to quickly take in and understand these updates. They were also required to enable the implementation of the changes throughout their service.

Nursing home providers are now required to inform the Chief Inspector about unexpected deaths in their centres. A review of the number of deaths reported to the Chief Inspector in 2020 compared to previous years shows a significant increase.

There were a total of 189 compliance assessments carried out in 189 nursing homes free of COVID-19 between April 29 and May 26.

The assessment programme concluded on 26 May 2020 when a decision was made to recommence risk inspections of nursing homes.

In total, inspectors made 2,826 assessments of compliance with regulations, averaging approximately 15 regulations assessed in each nursing home.

In general, a good level of compliance was found across the nursing homes assessed.

Of the 189 nursing homes, 142 (75%) were found to be fully compliant with all of the regulations assessed.

There were 13 nursing homes (7%) where one or more regulation was found to be not compliant.

Four nursing homes were not compliant with more than 20% of the regulations assessed, and

as a result, these homes will continue to be closely monitored by the Chief Inspector to ensure that they address the issues identified.

The three regulations with the highest level of non-compliance were Regulation 3: Governance and management; Regulation 15: Staffing; and Regulation 27: Infection control. These will be discussed in more detail in the next section of the report.

In one nursing home, the bedroom door of a resident who had tested positive was left open and another facility was deemed so unfit for residents it was taken over by the HSE and ultimately shut down.

HIQA also found that multi-occupancy rooms and outdated facilities made it difficult to stop the spread of the virus.

In one home, 29 members of staff tested positive for Covid-19, which had a knock-on effect on nursing care and proper cleaning of the centre in line with guidance.

Inspectors though found that the vast majority of nursing homes were staffed by people who were committed to keeping residents safe. Many staff had agreed to work additional hours and made themselves available on stand-by should the need arise. For example, one inspector reported: “All staff have been surveyed in relation to their willingness to increase their hours, particularly staff that do not currently work full-time.”

There was a screening and reporting process in place to ensure that symptomatic staff did not come on duty. Neither did staff come on duty if they were living with persons working in another healthcare setting that was affected by COVID-19.

Six nursing homes were found to be not compliant with this regulation, representing 3% of all centres inspected.

A recurring theme in this context was an insufficient number of staff on duty. For example, in one centre, the inspector wrote that “…the person in charge told the inspector that seven nurses had left to cocoon due to COVID-19 and a few other care staff had resigned from the centre. She said she was trying to manage the centre with minimum staffing at the moment. She only had a skeleton workforce and did not have any relief staff available.”

HIQA’s Chief Inspector of Social Services and Director of Regulation, Mary Dunnion, said: “COVID-19 has brought into sharp focus the need for reform of current models of care for older people in Ireland. The continued use of multi-occupancy rooms and outmoded premises in some nursing homes undoubtedly created challenges in containing the spread of infection. We must look to complementary models of care, such as homecare and assisted living, and ensure that there is improved clinical oversight in all nursing homes.

“Furthermore, the regulations governing nursing homes are outdated and must be revised to make them fit for purpose, particularly as regards governance, staffing numbers, skill-mix, and infection prevention and control. HIQA will continue to listen to the experiences of residents, relatives and staff to strive for safer, better care that focuses on the human-rights and individual needs of the person.”

From the onset of the pandemic, HIQA meanwhile has taken a number of initiatives to ensure the safety and welfare of residents and to support service providers and staff.

These include a quality assurance process, whereby all nursing homes are phoned on a fortnightly basis by an inspector of social services. From March 25 up until the time of writing this report, 2,851 such phone calls were made to nursing homes.