Watchdog review finds small nursing homes struggling and residents left afraid by Covid

Hiqa also found residents in nursing homes also suffered great trauma during the pandemic, feeling angry, afraid, and isolated.

Small nursing homes are closing and ever-bigger new nursing homes are opening which goes against the State’s plan to move away from large institutions, the Health Information and Quality Authority (Hiqa) has warned.

Residents in nursing homes also suffered great trauma during the pandemic, feeling angry, afraid, and isolated, an in-depth review of the nursing home sector by the health watchdog shows.

In the past, Ireland had a model where people with mental health illnesses or disabilities and older people were placed in large institutions. These have been closing down, under a State policy of moving residents into smaller more homely settings.

However, the review states the largest nursing home in the country has 184 beds while the national average is now 56.2.

“The last two years have seen further incremental increases in the size of the average nursing home as defined by the number of beds,” the report warns. “This ongoing trend towards bigger nursing homes is in contrast to the national policy for de-congregation of social care services.” 

Out of the 30 homes which closed during 2020 and 2021, Hiqa shut five of them and 25 closed voluntarily. District Court applications were made in two cases to shut homes because Hiqa feared there was a risk to life or safety of the residents. 

Residents at Donore Nursing Home in Wicklow, and Oaklands Nursing Homes in Kerry were re-housed by the HSE. All nursing homes must register with Hiqa, and they have found smaller homes struggle financially or owners cannot find someone to take them over on retirement.

An increasing number of nursing home closures during 2022 have been highlighted recently.  The review shows how up to 2021 the closures were balanced by the growth of larger new homes meaning the number of beds lost changed little.

There were 585 homes in 2019, across the public and private sector, and by the end of last year, this dropped to 567. But bed numbers dropped by less than 200. Bed figures for 2021 show Cork lost 121 beds, Clare lost 41 and Tipperary lost 24 but Waterford gained 78 beds among other changes.

Pandemic impact

Much of the review is taken up with how Covid-19 impacted nursing homes. It describes how the residents saw their homes change into places that looked like hospitals.

“Many spoke of listening to the news and being worried about their families and friends, while also feeling worried and afraid about what was going to happen," the review states. “Some residents told inspectors that they had decided not to leave their rooms until a vaccine was found.” 

Residents spoke with inspectors about feeling confused, angry, frustrated, and lonely.

Older people spoke with sadness of how clinical their homes became, with soft furnishings removed, and restrictions placed on their living habits. Many also said they felt safe because of this, citing the use of PPE by staff as reassuring.

“Although many residents understood the reason for using it and the protection it afforded them, residents often struggled to hear and understand people who spoke to them while wearing facemasks,” the review found.

“After years of moving towards a more homely, social model of care, the pandemic caused an instant reversal to a more medicalised model of care.” 

Many described their sadness at losing friends to Covid-19, people who lived in the home with them, as well as the isolation from family.

“One resident said “a hug on the big screen does not replace the real thing,” the review states.