Covid-19: Nursing home report finds one facility had three residents die in 12-hour period

Facilities must have the ability and space to isolate residents, according to the report. File picture: PA

A Government report on nursing homes found that one facility had three residents died in a single 12-hour period, and another three within a further 48 hours.

Staff are quoted in the report saying: "What were we to do?" as when Covid-19 got into the facility, it seemed to spread with "undue haste" and that staffing levels were overstretched due to illness and the need to isolate: "Something that still causes many of the staff concerned ongoing distress and guilt."

The report also found the visiting restrictions, whose rationale was understood, "were still thought to have been cruel", especially for residents who were close to death and also for residents with dementia whose diminished insight as to what was going on was compounded by not seeing their relatives.

The Covid-19 Nursing Homes Expert Panel published their report on Ireland's nursing home sector and includes 86 recommendations for how to avoid the spread of the virus in the sector.

Some of the recommendations include:

• The integration of private nursing homes into the wider framework of public health and social care should be advanced. This should be prioritised in the short-term with these recommendations and longer-term reform should be pursued 
• The Department of Health and HIQA should explore introducing a requirement that all nursing home providers promote and facilitate with independent advocacy services 
• The Department of Health should explore a suitable structure for external oversight of individual care concerns Provide nursing home residents with full medical card eligibility equality 
• Access to home support should be expanded and prioritised.

Amid an outcry about the management of certain nursing homes and governance issues the report found that there is "a need for clarity on clinical governance" of all residential care facilities private, public and voluntary at a regional and national level.

80% of long-term residential care provision is delivered within the private sector, and the report found that the crisis in recent months has demonstrated that "adequate and robust clinical oversight, monitoring with appropriate enforcement capability and clear governance structures are required across the nursing home sector".

It is also proposed that a clinical governance oversight committee should exist in all nursing homes.

The report also recommends that the HSE’s Covid-19 response teams, including the relevant clinical supports should be resourced to continue for the next 12 to 18 months.

It also recommended that all new residents to nursing homes must be tested for Covid-19 prior to admission.

Along with testing, new admissions "should only be made to nursing homes who can demonstrate their infection control measures are of sufficient standard to ensure there is no risk of onward infection," the report says.

It added that HIQA should maintain a register of nursing homes it deems to have demonstrated sufficient infection control standard reached.

New residents must also be isolated according to HPSC protocol and all nursing home residents should continue to be prioritised for testing with rapid reporting of results, and suspect cases and close contacts "need to be isolated" pending the results of "rapid testing".

Social distancing facilities for residents and staff should be in place and maintained and a plan for and monitoring of a programme of periodic testing for healthcare workers in nursing homes should be continued as well as management of entry and exit for the building.

Homes are also recommended to "examine options for zoning within care homes so different entrances/exits can be used for different parts of the home".

Facilities must have the ability and space to isolate residents and access to safe staffing levels must be kept at all times and include a required skill set on every shift.

The report was compiled by an expert group who undertook "comprehensive" stakeholder analysis after outbreaks across nursing homes caused uproar as many accused the government of "abandoning" the sector.

Nursing home deaths represent 56% of all the Covid-19 deaths across Ireland.

The report found that those who witnessed or suffered loss "may suffer varying degrees of emotional trauma", and it is important to recognise that residents will need a formal way of expressing their grief as a community.

Many respondents to the report recognised the "detrimental effect that loneliness and isolation had on their residents", and added that counselling supports may be needed for residents and staff in the aftermath of the crisis.

On a practical level, several respondents noted that not all facilities had access to Wi-Fi facilities and called for this to be addressed.

"If not facilitated, the resident may quietly fear their own death. Residents need reassurance that their own death will be acknowledged and their life celebrated and that friends and family will be cared for when their time comes," the report adds.

Minister for Health Stephen Donnelly said that staff in the sector had been traumatised by the outbreak, and continued planning and "robust funding" is a priority as we move into the winter months.

"We've learned a great deal about this virus over the past six months, and we continue to learn as more becomes known about advanced transmission, and about how it can be suppressed," he said.

It is essential that complacency does not creep in, planning, preparedness and the ability to evolve our response is key to suppressing and living with this virus, we have to balance health and safety, particularly for nursing home residents with the right and the needs to live as normal a life as possible.

"It's for all these reasons in the Covid-19 nursing homes expert panel was established, the panel was tasked with examining the complex issues surrounding the management of Covid-19 and nursing homes, to look at the national and the international responses to Covid-19, and to examine best practice and key learnings. In other words, what's working here and what's working around the world.

"Particularly in light of the reality that we are going to be living with this virus for some period."

Professor Cecily Kelleher, Chair of the Covid-19 Nursing Homes Expert Panel added: “The Panel’s work has been guided by the principles of in-action and after-action reviews where lessons learned in real time are acted upon. 

"This is not simply to identify those lessons learned but to seek to apply these insights in a tighter timescale in order to improve the outcome of the ongoing response. 

"In Ireland and internationally nursing home residents, families and staff have felt a heavy impact of pandemic. Our report reflects on this and is forward looking to ensure ongoing protection and support for nursing homes residents. 

"Our recommendations also reflect that systematic reform is needed in the way nursing home care and older persons care is delivered."