Failure to recognise atypical symptoms led to Covid-19 spread in nursing homes

Failure to recognise atypical symptoms led to Covid-19 spread in nursing homes

Professor Cillian Twomey who sits on the Covid-19 Nursing Homes Expert Panel and chair of the panel Professor Cecily Kelleher. Photo: Sam Boal/

A failure to recognise atypical Covid-19 symptoms in the elderly was a contributing factor in the virus spreading so rapidly across nursing homes in Ireland, the special committee on Covid-19 has heard.

The Covid-19 Nursing Homes Expert Panel has published its final report, with the chair Professor Cecily Kelleher, saying in her opening statement that asymptomatic spread and atypical presentation in older people was not understood early in the pandemic.

"The rapidity of spread in frail older people in a congregated setting was a feature in Ireland and elsewhere across the world," she added.

The report recommends the Covid-19 response teams, set up by the HSE to support individual nursing homes, should be sustained and regularised.

It also recommended that all nursing homes should have serial testing and a base stock of PPE, which the expert panel say has been implemented.

Staffing was another serious issue, with the report suggesting that nursing homes should have a clear written back-up plan when regular staff cannot work.

It was also outlined how there should be a GP in each community support team and on each Covid-19 Response Team.

Professor Cillian Twomey, who sits on the expert panel, said that there was a lack of oversight in the private nursing homes as they operated independently from the HSE.

"Hiqa told this committee that they felt the HSE did not know the private nursing home sector in its totality."

He added that 20 years ago, 80% of elderly care facilities were publicly run.

One of the consequences of [the move towards private nursing homes] was the separation of the oversight from the state's department and the HSE ... with private providers having no means of formal communication. 

"It is absolutely essential that some form of connection now needs to be established."

Later on in the session, Prof Twomey said it was never envisaged that elderly care in Ireland would become so institutionalised and rely on large, congregated settings. 

He said more support should be given to home care, and smaller residential settings of six residents should be considered in the future.

Ms Brigid Doherty, also on the panel, said staffing levels are decided by each nursing home and there is no statutory requirement for staff levels and skill mix.

"There is no statutory requirement for the number of staff or the skill mix. HIQA has no power, or the regulation clearly states it is down to the provider to decide the level of staff," said Ms Doherty. 

"That needs to change. The Department of Health is commencing the framework for safe staffing and skill mix and this needs to happen sooner rather than later."

When asked about families left searching for answers in relation to Covid-19 outbreaks in nursing homes by Deputy Fergus O'Dowd, Ms Doherty said the complaints procedure often means the nursing homes themselves investigate complaints, leaving families and residents alike dissatisfied. 

"The HSE safeguarding service has no authority to investigate. HIQA has no legal power to investigate individual complaints."

She noted that Sage Advocacy has helped many families, and later added that nursing homes have a responsibility to provide information to families of residents.

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