Letters lay bare how nursing homes were left unequipped to battle the pandemic
Stark reading for families of all residents
FOR the families and residents reading the correspondence that flew back and forth between Nursing Homes Ireland and the Department of Health as Covid-19 took hold, the details of what was going on behind closed doors make for a sobering read.
Painters’ overalls and homemade masks as armour; delays of up to four weeks for test results; transfers from acute hospitals without confirmation of a negative Covid-19 test; warnings that continued poaching of staff would lead to a “cataclysmic scenario”.
These are just a few examples of the claims made in letters and emails from Nursing Homes Ireland (NHI), the body that represents the private and voluntary sector, to the Department of Health (DoH).
The communication between the two bodies, which runs to hundreds of pages, began in February, when NHI first sought assistance for the sector in dealing with the predicted surge in nursing homes. By the time the published correspondence ends on May 12, more than 60pc of Covid-19 deaths had occurred in nursing homes.
In an email to Department of Health officials on February 28, Nursing Homes Ireland (NHI) CEO Tadhg Daly highlighted that “there is a requirement for dedicated guidance and advices for the nursing home sector and our members given the vulnerability of our members. Our request for guidance is now urgent as it has been confirmed there is one case of coronavirus on the island of Ireland”.
He referred to reports in the media that the HSE had “adequate stock” of PPE, but added Tadhg Daly, CEO of Nursing Homes Ireland, warned ‘things may get out of control’
“this is not the case for our nursing homes”.
Mr Daly received a reply from a DoH official thanking him for his commitment to working in “partnership” and stating “we are following the advice of the chief medical officer and the National Public Health Emergency Team (Nphet)”.
In a separate email to Minister for Mental Health and Older People Jim Daly, NHI stated it was “concerned at the fact that private and voluntary nursing homes have not received PPE and members are reporting that they are unable to access same”.
The hundreds of pages of documents that follow reveal that NHI made repeated attempts from the February to request PPE and highlight the lack of such in nursing homes across the country. A faceto-face meeting with Health Minister Simon Harris was facilitated on March 30.
Separately, correspondence shows that on March 6 Mr Daly wrote to the DoH to inform it of “increasing queries from members regarding safe and appropriate discharges from acute hospitals to nursing homes”.
He added: “There is an immediate requirement from the HSE to outline the procedures for discharge in the current unprecedented challenges.”
Mr Daly asked if swabs would be taken. He added that communication from the HSE on measures to reassure was important “or this may get out of control”.
The HSE issued interim guidance on transfers between care facilities on March 10, stating that asymptomatic patients identified as contacts of Covid-19 should be isolated for 14 days in a single en-suite room.
In following up with the DoH on March 11, NHI requested that the policy should be altered to “insist on a negative test” from all hospitals where there is evidence of Covid-19.
Last week, HSE boss Paul Reid said there is “no evidence whatsoever” that Covid-19 infection spread into Ireland’s nursing homes by the discharge of elderly people into nursing homes in March.
On March 16, as the country prepared to go in to lockdown, Mr Daly sent an email to a number of TDs, including Mr Harris, warning that there was “considerable anxiety” among private and voluntary homes regarding their capacity to access PPE.
“Suppliers have confirmed to NHI and members that they are not in a position to supply as they state that they are supplying all such products exclusively to the HSE at this time,” he said.
He added that members had started “to inform NHI that staff are being actively recruited on behalf of the HSE, severely pressuring the capability of nursing homes to meet resident care needs in an already pressurised situation”.
He added: “The continuation of such actions presents a potentially cataclysmic scenario for the health service.”
The correspondence released yesterday also provides insight into how NHI responded to being excluded from membership of Nphet.
On March 20, Mr Daly wrote to a department official, saying he was “appalled” that the department had established a working group on the nursing home sector as a sub-committee of Nphet without any representative for the provider of such care. To exclude NHI “beggars belief ”, he said.
In reply, he was told the group was happy to take written submission from NHI, and that the issues raised by NHI in the recent days and weeks had been provided to the group for consideration.
The following month, the issue was raised again: “It is like Hamlet without the actor,” he wrote to a department official on April 16.
The documents show that there was almost daily correspondence between NHI and the DoH in March and April.
During one exchange, a DoH official attempted to illicit information on supply chain details for oxygen, fluids and medical equipment.
Mr Daly replied, saying he didn’t have the information, but could state that “at this stage most if not all supplies are exhausted”.
On April 14, in an NHI paper prepared ahead of a video conference with Mr Harris, Mr Daly raised the prospect of sending in the army to assist Covid-stricken nursing homes.
“Consider mobilisation of resources for example from the Red Cross, St John’s Ambulance, FCA, Army, first responders Order of Malta to help nursing homes with staffing,” his note said.
As the crisis deepened in the same month, NHI conducted a survey of its members which was forwarded to Mr Harris.
Some 44pc of nursing homes said they were waiting more than 10 days for testing.
One operator reported that one resident had died while waiting on a test result, while another said, “still waiting 20 days later”.
Further comments about
‘They’re supplying all products exclusively to the HSE’
testing stated that it was “taking so long that it is redundant”.
In relation to PPE, 88pc of nursing homes surveyed said they had to source supplies privately, and 8pc said they had been forced to “utilise some homemade supplies”.
One operator noted: “We have received eye protection from a local school, overalls from a local vet and face masks purchased from a dressmaker.”
Another nursing home said it was using “painters’ overalls, painters’ goggles, surgical masks that cost €1.50 each”.
“We have spent over €12,000 and have more orders coming.”
Another operator said: “I have been waiting for PPE for 18 days and we have been assured we will be prioritised five times. Promised delivery yesterday as it had been dispatched, still waiting.”
A separate operator said: “My staff are threatening to leave if we cannot provide them with PPE.”
Meanwhile, on May 12, NHI took aim at the Health Information and Quality Authority (Hiqa) over comments made by its deputy chief inspector in a newspaper.
“We are extremely disappointed and offended by comments in the article stating ‘prison-type visiting scenarios’ are among the solutions being considered to reopen homes to visitors,” Mr Daly wrote to Hiqa CEO Phelim Quinn.
“For a representative of Hiqa to associate nursing home care with ‘prison’ is deeply offensive, upsetting and irresponsible,” he said.
He also took issue with the suggestion, contained in the article in which the inspector was quoted, that there was no relationship between the sector and the HSE.
“This is not reflective of the reality of the ongoing constructive, sometimes challenging engagement between both organisations that was undertaken in advance of Covid-19 and continues on a daily basis.”
‘We have spent over €12,000 and have more orders coming’