Wayne O’Connor
The invisible enemy outside our nursing homes, with at least 40 now infected by the virus
ANN O’ROURKE died alone in a nursing home, social distancing restrictions a cruel and necessary burden on her and her family. Days later, her son Ciaran poured his grief across the airwaves.
The 69-year-old was loved by her son, her family and neighbours yet, in her final moments, none of them could come near her.
“I just hope people stay in and listen, take the proper procedures,” Ciaran appealed, his voice breaking as he told RTE Liveline listeners about Ann’s death in a nursing home after contracting Covid-19.
“It is very hard for someone to lose someone like that over this disease. You can’t even see your mother, hug her. Just please take proper precautions. My mother would have liked me to say that so I can help someone else.”
People living in nursing homes are cocooned and unlikely to pick up Covid-19 unless it is introduced by someone who has been outside the facility mixing with others. Nobody does this intentionally but more than 150 nursing home residents across the country have tested positive for the killer virus. At least 40 nursing homes are infected and under siege. Private, voluntary and public nursing homes house 30,000 people.
An internal HSE memo circulated last week says outbreaks are having significant implications for residents and potential transfers to acute hospitals. It said Dublin nursing homes have been worst hit but officials “identified the early emergence of outbreaks across the country”.
“These outbreaks put significant strain on the healthcare workers within these facilities, severely compromising their ability to provide safe levels of care in some instances.”
Crisis support teams have been dispatched to residential settings to assist carers, an attempt to stem the flow of residents into acute hospitals. “Residents are not going to get this disease unless someone brings it in to them from outside,” one nursing home owner told the Sunday Independent. He is reluctant to be named because he does not want to alarm residents.
Some nursing homes erected decontamination tents, ensuring safe entry and exit procedures for staff. Most have procedures in place preventing outsiders from entering. However, they say a one-size-fits-all approach has been lacking. “Much of the official advice is open to interpretation,” the nursing home owner said. “I would like it to be more matter-of-fact.
“You would wonder if it goes far enough. We looked at getting a [decontamination] tent up but there was no advice to do it so we didn’t.”
Another nursing home owner said his facility has not had trouble interpreting memos and advice issued from public health officials but he still has questions.
“We are unsure what to do if we get a positive test. We know to isolate the person, use PPE, but we have had to seek guidance on how to treat the person. We don’t know should we give them oxygen or not. Some of our people may not be able to tolerate that.”
Last week, Nursing Homes Ireland (NHI), the representative body for private homes, issued advice to members telling them to check the temperatures of staff and resis idents twice per day. Similar measures were announced by Health Minister Simon Harris yesterday.
NHI also steered members to public health measures for managing the disease. Members were told to decontaminate oxygen bottles and were directed to an academic paper highlighting “the critical importance of vitamin D in enhancing resistance to respiratory infections including Covid-19”. Home carers are to be deployed to nursing homes and State funding is being provided to deal with cost issues.
The HSE says “residents of long stay residential settings are prioritised for testing through a pathway involving the National Ambulance Service (NAS)”. Someone from the NAS visits the home, takes swabs and brings the sample for analysis. Nursing homes say they are waiting up to 10 days for results but feel they have staff capable of carrying out the test and delivering it to a lab to speed up the process.
Executive director of Sage Advocacy, a group representing elderly and vulnerable people, Mervyn Taylor, has called for further oversight of nursing homes. He says health watchdog Hiqa must provide guidelines on the level of nursing staff and medical care required in the sector.
“Care in congregated settings such as nursing homes has been privatised to a degree which is now worrying,” he told the Sunday Independent.
“The closer oversight of the nursing home sector which is called for in the current public health emergency must be accompanied by a genuine willingness by the HSE to step in when the public interest and the health of individuals demands.”
NHI chief executive Tadhg Daly said private nursing homes are “heavily regulated health and social care settings”, but his focus at this time is on staff and residents.
“The care provided by the men and women within these homes is vital to the lives of our most vulnerable, providing them with comfort and reassurance during a worrying time. Staff in our nursing homes fulfil an essential role in Irish society.”
Geriatrician Prof Des O’Neill described the privatisation of nursing homes as problematic. He wants a re-evaluation of elderly care.
Public-funded nursing homes are also an issue, he said. Hiqa has regularly expressed concern about these, criticising hygiene standards and the layout at some homes where residents frequently share rooms. This raises questions about how they would cope with a Covid-19 outbreak.
“The chickens are coming home to roost here,” Prof O’Neill said. “There may be an imperative to look at alternative accommodation.”
Hiqa has enabled the registration of 320 new nursing home beds through inspections since this crisis erupted.
The watchdog was asked by the Sunday Independent if it was satisfied with infection control standards at nursing homes where residents tested positive for Covid-19.
A spokeswoman said it has “written to the providers of all nursing homes, disability centres and special care units requesting that they review their contingency plans”.
This week Hiqa will open an infection control hub to provide assistance and advice on managing a Covid-19 outbreak.
For some, such as Ciaran’s mother Ann, the ramping up of efforts to address this crisis has come too late. A HSE memo says outbreaks in nursing homes have a mortality risk “approaching 35pc”.
‘At least 40 nursing homes have Covid-19’