DEV­AS­TAT­ING TIME

Deal­gan House COVID-19 deaths

The Argus - - FRONT PAGE - By MAR­GARET RODDY

MAN­AGE­MENT and se­nior nurs­ing staff at Deal­gan House nurs­ing home spoke to re­porter Mar­garet Roddy about how ‘ab­so­lutely dev­as­tat­ing’ the deaths of 22 res­i­dents dur­ing the COVID-19 pan­demic has been for the staff, man­age­ment and own­ers as well as the fam­i­lies who lost loved ones.

As they await the find­ings of the Health In­for­ma­tion and Qual­ity Author­ity re­port into how the highly con­ta­gious novel coranaviru­s swept through the pri­vately run nurs­ing home, they say they have ‘no re­grets’ as to the level of care which they de­liv­ered in the most chal­leng­ing of cir­cum­stances.

They state that the lack of test­ing ham­pered their ef­forts to care for their vul­ner­a­ble el­derly res­i­dents and re­veal that staff are suf­fer­ing post-trau­matic stress.

‘IT’S been ab­so­lutely dev­as­tat­ing both for the fam­i­lies and also for the staff, man­age­ment and own­ers,’ says Eoin Far­relly, Chief Ex­ec­u­tive Of­fi­cer of Deal­gan House Nurs­ing Home, of the COVID-19 out­break which is be­lieved to have claimed the lives of 22 res­i­dents. ‘ There is not one per­son in here who has not suf­fered trauma. It has been a horrendous time for us.’

Deal­gan House had en­joyed an ex­cel­lent rep­u­ta­tion as a ‘ home from home’ for its el­derly res­i­dents, with a long wait­ing list of peo­ple look­ing to have fam­ily mem­bers cared for there.

The pri­vately run nurs­ing home re­ceived pos­i­tive re­ports from Health In­for­ma­tion and Qual­ity Author­ity (HIQA) in the past, with the most re­cent one, from an unan­nounced in­spec­tion in Fe­bru­ary 2019, prais­ing the fa­cil­ity for its in­fec­tion con­trol and how it had han­dled an out­break of flu.

So what hap­pened for it to be­come one of the nurs­ing homes with the un­en­vi­able rep­u­ta­tion of hav­ing one of the high­est num­ber of deaths in the coun­try?

Eoin and Di­rec­tor of Nurs­ing Ca­tri­ona Hande, along with As­sis­tant Di­rec­tor of Nurs­ing Dolores Conroy, want to know the an­swers as much as any­one else.

As they await the find­ings of a HIQA in­ves­ti­ga­tion, they say they have ‘ no re­grets’ as to how they han­dled the sit­u­a­tion, which saw them strug­gling to care for el­derly pa­tients, many with un­der­ly­ing health is­sues, in the midst of a global pan­demic which had taken the world by sur­prise.

They feel that the lack of test­ing in nurs­ing homes from the start of the COVID-19 out­break in Ire­land led to the cat­a­strophic clus­ter of cases which claimed the lives of al­most a quar­ter of their res­i­dents.

‘We had al­ways coped in­cred­i­bly well with in­fec­tions and would have thought that our in­fec­tion con­trol was ex­cel­lent,’ says Eoin.

He fol­lowed the progress of the pan­demic as re­ports emerged from China and Italy. ‘It was around that time, when it started to hit Italy, that PPE started to be­come scarce.’

‘We ap­plied the stan­dard in­fec­tion con­trol pre­cau­tions from the out­set,’ says Ca­tri­ona.

Eoin points out that the nor­mal stocks of PPE which they use com­prise aprons and gloves, but never masks. ‘Masks are not re­ally a big thing in nurs­ing homes - the stan­dard pre­cau­tions were aprons, gloves and good hand hy­giene.’

‘I’ve been nurs­ing 20 years here and never had to put a mask on,’ adds Ca­tri­ona.

Eoin points out that while there was a lack of clear guid­ance about masks, they be­gan to build up their sup­plies. There were, he says, huge dif­fi­cul­ties in sourc­ing stock as the HSE was buy­ing them up. ‘ We got them through phar­ma­cies and med­i­cal sup­pli­ers but the max­i­mum or­der which could be placed was 500.’

‘We had plenty of sup­plies, it was never an is­sue,’ he in­sists.

Asked about a post which was widely shared on Face­book ap­peal­ing for do­na­tions of PPE to the nurs­ing home, he said that they hadn’t posted it. ‘ We did have a post about a creche that do­nated PPE and it es­ca­lated from there. We were blown away by the gen­eros­ity of the com­mu­nity.’

‘We had gowns and masks be­fore the out­break,’ in­sists Dolores.

Plans were al­ready in place to deal with COVID-19 when their first case was con­firmed, says Ca­tro­nia, who her­self fell ill just days after­wards, fol­lowed by Eoin.

How­ever, the new­ness of this novel coro­n­avirus, meant that they were at a dis­ad­van­tage when it came to know­ing what symp­toms to look for, es­pe­cially in their el­derly res­i­dents.

‘Ev­ery­one was keep­ing an eye out for a high tem­per­a­ture, a fever, a cough, but a lot of our res­i­dents that got the ill­ness never had those symp­toms.’

Dolores adds that some res­i­dents would have ap­peared well, but be­came ill, de­te­ri­o­rated rapidly and died.

‘We now know that in the el­derly, things like the loss of ap­petite, tired­ness and lethargy are the symp­toms in older peo­ple.’

Added to that, they point out, is the fact that a large num­ber of peo­ple can be asymp­to­matic with the dis­ease.

They be­lieve that the lack of test­ing for res­i­dents and staff was a big fac­tor in how the lethal ill­ness spread so quickly through the nurs­ing home, as with­out it they didn’t know who among staff and res­i­dents were in­fected.

‘We were plead­ing for test­ing and help, all the way to the top,’ says Eoin.

The only way they could get tests, or swabs, car­ried out was by ask­ing a GP to re­quest them, says Dolores. ‘Nurses couldn’t re­quest them and we couldn’t get them at the week­end, and even when they were car­ried out, we had to wait two or three days for re­sults.’

Be­fore he fell ill him­self, Eoin over­saw the set­ting up of an iso­la­tion unit, as ad­vised by the HSE, in the din­ing room, where pa­tients with or sus­pected of hav­ing COVID were to be placed. Plans were put in place to keep the dif­fer­ent units sep­a­rate, with their own staff.

‘ There was no risk of cross con­tam­i­na­tion at any stage,’ says Dolores.

Hav­ing im­posed visi­tors re­stric­tions on March 6 and ban­ning all vis­it­ing from March 12, Eoin says they don’t be­lieve that the virus en­tered the nurs­ing home though visi­tors. ‘We have also in­ves­ti­gated staff leave and ab­sences so we don’t be­lieve it came in that route ei­ther. We are 95% sure it came from a res­i­dent, who was ad­mit­ted to hos­pi­tal and then dis­charged to us, with an ap­par­ently neg­a­tive swab. We were told the pa­tient was neg­a­tive.’

Eoin says that as the nurs­ing home be­gan to ex­pe­ri­ence staff short­ages, due to staff be­ing ill, self-iso­lat­ing or not want­ing to work be­cause of fam­ily mem­bers co­coon­ing, they started to re­cruit for car­ers, house­keep­ers and kitchen staff. While they were ‘quite suc­cess­ful’ in get­ting these staff, the were not able to get nurses, due to the big drive by the HSE to get nurses back into hos­pi­tals.

Even when he fell ill him­self, he con­tinue to work from his sick bed in an ef­fort to re­cruit more nurs­ing staff, ‘ to get more feet on the ground.’

He says they were happy with their level of staffing be­fore the out­break, but ‘ the level of the staff short­age once COVID hit was never ex­pected.’

As their first COVID-19 case was con­firmed on April 4, they moved pa­tients sus­pected of hav­ing the ill­ness to the iso­la­tion unit. Dur­ing the course of the out­break, a num­ber of pa­tients were trans­ferred to Our Lady of Lour­des Hos­pi­tal, Drogheda, while oth­ers were cared for in the nurs­ing home.

‘I came up from Dublin and set up the unit,’ says Eoin. ‘ We had the beds sep­a­rated, two me­tres apart to try to stop con­tam­i­na­tion,’ he ex­plains.

As well as sourc­ing ex­tra PPE, he said they did ev­ery­thing they could to get oxy­gen sup­plies as they were aware that res­i­dents who were ill would need it.

Even though they were un­able to get as much as they wanted due to the fact that sup­plies were go­ing to the HSE, he says ‘I don’t think we ever ran short although it wasn’t the sup­ply I wanted go­ing into this.’

It was only when the first case was con­firmed that they got the level of test­ing they had sought, says Eoin. ‘Up un­til that point it was very dif­fi­cult to get test­ing. It was the same for nurs­ing homes coun­try­wide.’

He says that the first thing the Royal Col­lege of Sur­geon’s (RCSI) team did when they moved into the nurs­ing home on April 17 was to test all the res­i­dents. ‘I had asked weeks pre­vi­ously for mass test­ing of res­i­dents and staff as nat­u­rally we want do know who had COVID-19 and who didn’t.’

As test­ing was car­ried out, it then emerged that some peo­ple who had no symp­toms tested pos­i­tive, which they be­lieve lies at the root of the lethal clus­ter in the home.

‘We are in­or­di­nately grate­ful to the RCSI for ev­ery­thing they did,’ says Eoin. ‘ They turned the nurs­ing home into a mini-hos­pi­tal with a huge num­ber of nurses. They brought tanks of oxy­gen, drip stands, drugs trol­leys and clin­i­cal waste bins.’ The lat­ter, he adds, were some­thing which Deal­gan had been try­ing to source for weeks but had been un­able to pur­chases as the HSE had bought them all up be­fore the out­break.

The RCSI team also gave spe­cific train­ing for deal­ing with COVID-19 in­clud­ing in­fec­tion con­trol and the cor­rect use of PPE.

‘It was scary see­ing peo­ple in sur­gi­cal gowns and boiler suits,’ re­calls Eoin. ‘It was a dif­fer­ent world, we would never see them in a nurs­ing home.’

As they await the find­ings of the HIQA in­quiry, which is ex­pected to be pub­lished later this sum­mer, Ca­tri­ona says what hap­pened in their nurs­ing home will be ‘ a test case’ as they were deal­ing with a virus which the med­i­cal world is still strug­gling to get to grips with.

‘We tack­led ev­ery­thing head on,’ says Eoin. ‘ We were never classed as high risk.’

He is con­fi­dent that his staff did ev­ery­thing they could to care for their res­i­dents and they are com­mit­ted to do­ing so in the fu­ture.

Eoin Far­relly, Chief Ex­ec­u­tive Of­fi­cer of Deal­gan House Nurs­ing Home

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