DEVASTATING TIME
Dealgan House COVID-19 deaths
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.