Implementation of report findings must become Government priority

19th August 2020: Nursing Homes Ireland (NHI) has stated the COVID19 Expert Panel Report should represent a milestone for care of the older person. NHI states its recommendations require immediate prioritisation by Government and the required backing by the State to address substantive policy shortcomings that have deprioritised nursing home care within our health services. There is requirement to implement measures with immediacy where feasible.

Tadhg Daly, NHI CEO states: “The Expert Panel finds nursing home care has been an outlier within our health services and there is requirement for enhanced and more formalised integration of it. Coupled with this, it advances long-standing requirement for policies to remove the disjointed nature of financing, provision and regulation of nursing home care.”

NHI has welcomed the public health measures recommended by the panel to support nursing homes in managing Covid19. The report states the very infectious nature of COVID-19 makes it difficult to prevent and control in residential care settings and people within them are disproportionately likely to contract it given they are more medically vulnerable and frail. The recommendations include access to PPE, timely testing of residents, enhanced infection prevention control measures. Mr Daly states: “The measures recommended to protect residents in our nursing homes must be a public health priority and must be in place across the country as we continue to live with COVID19 and do all we can to protect residents in our nursing homes.”

A critical finding in the report is the positive feedback derived from the engagement between nursing homes and HSE CHO teams in managing and responding to the virus, with respondents calling for continuance of the enhanced working relationship. Mr Daly welcomes its recommendation for such engagement to become permanent within our health services. He states: “Enhancing working relationships between community healthcare specialists and nursing homes and introducing greater integration can ensure residents have their specialised care needs crucially supported through timely access to medical, clinical and community healthcare specialists. The recommendation that an identified GP lead be contracted to engage with individual nursing homes was one that was glaringly absent from the heralded GP agreement and now requires urgent prioritisation for nursing home residents. We note the panel “fully recognises the existing significant capacity constraints with regard to GP manpower” but states “the importance of the general practitioner in providing clinical support and services in nursing homes cannot be overstated”.”

“For a period of years, NHI has highlighted residents in private and voluntary nursing homes are discriminated against when seeking timely access to GMS services that should be readily available to them. We welcome the panel’s statement residents should have access to the same services as are available to community-based residents. As the report states, nursing homes should be part of a continuous spectrum of care of the older person within the wider healthcare system and supported by multidisciplinary support.”

The Panel notes feedback from nursing homes regarding need for enhanced supports from geriatricians, clinical nurse specialists, old age psychiatry and mental health clinicians to support the care for residents. Nursing homes presented to it requirement for improved protocols and working relationships between nursing homes and health expertise within the community. It further notes feelings of powerlessness and loneliness amongst nursing homes as the State did not encompass the sector in its planning for COVID19.

The report presents nursing homes are an integral part of the health and social care system in Ireland, providing care to people with high levels of need. It presents requirement for enhanced integration and recognition of nursing home care in policymaking, stating policies to remove the disjointed nature of financing, provision, and regulation need to be considered. In keeping with the Comptroller and Auditor General report published last week, the Expert Panel states concerns regarding a disconnect between the reality of funding of nursing home care as negotiated by the NTPF and the reality of the costs entailed, with it noting a reported disconnect between HIQA requirements for people living with dementia and fees payable for provision of such care.

The report notes: “The unfairness in the funding as determined by the National Treatment Purchase Fund (NTPF), that administers the Nursing Homes Support Scheme (NHSS) was a recurring theme of submissions. The perceived disparity between the funding provided in comparison to the resident’s required service care costs is highlighted while the inequity of funding as between private versus public sector nursing homes is also underlined. It is a clear source of dissatisfaction for private sector operators. Many called for this anomaly in the NHSS to be addressed. Many respondents claimed that there is a disparity between the levels of funding provided, particularly through the NHSS, and the actual cost of providing the required care.”

Mr Daly comments: “Following on from the C & AG report last week, within the space of a week we are presented with further evidence the care needs of nursing home residents are not served by a funding model overseen by the NTPF that does not recognise the legitimacy of costs incurred to provide specialised care to nursing home residents.”

The report points to a perceived hypocrisy with regard to HIQA, with several respondents bringing to the attention of the panel why purported concerns of the Authority were only coming to light as a result of COVID-19, with them pointing to the 2019 HIQA Annual Report that had expressed satisfaction with the levels of governance and compliance within the sector.

It identifies the characteristic of the nursing home setting as being a person’s home and not a medical institution but poses there are aspect of this that pose inherent risk due to the person-centred nature of the care and the dependency needs of residents. It states the very infectious nature of COVID-19 makes it difficult to prevent and control in residential care settings, with people in nursing homes were disproportionately likely to contract it compared to their peer-age-group because of their being more medically vulnerable and frail.

The report maps the considerable increase in the transfers from acute hospitals to nursing homes as COVID19 emerged and brings to light data that informs of number of such persons who were tested positive for COVID19 at some point in their hospital stay.

Yet again the role of nursing home staff during COVID19 is signalled for praise. The report acknowledges the positive feedback provided by residents and their families in praising the courage and persistence of staff in the face of a frightening outbreak. It speaks of the “unprecedented challenge, never before experienced and once the infection had entered a nursing home, it spread rapidly”. The report further adds: “It is also evident however that many nursing homes had the ability to manage the outbreak effectively. It is clear from the submissions of a range of stakeholders that healthcare staff worked tirelessly and with admirable resilience to continue to provide care to the residents and valued the support of the HSE’s clinical support teams”.

Saturday June 6, 2020

Tadhg Daly CEO of Nursing Homes Ireland (NHI) states: “We welcome the announcement of phased reintroduction of visiting to nursing homes from Monday June 15th. Our members have been anxious that this would happen as soon as was safely possible. NHI has advocated for this and we inputted to the HSPC guidelines that will oversee phased visiting.

“We acknowledge all those that have supported the nursing home in protecting residents by staying away and we acknowledge the sacrifice that families and friends of residents have made by not visiting in person over the last while.”

“We need to remain vigilant about protecting the safety of all residents, staff, and visitors to nursing homes as part of the ongoing challenges presented by Covid19. We are working with our members to develop a technological solution for booking visits. NHI thanks all colleagues, homes, residents, families and friends for their tremendous sacrifices during Covid19 and particular thanks to those who kept residents connected and engaged during these toughest of times.”

26th May 2020

Mr Chairman and Committee Members, thank you for the opportunity to address you today. I am joined by my colleague Ms Anne Costello, NHI Nursing Committee Director.

The work of this Committee will represent one of the most important analyses of a national emergency that will forever be engrained in our country’s history. I wish you well in your work in the weeks ahead.

Nursing homes are traditionally very positive settings – homes of inspiration and happiness to the community within them. Covid-19 has brought huge levels of upset, sadness and worry in through their doors. I now take this opportunity to call upon us to forever commemorate all who tragically lost their lives in our nursing homes and in our country because of this cruel virus.

We should take this opportunity to laud the considerable sacrifices of nursing home residents. The loss of loved ones personal touch and for many the loss of friends has caused huge upset and worry for thousands of our most special people. Under very pressurised circumstances, our staff have made extra time to sit with residents and have prioritised the use of technology to connect residents with loved ones, often taking time outside of working hours to fulfil such. In recent days, a newspaper has reported on an NHI memo from very early in the crisis regarding communication. That memo was replaced following further guidance in April.

We applaud the staff across all our nursing homes – HSE, private and voluntary. These 40,000 people are on the Covid-19 frontline. They’ve made supreme sacrifices willingly and with great commitment to continue providing person-focussed care, comfort and support to people who are most susceptible to this cruel disease. Mr Chairman we, as a society, owe all frontline workers a great debt of gratitude. I would like to particularly thank staff in nursing homes for the care and support provided to residents over the past weeks and months, with many providing care to residents with Covid. The recent months have presented a very stressful and demanding time and these people ensured residents received excellent care in the most challenging circumstances. I know the majority of you here today understand the inter-connected role our homes fulfil in assisting the public health system to function in dealing with the Covid crisis. I particularly acknowledge our providers who, despite challenges with resources at every-level, ensured excellent care continued to be provided and hundreds of discharges were facilitated from our acute hospitals. This was despite refusal to test patients prior to discharge from hospitals to nursing homes and we know the extent of community transmissions.

Covid-19 has presented tragedy for nursing home residents. But it should not be lost upon us four out of every five nursing home residents who contracted Covid-19 recovered from the virus. This is testament to the tremendous dedication and professionalism fulfilled by staff under extremely strenuous circumstances to continue providing specialist care to our most vulnerable during this health pandemic. There needs to be greater appreciation that care of the older person is complex. Nurses in our nursing homes have very specific clinical expertise and a broad knowledge-base, based on the science and art of a person-centred gerontological care model. Supporting them are dedicated healthcare assistants and team members across the home, coupled with medical experts from the community.

Mr Chairman, I sit here today representing one of the most vital elements of the health service in Ireland. Our health service cannot function properly without the critical role fulfilled by our nursing homes. During the first three months of the year, over 2,500 people entered nursing home care under Fair Deal. 1,000 people every month transfer from our acute hospitals into private and voluntary nursing homes. 460 private and voluntary operated nursing homes provide essential and specialised clinical, health and social care to 25,000 older people. Even during the national emergency, just 7% of Covid-19 cases entailed transfer of the resident to hospital.

Covid-19 has presented the most seismic challenge for our health services and specifically for nursing homes. Stories from overseas emerged early in the year regarding the devastating impact it possessed for older persons and for all residential care settings. Cognisant of what was emerging, in January we in NHI began engagement with nursing homes to provide Covid-specific guidance. In February concerted engagement was undertaken with the HSE to deliver specific Covid-19 education and guidance for nursing homes. We requested the Department of Health to provide dedicated guidance for residential care settings.

An easily transmissible virus that we knew could take the lives of nursing home residents was in our communities. Preliminary research indicates up to 40 per cent of transmission is passed by asymptomatic persons. The mass testing of nursing home residents has seen asymptomatic residents and staff test positive. Nursing homes have huge levels of experience in managing the outbreak of flu and norovirus every winter and have extensive experience and clinical expertise in implementing Infection Prevention Control measures on an annual basis. But as a global pandemic, Covid-19 is on a different scale to any previously encountered in the sector.

We were exasperated. The sector required a specific plan. We knew that Covid19 disproportionately impacts on older people. The planning and focus was almost exclusively on our acute hospitals. Multiple clusters initially emerged in our hospitals. But the numbers in nursing homes started to increase.

We were already aware people in our homes would be amongst the most susceptible to the virus and a national strategy and response was required. In the absence of such, the challenges emerged. These were versed publicly:
• insufficient testing of residents and staff;
• mass shortfall of PPE – providers have suppliers they would utilise to source such equipment but they were informed of a global shortage when they sought to source such and the HSE had priority over limited supplies
• aggressive recruitment of nursing home staff initially by the HSE;
• discharges from acute hospitals to nursing homes without testing.

Our decision to restrict visitors on Friday 6th March was informed by our Nursing Committee, comprising of clinical experts representing nursing homes across the country. It was not taken lightly; Covid-19 was within our communities and the weekend presenting would see thousands of people engage in close contact with residents and staff.

At the NPHET briefing of 10th March, the decision was taken to publicly challenge the decision to restrict visitors as premature. This is despite HIQA, presented as the representative voice for our sector at NPHET, announcing that same day it would suspend visits by its inspectors to hospitals, citing the safety and wellbeing of people using services and staff. Two days later – 12th March – it cancelled inspections of all social care services. Its first specific guidance regarding care management was issued 23rd March, weeks into the national emergency.

The NTPF, the authority responsible for the commissioning of nursing home care, fell silent as homes incurred considerable and responsible costs to manage the pandemic. The Department of Health eventually intervened.

Key State organisations left the nursing home sector and its residents isolated in those early days. The dismay will live forever with us. But we welcome Minister Harris lead in eventually bringing senior officials from his Department and the HSE around the table to support the sector in coping with Covid-19. The evidence from Ireland and internationally is no individual health sector can manage the crisis presented by Covid-19 alone. The supports provided by HSE community services for residents are appreciated and have delivered valued resourcing supports. The support framework implemented by the Minister and colleagues has fulfilled a lead role in managing and curtailing the prevalence of the disease in our nursing homes.

Covid-19 continues to live with us. We give early welcome to the Minister’s commitment to establish a nursing-home expert panel to support good planning and safeguards to protect people who call nursing home, home. However, one significant voice is absent; that representing nurses from our nursing homes, which continue to operate on the frontline.

Oireachtas members will be aware from our engagement year on year, for the past decade, of Nursing Homes Ireland’s request that the Government to lead in establishing a forum to plan for the long-term care needs of older people. Our call has gone unheeded. Today we reiterate it.

We wish to move forward but Covid-19 now lives among us. We are actively engaged with Minister Harris, his officials and colleagues in the HSE in presenting measures that can ease visitor restrictions in our nursing homes. Clear policy is required. There is requirement to delicately balance health, safety and risk to life against the mental wellbeing and happiness of residents. Social connection for nursing home residents is critical. We see continuous testing of staff and residents and timely turnaround of results as imperative within any roadmap forward. A national strategy is immediately required in this regard.

Concerted focus and engagement must persist in tackling Covid-19’s threat to the lives of nursing home residents and staff.

The Covid tragedy must focus minds. Nursing homes are integral to the provision of specialised health and social care in our communities and a well-functioning health service. Our members and staff take great pride in fulfilling their essential role in Irish society. There is requirement to look at the structures to support our residents and skilled staff in meeting the specialised needs of people who require access to 24/7 nursing and multidisciplinary care. Timely access to community services such as GP, geriatricians and specialised therapies must be enshrined.

Lessons can be learned from the closer engagement brought upon us by Covid. There is requirement for a better and more integrated working relationship between the State and our sector. The core focus has to be on meeting the complex health and social care needs of nursing home residents. We will be stronger working together.

ENDS

Just a brief note to again thank families for your continued support and understanding at this difficult time. Your kind messages are very much appreciated.

Overall, residents are bearing up very well, helped by the steady increase in families’ phoning and your sending in letters, texts, and cards.

We will continue to facilitate calls on WhatsApp if requested though, importantly, this would need to be set up ahead of time with nursing staff (eg afternoons are quieter than mornings). Please send all emails and general enquiries to reception@brccork.com and WhatsApp messages/texts to the BRC mobile phone on 087 6072823.

It is absolutely critical we do everything we can to keep the Covid-19 virus outside of the home and, given that the majority of transmissions are now community spread, we are today stepping up restrictions further. All visits to the home are stopped until further notice.

As members of Nursing Homes Ireland (NHI), rest assured we continue to liaise on a daily basis with the health authorities and seek their advice where necessary.

Taking such measures at this time will hopefully result in much improved outcomes for your loved ones and staff.

Stay safe,

Kieran & Fiona O’Brien

Please be advised that the visiting restrictions set out in Wednesday’s communication (11 March 2020) still apply, with the following expanded definition of what constitutes an “affected area”

– China, Hong Kong, Singapore, South Korea, Iran, Japan
– All of Italy, Spain, Germany, France
– Cheltenham

We ask family members not to visit the home if they have recently visited one of the above affected areas. In the absence of any clear advice on those who attended the Cheltenham festival we are also including this in our areas of concern.

Thanks again for your patience and understanding with the above and we will continue to keep you up to date should the situation change.

Kieran & Fiona O’Brien

11th March 2020: Following a review of the latest Coronavirus information and expert advice, Beaumont Residential Care has decided to maintain its current policy of curtailing non-essential visits to the home. As evidenced from other jurisdictions, nursing home residents are particularly vulnerable to this virus and, while accepting this can be stressful for residents and their families, we firmly believe this is the correct course of action.
Importantly, we remind families/friends:
• not to visit the home if you have recently visited an affected area, or have had any direct or indirect contact with infected persons in Ireland. If in doubt please speak to our senior nursing staff.
• not to visit the home if you have any symptoms of respiratory infection (fever, cough, shortness of breath)
• where a visit is deemed “essential” by our nursing staff, the same person should visit i.e., not seven different people weekly (in order minimise the risk of spread)
• to please sign in and out at Reception. This is important should the authorities need to identify possible contacts in the event of an outbreak.
• to at all times disinfect well on entry and follow recommended hygiene practices.
• if at all possible, to meet residents in their bedrooms and limit travelling around the home.

Thank you for your patience and understanding with the above and we will of course continue to keep you up to date should the situation change.

6th March 2020: For the protection of nursing home residents, NHI has confirmed that visiting restrictions are now in place in nursing homes nationwide. No non-essential visiting, children or groups will be allowed.

All visitors are asked to contact prior to attending. Visitors should only seek to attend in urgent circumstances and the management reserve the right to impose full restrictions where necessary.

We urge prospective visitors to nursing homes to be cognisant and understanding of the measure that is required in the interest of resident and staff safety. Older people and people in nursing homes with pre-existing medical conditions are particularly vulnerable if they contact the virus. The virus presents an unprecedented situation for our nursing homes and the care provided within them. Nursing homes are imposing the visitor restrictions in the best interests of residents and staff. We thank people for their understanding and patience during this period of unprecedent challenges presented by Covid19.

Nursing Homes Ireland is monitoring the evolving situation on an ongoing basis and is in continuous contact with the Department of Health, National Public Health Emergency Team (NPHET), HSE and all relevant health authorities.

Thursday February 27, 2020

Nursing Homes Ireland has tonight, 27th February, accused the HSE of trying to bury the amount it pays pubic nursing homes by releasing the figures late in the evening on a busy news day where virus issues dominate. NHI has also questioned the legality of the HSE’s actions by using money outside Fair Deal, separate to wage budgets, to top up the fees payable to public nursing homes under the scheme. It has demanded the Government immediately publish the long-overdue review of the Fair Deal pricing mechanism, now approaching three years past its date for completion and continuing to be covered up by the Department of Health.

Tonight the HSE revealed it has again increased the national average fee payable to its nursing homes. Private and voluntary nursing homes were paid fees 66% below those payable to HSE counterparts when the fees were last published in June last year.

In the growing inequality of treatment between public and private and voluntary homes, the HSE has revealed it is paying wage increases to staff in its nursing homes from another budget outside of Fair Deal. This budget is not open to private and voluntary homes to do the same. Despite there being a statutory requirement to bring before the Houses of the Oireachtas the cost components for each of its nursing homes, including pay, the HSE is openly flouting this statutory requirement. It has given no explanation as to why elements of pay are being funded separately from the Fair Deal Budget in the HSE nursing homes. This raises serious legal issues as to the reality of HSE costs that have not been presented before the Oireachtas.

Tadhg Daly, Nursing Homes Ireland CEO states: “The HSE continues to utilise the €1 billion Fair Deal budget to increase payments to its nursing homes minus accountability. As the Fair Deal budget comes under huge strain and older people have faced weeks waiting to avail of its financial support, the HSE uses the budget to pay its nursing homes much greater fees than those payable to private and voluntary counterparts operating beside them. The Oireachtas Public Accounts Committee has expressed strong concerns regarding the value provided by the HSE in its utilisation of the Fair Deal budget. Yet instead of the gross disparity being addressed, State discrimination in the operation of the scheme is growing.”

“The Fair Deal scheme is fundamentally flawed, with no recourse for private sector and voluntary providers to independently appeal the fee set by the NTPF under the Scheme. Providers seeking fair fees to provide specialised care are dismayed that fees under the Scheme are not commensurate with the reality of costs incurred. As it stands, Fair Deal is leading to the closure of private and voluntary nursing homes and placing unsustainable cost pressures upon nursing home providers. We are insisting that the next Government introduces a commitment to the introduction of an independent appeal process for nursing home providers under the Nursing Home Support Scheme (Fair Deal). This is a very legitimate and fair ask for private and voluntary providers within a scheme that is inherently unfair.

“From what budget are pay increases being met? There are serious questions to be asked of the HSE with regard to how it is funding nursing home care in its homes. Are operational and administrative costs entailed within the published fees or funded from a budget separate to Fair Deal? It is important a new Public Accounts Committee is appointed soon to question the HSE increasing its own payments to its nursing homes without any oversight from anyone.”

ENDS

Tuesday August 20, 2019

HIQA Overview report highlights discrimination of residents in access to medical card services

Commenting today, 20th August 2019, on HIQA’s Overview report on regulation of designated centres for older people – 2018, Tadhg Daly, NHI CEO states: “For the second year running, HIQA has stated the present funding model is resulting in the closure of nursing homes. The regulator is informing of a funding environment that is not fit for smaller providers to operate in, yet our Government are standing idly by and allowing dedicated care providers in our local communities to close their doors. Two years have now passed since the deadline for completion of the Fair Deal pricing review, commissioned by then Minister for Health Varadkar. Yet this Government has facilitated protracted delays with regard to this vital body of work and the result is some nursing homes are closing their doors. The warnings from the regulator are seismic and cannot go unheeded – ‘nursing homes closing voluntarily due to concerns over their financial viability’. We call upon the Government to immediately publish the Fair Deal pricing review and prioritise a funding model that recognises the true costs of meeting the care needs of nursing home residents.”

Mr Daly also welcomed the regulator’s highlighting of issues for nursing home residents surrounding access to services covered by the medical card. “NHI has continually raised this issue with Department of Health and have advanced to the Oireachtas Public Accounts Committee the discrimination that operates with regard to nursing home residents accessing a range of allied health services covered by the medical card. This report highlights delays and a lack of priority in accessing such have significant consequences for the wellbeing of residents. It acknowledges providers have taken action to redress this very serious issue and secured services on a per-fee basis to ensure the health and wellbeing of residents in their care. We welcome HIQA statement that nursing home residents should not be any way disadvantaged by virtue of living in a nursing home and services that they could avail of free in charge in the community should be equally available to those living in the nursing home. We welcome the fact that HIQA inform its Chief Inspector has also formally raised this issue with the Department of Health.”

Mr Daly concluded by commending staff in nursing homes. “This report once again highlights compliance rates are very high within the private and voluntary nursing home sector. This is a testament to the compassionate, caring staff and providers within our nursing homes who are committed to providing residents with the very best standards of care.”

Nursing Homes Ireland notes today’s publication by the CCPC. This guidance from the CCPC will further support residents and nursing homes. Under the Health Act 2007, nursing homes must agree upon admission a contract with every resident. On an annual basis over 8,000 people enter 580 public, private and voluntary nursing homes and providers agree individual contracts with each individual.

Contracts within every nursing home – HSE, private and voluntary – are required by regulation and are subject to independent oversight and scrutiny by the independent health regulator HIQA. Nursing homes proactively engage with prospective residents and their families at enquiry stage in an open and transparent manner regarding their contract for care. Our Members are committed to a process of engagement, openness and transparency to provide a thorough understanding of the contract and ensure their decision is informed. Such engagement supports both the nursing home and the resident in establishing and maintaining a good relationship. We engaged with the CCPC to inform development of the guidelines and will consider them with view to briefing our Members with regard to supporting residents during a difficult and often stressful time in transitioning to nursing home care.

As presented by the CCPC and stipulated within the regulations, nursing homes charge for services that are not encompassed within the fees payable under Fair Deal. Charges for services excluded from Fair Deal are, by regulation, stipulated within the contract and the services presented. Residents are supported by personalised care plans that are stipulated within their contracts to encompass their needs, preferences and interests.