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.