Nursing Homes Expert Panel Report Findings

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”.