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Oireachtas report calls for 'urgent' action to protect nursing homes in potential Covid-19 second wave

By Mindo - 31st Jul 2020

Geriatric doctor (geriatrician) consulting and diagnostic examining elderly senior adult patient (older person) on aging and mental health care in medical clinic office or hospital examination room

The Special Committee on Covid-19 Response is calling for immediate action and reform of the nursing home sector, to protect the older population, in the event of a second wave of the virus, in an interim report published today.

An urgent review of current regulations and standards relating to the care of older people in nursing homes, a workforce and infection control plan, and strengthened governance and oversight of private nursing homes are among the wide-ranging recommendations in the Committee’s report.

Committee Chairman Michael McNamara TD said the impact of Covid-19 in Ireland has been most profound on the residents of our nursing homes. He said the fact that their deaths accounted for 56% of the overall total shows the extent to which our older and most vulnerable population was disproportionately affected.

 “The Committee is strongly of the opinion that the lack of statutory clinical oversight of care for residents in the private nursing home sector is one of the biggest weaknesses exposed by Covid-19.   The Committee recommends the Department of Health urgently review clinical oversight and governance arrangements for private nursing homes. The Committee is strongly of the opinion that we need to strengthen clinical oversight of individual nursing homes, both public and private, by requiring a designated medical officer be appointed to each nursing home,” Deputy McNamara added.

The appointment of designated medical officers to nursing homes is among 19 recommendations made in the Interim Report on Covid-19 in Nursing Homes.

Other recommendations include:

  • The Department of Health in conjunction with the HSE and HIQA take immediate steps to develop a plan that will ensure that staffing levels and infection control procedures in the nursing home sector are adequate to meet any possible second wave of Covid-19.
  • The Department of Health urgently reviews current regulations and standards relating to the care of older people in nursing homes to assess whether they fully/adequately protect patients’ health and welfare in discharging patients to nursing homes which have been determined by HIQA to be non-compliant with infection control requirements. The Committee further recommends that no patients are discharged from hospitals to any nursing home which fails to meet infection control requirements and that no arrangement should be made by the State to place any older person in such homes under the Fair Deal Scheme.
  • The HSE and HIQA ensure that all nursing homes are adequately stocked and supplied with PPE in the months ahead.
  • The Department of Health develops an integrated system of long-term support and care spanning all care situations with a single source of funding, and the Department should work closely with the Department of Housing to develop models of independent living, supported housing and sheltered housing to cater for the wide range of housing preferences among older people.

The Committee examined whether residents in nursing homes were adequately protected and the extent to which the Covid-19 crisis has highlighted the need to move to a different model of care where more of our older population are looked after at home or, at least, in their communities, rather than in congregated settings.

Deputy McNamara said: “It also allowed a review from which it is evident that, if there is a second wave of the virus, different measures will be taken. We know, for instance, that the discharge of patients from acute hospitals to nursing homes has been tightened up through testing and isolation procedures, which is welcome. However, the fact that the HSE still facilitates the placement of older persons in a nursing home with known infection control risks is, in the view of the Committee, indefensible. This practice must end.”

This Committee intends to return to this issue in September when it has examined the HIQA report on the impact of Covid-19 on nursing homes and the forthcoming Expert Advisory Panel report on the issue. Deputy McNamara said the Committee will then be in a position to determine how best to continue the investigation and whether a public inquiry is necessary to examine the impact of Covid-19 in nursing homes from March to May 2020.

The Committee held three meetings in relation to the issue with engagement with Government Departments, State bodies, the World Health Organization as well as representatives of the nursing homes sector. Representatives from Sage Advocacy provided an insight into concerns of residents and families during the Covid-19 crisis.
The Committee also received 20 written submissions from medical experts, organisations and groups advocating for the rights of older people during its examination of the issue.

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