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'This is a huge scandal': No definitive plan for transferring of patients to nursing homes, committee hears

The committee heard from Hiqa this afternoon that the HSE “did not know this sector”.

Nursing Homes Ireland CEO Tadhg Daly in the Dáil today.
Nursing Homes Ireland CEO Tadhg Daly in the Dáil today.

Updated May 26th 2020, 3:30 PM

NURSING HOMES IRELAND has said the discharging of patients from hospitals without testing was a contributory factor in how Covid-19 made its way into Irish nursing homes. 

Tadhg Daly, CEO of Nursing Homes Ireland, told the Oireachtas Special Committee on Covid-19, that the virus was “easily transmissible” and the transfer of patients to nursing homes was a “contributory factor” to the Covid-19 clusters in Ireland’s nursing homes.

Daly said documents he has seen state that patients being discharged from hospitals into nursing homes were categorised as “low risk”. 

He said in early March there was “no definitive” plan for the transferring of patients to nursing homes.

The committee heard that on 19 March, NHI wrote to the Department of Health asking for a two-way dialogue on the issue.

“I am following up again regarding critical issues,” said the letter, which is just one of the hundreds of documents from the Department of Health released just two hours before today’s committee meeting.

Sinn Féin’s Louise O’Reilly said the hundreds of documents show that the nursing homes were “begging” for assistance from the government very early in the year.

She questioned why there was no plan in relation to sending patients to nursing homes, stating that these care homes were being flooded with discharges from hospitals.

Daly said nursing homes had concerns about the large numbers being discharged from hospital in March.

The issue of testing was critical, he said, stating that residents that came from hospitals weren’t tested prior to admission to the nursing home.

The committee was told there was no plan or instructions for those people to isolate when they arrived at the nursing home.

While it was not the sole component for the virus getting into nursing homes, people being discharged without testing was a major factor, said Daly.

HSE boss Paul Reid has previously said there is no evidence that this is the case.

The committee was told today that NHI first sent correspondence in February to the Department of Health seeking assistance with planning for Covid-19.

Daly said he didn’t get a meeting with Minister for Health Simon Harris until 30 March. He said a national strategy did not kick in until April.

He added:

As a society we didn’t pay attention to the needs and care of those in residential care.

Sinn Féin’s David Cullinane cited the hundreds of pieces of correspondence that were released today.

A letter dated 16 March from NHI to a senior government official said there was “considerable anxiety”  being raised, and that issues with PPE were being highlighted.

Two days later, another letter on PPE was sent to officials, with concerns also raised about patients and staff awaiting testing.

An urgent meeting was sought. In the same letter, Daly said the delay in testing could present “cataclysmic consequences”.

On 19 March, another letter was issued, seeking a meeting with the minister. 

“This was your organisation crying out for help on a daily basis,” said Cullinane.

Another piece of correspondence states that some nursing homes were forced to use painters’ overalls and supplies from a local school and vet as personal protective equipment.

‘No formal clinical guidance links’

This afternoon, representatives from the Health Information and Quality Authority (Hiqa) also appeared before the committee. CEO Phelim Quinn pointed out that 80% of nursing homes are operated by private providers.

“Although funded through the Nursing Home Support Scheme, the HSE did not know this sector. As a consequence, the infrastructure required by the HSE to support the private sector was under-resourced and became increasingly challenged.”

He said Hiqa had passed on information to the HSE about nursing homes that had informed the authority about their ability to cope. Quinn said the HSE is not “familiar necessarily with the entirety of the sector” and Hiqa also provided information such as the locations of these homes, the number of residents and the number of staff.

A list of homes that Hiqa considered high risk had also been provided to the Department of Health. Since 1 March, nearly 200 inspections across the nursing home sector have been carried out. 

Quinn also said the current model of private residential care for older persons “has not formal clinical governance links” with the HSE.

“Importantly this means there is no national clinical guidance of the care being delivered to some of our most vulnerable citizens,” he said. 

Mary Dunnion, chief inspector of social services and director of regulation at Hiqa told the committee that 176 concerns were raised with the authority in relation to nursing homes in April and there have been 88 in May so far.

Concerns raised by staff include a lack of access to PPE, those raised by family members include safeguarding, quality of care and the impact of visitor restrictions. The majority of concerns raised by residents related to their own isolation and loneliness due to the current visitor restrictions.

Dunnion said Hiqa has written to the Health Protection Surveillance Centre (HPSC) seeking public health guidance on how to reopen nursing homes to visitors in a safe manner. 

‘Not a fact’

In this morning’s session, Fine Gael’s Fergus O’Dowd said Tadhg Daly’s statement that nursing homes were left isolated “is not a fact”, stating that State funding was provided to the private sector nursing homes to aid in the procurement of PPE.

O’Dowd focused on the lack of compliance of nursing homes, particularly in infection control, stating:

“I am going to say this as loud as I can.. that the care of older people in nursing homes is not acceptable.”

He said nursing homes are “not complying in the main, right across” the country, stating that wealthy companies are complaining that the State did not do enough for them.

“We need to stop this game of blaming everyone… we are not doing enough, we never did enough,” he said, adding:

“It is a scandal that this happened.”

O’Dowd’s Fine Gael colleague Jennifer Carroll MacNeill also took issue with NHI’s statement that the sector was left isolated.

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She said there was lots of back and forth with the Department since January, stating that the first letter was sent to Junior Minister Jim Daly, who had responsibility for older people.

She noted today that he was “not seeking re-election”. 

Fianna Fáil’s John McGuinness said “clearly this is a huge scandal”, stating that it was a clear policy failure.

While engagement is happening on a twice-weekly basis with the minister now, said Daly, he still believes that nursing homes should have seat on the National Public Health Emergency Team (NPHET).

Mervyn Taylor from Sage Advocacy, which advocates for vulnerable people such as the elderly, said he still does not believe the voice of older people is being heard.

- With reporting by Michelle Hennessy.

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