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‘Stay away from blame’: Health officials say no single reason for nursing home outbreaks

The issue of elderly patients being discharged from acute hospital settings was raised by Sinn Féin’s Louise O’Reilly today.

Questions were raised in the Dail about whether the discharging of elderly patients into nursing homes might have caused the spread of the virus.
Questions were raised in the Dail about whether the discharging of elderly patients into nursing homes might have caused the spread of the virus.
Image: LEON FARRELL

HEALTH OFFICIALS HAVE said there is ‘no single reason’ for the high level of infection in nursing homes, but they are considering the various ways it may have entered and spread throughout these settings. 

When asked about the issue at this evening’s Department of Health briefing, Chief Medical Officer Dr Tony Holohan said “the reality is any form of movement of people in and out of any setting increases the risk of transmission of this infection”.

“And if there’s movement of individuals in and out of nursing homes and longterm residential care facilities happening, that can increase the risk of transmission.”

He has previously stressed that officials do not believe, based on the data, that visitors brought this disease into nursing homes. 

Holohan said he wanted to “stay away from” attaching any blame to anyone in relation to the introduction of Covid-19 into nursing homes. 

“Clearly staff have to go in and out of work in these settings and nursing homes are places that have to be visited by other categories of workers who move in and out and so on.

So it’s impossible to attach blame to that, that’s vital activity for the operation of residential nursing home facilities. And they’re amongst the means through which the highly transmissible infection gets around the community, it gets around through the movement of people.

Dr Colm Henry, HSE Chief Clinical Officer, said in the early days of the outbreak in Ireland, there was a lot about this virus that health officials did not know, including the high levels of asymptomatic transmission.

“Also, the atypical presentation, just about a third of older people have any kind of typical presentation. Many of the, even severe cases, the illness is a very unusual presentation compared to younger people.”

He also pointed out that the care in nursing homes is “very close” as many of the residents have mobility issues.

“The very nature of the model of care for older people which involves congregation of older people, involves a form of care that is expert but also hands-on, means it doesn’t lend itself well to a pandemic.”

‘A better understanding’

Earlier today, HSE boss Paul Reid said  there is “no evidence whatsoever” that Covid-19 infection spread into Ireland’s nursing homes by the discharge of elderly people into nursing homes in March.

Speaking at the Special Dáil Covid-19 Committee today, Reid said how the virus got into residential and nursing homes is still something the National Public Health Emergency Team (NPHET) is “trying to get a better understanding of”.

The issue of elderly patients being discharged from acute hospital settings was raised by Sinn Féin’s Louise O’Reilly today, stating she had heard references that it could have been the reason for the virus in nursing home settings.

With Reid stating that NPHET is still trying to ascertain the cause of the spread in nursing homes, she said the HSE boss could not state that he is confident that discharges from hospitals was not one of the reasons.

Reid said he did not state he is confident, but said there is no evidence.

He added that in early March the health service was predicting a “massive surge” on hospital settings.

“Where we needed to provide massive supports also was the acute settings. We would have had an ongoing process of what we would call delayed transfers of care where people are deemed clinically fit and not suitable to be in an acute hospital setting for the transfer of those patients, and in most cases elderly patients, out of that care.  

“That is a process we would have done, and that was the right thing to do at the point in time of doing it,” he said.

Hiqa compliance

In the Dáil earlier, Fine Gael’s Fergus O’Dowd also raised the issue of clusters in nursing homes.

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Published data from August 2019 shows there was 31,000 residents in 581 homes.

Only 128 of those homes were fully compliant with the Hiqa regulations – that is 128 out of 581.

“That percentage of compliance was down from 27% in 2017 to 23% in 2018,” said O’Dowd, stating that compliance with Regulation 27, which deals specifically with infection control, was also inspected by Hiqa in only 215 of those homes.

“Only 215 out of 581 were inspected for compliance in 2018. Of those, 37 were found to be non-compliant, therefore, there is an 18% level of non-compliance in the very basic protection for all of those residents in terms of infection control,” he said.

O’Dowd said the hands of nursing homes were clearly tied.

“We knew that nursing homes were the most vulnerable. We knew from the evidence that this would be the case,” he said, asking if proper infection control is in place.

Secretary General of the Department of Health, Jim Breslin said a huge range of supports have been put in place to try to help the nursing home sector.

“The sector is a mix of publicly operated and privately owned facilities. It is not line managed in its entirety by the HSE; much of it is outside the HSE,” he added.

- With reporting by Michelle Hennessy. 

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