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Nursing home complaints during Covid: Concerns over isolation and lack of social distancing

The allegations are contained in documents released to TheJournal.ie under the Freedom of Information Act.

Image: Shutterstock/David Pereiras

SINCE THE BEGINNING of the Covid-19 crisis in Ireland, multiple allegations have been made regarding a lack of social distancing, visitation issues and staff not adhering to guidelines in nursing homes across Ireland.

Further complaints were also raised about the quality of care given in some nursing homes during the crisis.

That’s according to documents released to TheJournal.ie under the Freedom of Information Act.

Between 1 March and 1 October 2020, the Health Information and Quality Authority (Hiqa) received more than 800 pieces of information raising issues of concern in relation to older persons’ services in Ireland. 

Hiqa is responsible for the monitoring, inspection and registration of designated centres for older people, such as nursing homes, in Ireland. 

The concerns are heavily redacted in places. All identifying material relating to the centres and people involved is removed, in order to respect their privacy.

Despite this, the concerns give a real glimpse into the issues in residential care centres and nursing homes across Ireland, at a time when a spotlight has been shone on the sector as a result of the Covid-19 pandemic.

Nursing homes have been badly affected by the Covid-19 outbreak. As of early December, there had been 358 clusters – defined as a location where two or more cases have been confirmed – reported in nursing homes.

On 18 June, the secretary general of the Department of Health confirmed that almost one in five residents in Ireland’s nursing homes had been diagnosed with Covid-19.

PPE issues and social distancing

The documents released to TheJournal.ie show that many complaints were made in relation to infection control, social distancing and the supply of PPE soon after the arrival of Covid-19 in Ireland. 

In one piece of correspondence sent to Hiqa in April, a person raised concerns over “infection prevention and control measures in [a] nursing home in relation to staff having access to PPE”. 

Another piece of correspondence sent in the same month outlined that “staff claim appropriate PPE is not provided”.

One concerned person claimed there was “little PPE” being provided by the HSE in one instance, and that “many staff have tested positive and are not being replaced due to lack of support from HSE”. 

Between March and September, over a dozen complaints were made regarding alleged social distancing issues in nursing homes. 

In March, an anonymous person raised concerns regarding alleged “poor practice of social distancing and cleanliness concerns” in a nursing home.  In May, one person alleged that a staff member at a nursing home was “not adhering to the rules of social distancing”. 

Other concerns were raised with Hiqa throughout the year regarding issues with staff members. 

In April a complaint was made about a number of staff members from one home allegedly wearing their uniforms in local supermarkets after work. The complainant was concerned about potential “cross-infection”. 

Self isolation

People must self-isolate when they have symptoms of Covid-19, while they wait for a test appointment and results and if they have had a positive test result for the virus. 

Anyone who has been identified as a close contact, but does not have Covid-19 symptoms, does not have to self-isolate but does have to restrict their movements. 

The difference between self-isolating and restricting movements can be read here.  Most people travelling to Ireland from abroad are asked to restrict their movements for 14 days on arrival. This includes Irish citizens returning home, as well as people with no symptoms. There are some exemptions to this, which can be read here

Throughout the pages of correspondence to Hiqa, many concerns were raised regarding issues around staff and resident isolation, or the lack thereof. 

In March, one complainant claimed that a staff member in one nursing home had returned from Spain, where the virus has struck particularly badly, went back to work “without any quarantine”. 

Similarly in July, another person raised concerned that a senior staff member at one home had allegedly “been abroad and had not self-isolated in line with government guidelines”. 

Another person claimed that staff in a particular nursing home “who had tested positive” but had no symptoms had been “requested to continue to work instead of self-isolating”. 

In relation to residents, one concerned person alleged that a nursing home had admitted residents who had “returned from abroad without any quarantine”. 

Visitation issues

While dozens of concerns were raised regarding the lack of adherence to Covid-19 guidelines, many other people expressed concern about the impact of visiting restrictions on residents. 

On 6 March, Nursing Homes Ireland introduced strict new visitor restrictions asking people to only attend homes in “urgent circumstances”. Visiting of nursing homes was again allowed under certain conditions from 15 June, as Ireland entered Phase Two of the easing of Covid-19 restrictions. 

However, under Level 3 restrictions, visits were suspended again, aside from critical and compassionate circumstances. 

Several complaints were made about the isolation of residents after visiting bans were imposed.

In March, one person raised concerns that poor phone coverage at the nursing home could lead to “further isolation” of the residents. 

Another person, in May, expressed concerns for a resident’s mental health “due to visit restrictions causing social isolation”. 

In the same month, one person told Hiqa of their concerns about the visitation ban “impacting on residents’ quality of life, interaction with families, social isolation and loneliness”. 

Some people also contacted Hiqa raising concerns over the well-being of residents during the visitation ban periods. 

In March, one person alleged that a resident was being “neglected by staff” and was “being left in bed and missing their meals”. 

Another person, in April, complained that there was alleged “poor communication” from a nursing home provider with families regarding their relative who had tested positive for Covid-19.

New guidelines for nursing homes and other care facilities came into effect from 7 December, whereby operators were advised that residents should be allowed one visit per week. 

Other complaints

Over the course of 2020, Hiqa was contacted dozens of times with other non-Covid concerns. 

In May, one person raised concerns with Hiqa over the quality of care within one nursing home, particularly regarding “management of falls, medical treatment, bruising and communication with family”. 

In September, another person raised concerns about “the safeguarding of residents and the management of an allegation of abuse”. 

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One person contacted Hiqa in June as they were concerned that a report of physical abuse may not have been reported to the watchdog. 

A number of allegations were made throughout the year in relation to staff members at nursing homes. 

An anonymous person, in March, expressed concern about a staff member allegedly “smoking cannabis” on the grounds of a centre. 

In the same month, another allegation was made about staff in a nursing home “being rough when caring for residents” and “derogatory comments being made by staff about residents”. 

In July, one person raised concerns about “safeguarding of residents, particularly during intimate personal care”. 

Hiqa response

Hiqa does not have a remit to investigate individual complaints. However, all unsolicited information, which can be received from anyone concerned about a centre, is used to inform the watchdog’s monitoring of each residential centre.

Hiqa monitors and inspects designated centres for older people, such as nursing homes, against regulation and standards.

“The aim of the Health Information and Quality Authority is to advance high-quality and safe care for people accessing health and social care services in Ireland,” a spokesperson for Hiqa said in a statement to TheJournal.ie. 

“Where Hiqa has concerns related to the safety of residents and the quality of care that they are receiving, providers are required to take immediate action to address their,” they said. 

The spokesperson said Hiqa inspectors follow up with providers to “ensure that the actions are being implemented and are resulting in improvements for residents”. 

“Where there are risks to the safety of residents or where the provider has failed to address areas of concern repeatedly, Hiqa can take escalated action, up to and including court action to cancel the registration of the centre,” they said. 

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