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Half of nursing homes inspected after Covid-19 outbreaks not infection-control compliant

One nursing home had left bedroom doors open for residents that had tested positive for Covid-19.
Jul 21st 2020, 4:06 PM 11,346 30

IRELAND’S HEALTH WATCHDOG found half of the nursing homes it inspected following Covid-19 outbreaks were not compliant with infection prevention and control regulations.

A report published by the Health Information and Quality Authority (Hiqa) today has detailed 44 risk inspections at centres that had outbreaks since 27 May.

None of the nursing homes inspected were found to be fully compliant with regulations that were assessed. Half of these nursing homes were rated as non-compliant with infection prevention and control regulations.

One nursing home had left bedroom doors open for residents that had tested positive for Covid-19. In another nursing home, staff were observed caring for residents in close proximity without using surgical masks in line with HSE guidance.

There were also issues with incomplete documentation and records relating to infection prevention and control. In some centres, temperature checks on staff were not being documented.

“Proper cleaning and sanitary practices were also hampered in some centres by inadequacies associated with the layout of the physical premises,” the report noted. 

‘Ill-equipped’

Nearly six out of ten nursing homes were found to be not compliant with the governance and management regulation. Hiqa said this indicates these centres were “ill-equipped to manage the challenges presented by Covid-19″.

Inspectors found examples of poor contingency planning, a failure to identify replacement staff, and a lack of effective communication and supervision between staff and management.

The Chief Inspector was sufficiently concerned regarding the management and systems in place in one nursing home and sought a court order for an emergency closure order, which was granted by a district court on 30 May 2020.

Inspectors also reviewed the suitability of the physical environment and how it enables the nursing home to meet the needs of the residents. This regulation had a non-compliance rate of 32% among these 44 centres.

The report notes a significant number of nursing homes have “outdated” premises in which residents are required to share bedrooms and bathrooms. This compromises the effectiveness of infection prevention and control as well as the privacy and dignity of residents, Hiqa said.

Inspectors also found a rate of 21% noncompliance with the staffing regulation.

One centre was found to have had 29 members of staff that had tested positive for Covid-19 and were unavailable to work.

“This resulted in knock-on negative effects in terms of nursing care for residents and the proper cleaning of the centre in line with national guidance.”

Source: Hiqa

‘Outmoded premises’

The first confirmed case of Covid-19 in a nursing home in Ireland was reported on 13 March.

In the report, Mary Dunnion, Hiqa’s chief inspector of social services and director of regulation, said it soon became apparent that the presentation of the disease in older people was different to that of the general population, with many residents showing no symptoms or displaying symptoms that were inconsistent with the case definition for the virus.

“This made the detection of the virus in nursing homes particularly difficult,” she said.

Dunnion said the Covid-19 has “brought into sharp focus the need for reform of current models of care for older people in Ireland”.

“The continued use of multi-occupancy rooms and outmoded premises in some nursing homes undoubtedly created challenges in containing the spread of infection,” she added.

“We must look to complementary models of care, such as homecare and assisted living, and ensure that there is improved clinical oversight in all nursing homes.

Furthermore, the regulations governing nursing homes are outdated and must be revised to make them fit for purpose, particularly as regards governance, staffing numbers, skill-mix, and infection prevention and control. 

Dunnion said residents in nursing homes who spoke with inspectors during this time described their fear of contracting the virus as well as their “deep sense of isolation and loneliness” as a result of the visiting restrictions. 

Family members also contacted Hiqa about their concerns in relation to the impact of visitor restrictions. One said: “My dad is a broken man, he misses his family more than anything.”

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Today’s report notes many residents told inspectors they missed “the human touch of a family member or staff”. 

One inspector reported:

Residents confirmed that they were supported and encouraged to keep in contact with their families by phone and some looked forward to window visits but wondered if they would ever be able to hug their families again.

Inspectors reported residents were sometimes confused by the pace of change in the public health advice. One resident remarked that they were “not going to leave [their] room again until a vaccine was found”.

Dunnion, said: “Without exception, residents were deeply grateful to staff in nursing homes for the care they provided in extremely challenging circumstances.”

“Covid-19 has “deeply affected many people and the fallout will be with us for a considerable period of time,” she said.

“Our sympathies go to all those who have lost a loved one or a friend due to the virus,” she said.

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Michelle Hennessy

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