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Patients being left in hospital for longer periods due to delay in transfer of care into nursing homes

The outbreak in nursing homes has left some non-Covid patients, who are ready to leave hospital, stuck in hospital.

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THE COVID-19 OUTBREAK has led to some vulnerable patients awaiting transfer to a nursing home, including older people and those with disabilities, left in hospitals for longer than necessary. 

Nursing homes are cautious about welcoming new patients into their facilities while the HSE and medical professionals attempt to bring clusters of the virus in residential settings under control. 

It means patients treated for a variety of reasons unrelated to Covid-19 are being forced to stay in hospital for longer periods of time than needed.

On Sunday, Anne O’Connor, chief operations officer at the HSE, indicated that there are delays in the transfer of care from acute hospital settings to residential care facilities. 

“In relation to delayed transfer of care, the transfer of people whose care has been completed in the acute [hospital] setting. That has gone up in the last week from 215 the previous week to 270, that’s an indication that people are not flowing out of our acute hospitals as quickly,” she said. 

“That could be linked to the challenges in our nursing homes, many people who would be delayed transfers of care would be waiting to go to nursing homes.”

Delays in transferring patients were being highlighted by organisations including Nursing Homes Ireland (NIH) as far back as January, however, before Covid-19 arrived in Ireland.

At the time, the organisation claimed “the discharge process within hospitals is disorganised, inconsistent and supports are not available to enable staff facilitate the timely discharge of patients to nursing home care”.

With Covid-19 outbreaks now present in both hospital settings and nursing home settings, patients are left in a catch-22 scenario.

TheJournal.ie understand that some nursing homes, particularly in the east of the country, are reluctant to admit new residents at present. 

Tadhg Daly, CEO of Nursing Homes Ireland said: “Some are cautious about accepting patients coming from another setting because they could be a vector for the virus. Most places are closed for visitor access and they don’t want anyone coming in.”

Daly also said the that while “there are 40% of nursing homes with the virus, there are still 60% without” and they are working to make sure Covid-19 doesn’t take up residence in those.

“But it’s about care for the older person or the person transferring, we get fixated on location or setting but it’s about ensuring we have the right care, in the right place, at the right time,” he added. 

Outbreak

In the latest update from the HSE, it emerged that some 425 nursing homes in Ireland required supports due to the coronavirus outbreak, with 75 of those in the red zone and at “signficant risk”. 

A further 129 long-term care facilities are also in need of continued intervention and enhanced supports from the HSE.

Last night the Department of Health reported 362 clusters – totalling 3,455 cases – in residential care facilities, and some 218 of those clusters are in nursing homes, specifically. 

Stephen McMahon, head of the Irish Patients’ Association said an interim location for patients awaiting transfer should be considered to tackle the uncertainty facing those in this situation, and to free up healthcare staff who could be providing care to other patients. 

“If the nursing home isn’t available at the moment, then an alternative for their care might be identified so that it takes them out of the hospital setting,” he said. 

“It may be that they need to get another hotel for people as an intermediary transfer until the nursing home identified for them is available.”

McMahon suggested having a setup similar to that at the Citywest Hotel and Convention Centre in Dublin which is being used for patients in need of step-down care from Covid-19 – the centre has become a make-shift hospital while the hotel is a self-isolation hub. 

Other hotels could be brought into use as an interim nursing home for patients leaving hospital, it’s suggested.  

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“It would be like a nursing home of sorts except not a nursing home, it would be a type of hospital or maybe some of the private capacity could be used, people who are candidates to be moved to the nursing home sector could be accommodated in private hospital capacity.”

Sinn Fein’s health spokesperson Louise O’Reilly also suggested an interim solution was needed to protect vulnerable patients who cannot be moved to nursing homes at present. 

“The hospital is not the ideal place for them,” she said. “The HSE should look at some of the additional capacity that has been sourced, and have it ringfenced for getting people out of an acute hospital setting becuase if they don’t need to be there, they should be able to free up that bed.

“It’s a very different model of care in step-down and in a nursing home than in acute hospital setting and with staffing levels the way they are – there will be staff off in self-isolation, or some with covid or off minding their kids.

“So anytime there is pressure on staff within acute hospital sector an ifd their time could be better spent looking after other patients, and if their current patients don’t need acute care, then being in an acute setting isn’t ideal.”

The HSE said 177 of the 272 patients in acute hospital settings are awaiting transfer to a nursing home but that the prevalence of the Covid-19 is a factor in determining whether this can occur. 

“Since mass testing in residential care facilities began, around 13,000 tests have been reported, with the level of Covid-19 at 16% positivity rate,” a spokesperson said. 

“Our clinicians would factor this into any decision to recommend transferring a patient from acute care to residential care.”

The HSE also said the “complex process” of transferring a patient to a residential setting under the Fair Deal scheme can delay the transfer of care in some cases. 

In such cases, it said “transitional care funding to facilitate the transfer from acute hospital to residential care while an application for Fair Deal is being processed” is provided. 

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