Many who died helped to build the State – it should never happen again’
The devastating toll which Covid-19 wreaked on the lives of hundreds of elderly nursing home residents who helped build our State must never happen again.
That was the warning issued yesterday by a group of government-appointed experts who investigated the heartrending distress and suffering which led to the deaths of nearly 1,000 nursing-home residents since the pandemic struck.
Prof Cecily Kelleher, who chaired the group, said: “As we work our way through this pandemic we know that older people have suffered most.
“We talk of centenary and 100 years to mark the Republic of Ireland. Many of the people affected were the citizens and taxpayers who helped to create this State.
“We owe it to them now to ensure we have a healthcare system that is entirely fit for 21st-century purpose.“
The report warned that deaths experienced during the pandemic may lead to a large number of families suffering pathological grief into the future.
Death and dying grief supports were curtailed or non-existent in some cases.
The group, whose report was launched by Health Minister Stephen Donnelly, found many nursing homes were ill-prepared for the killer infection which swept the country and led to hundreds of deaths among frail and elderly residents.
Mr Donnelly said he is now setting up an implementation group to draw up a plan based on the report’s 86 recommendations, which he will cost and bring to government.
Heartbreaking scenes are laid bare in the report, revealing how three elderly friends in one facility died within 12 hours of each other.
Within another 48 hours, three more frail residents succumbed to the disease in the same home.
More than half the people who have died here were in nursing homes.
Retired geriatrician Dr Cillian Twomey, who visited a number of nursing homes, said the deaths were occurring against a background where their families were unable to visit them in their final hours.
Overstretched staff were attempting to cope with this pressure.
“We must never allow us go back to those days,” he said.
“We owe it to the people of that age cohort.”
He recalled one staff nurse who was ill at home with the virus feeling deep guilt because she could not be on duty supporting her colleagues.
The report revealed staff pleading: “What were we to do?”
Visiting restrictions “were still thought to have been cruel”, particularly for residents who were close to death and also for people who had dementia.
The majority of nursing homes are private and the report stresses that there needs to be “adequate and robust clinical oversight as well as monitoring with greater ties to the HSE and hospitals.”
The group heard about the difficulties of nursing homes getting PPE gear to protect staff and problems with testing.
Prof Kelleher said the key now is planning for the future with interdisciplinary support for nursing homes and a clear winter plan.
It is important that there is a roll-out of the flu vaccine and there should be consideration given to making it mandatory for all staff.
It also needs to be considered whether it should be made mandatory for nursing-home staff to get the flu vaccine. Nursing-home residents should continue to be prioritised for Covid-19 testing and infection control training should be compulsory for all nursing home staff
There is a need to ensure all nursing homes have several days supply of PPE.
End-of-life visits must be arranged on compassionate grounds and meaningful communications need to take place with relatives regularly on visiting protocols.
HSE Covid-19 response teams which provide support to nursing homes need to remain in place and there should be community teams which are linked to local hospitals.
All new residents coming from the community or hospital should be tested for Covid-19 prior to admission.
Nursing homes need a back-up plan when staff cannot turn up and there should be a review of the employment terms and conditions of nurse and healthcare assistants.
Every nursing home needs to link with the community palliative care team.
As cases of Covid-19 rise again and threaten to invade nursing homes, the minister said that implementing the report’s short-term recommendations will ensure the ongoing protection of nursing-home residents.
“It will prepare nursing homes in response to Covid-19 and the winter ahead.
“We will focus immediately on the establishment of implementation structures with an inter-agency implementation oversight team to be set up and have its first meeting in the next week.”
Responding to the report, Tadhg Daly of Nursing Homes Ireland (NHI), representing private homes, said it should represent a milestone for care of the older person.
“NHI states its recommendations require immediate prioritisation by government and the required backing by the State to address substantive policy shortcomings that have deprioritised nursing home care within our health services,” he said.
“There is requirement to implement measures with immediacy where feasible.
“It finds nursing home care has been an outlier within our health services and there is requirement for enhanced and more formalised integration of it.
“Coupled with this, it advances long-standing requirement for policies to remove the disjointed nature of financing, provision and regulation of nursing home care.
“NHI has welcomed the public health measures recommended by the panel to support nursing homes in managing Covid-19.
“The report states the infectious nature of Covid-19 makes it difficult to prevent and control in residential care settings, and people within them are disproportionately likely to contract it given they are more medically vulnerable and frail.
“The recommendations include access to PPE, timely testing of residents, enhanced infection prevention control measures.”
The organisation has now written to the minister asking for a review of visiting restrictions in light of the increased risk to residents from the resurgence in Covid-19.
The issue is expected to be discussed by the National Public Health Emergency Team today and may lead to stricter rules around visiting.