How did we let nursing homes succumb to the third wave?

On Saturday last, I cycled past a nursing home where I had spent much time several years ago. The nursing home had been randomly selected for a research study on quality of life and cognitive impairment. It is a renovated building but not in an age-friendly or dementia-friendly way.

The front garden has been converted into a concrete visitors’ car park with a few potted plants visible and on a hot summer’s day, there was no evidence of any resident sitting outdoors, enjoying the pleasures a multisensory garden offers.This nursing home appeared locked up and its residents locked in, away from the many attractive amenities surrounding it.

As I cycled by, memories flooded back of several of the residents I had interviewed there some time ago: the lady who sat by the front door and loved to watch visitors come and go; the man in the wheelchair saddened that he could no longer go out alone; the woman who regretted telling her relatives she had cognitive problems, convinced that had she remained silent, she might still be living at home; and the many residents who talked about their favourite staff members and how much they cherished visits from relatives and friends.

The personal is political and the private troubles of distressed and bereaved family members must become a public concern

I wondered how many of these residents were still alive and how had Covid affected their lives.

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Covid-19 has had a disproportionate impact on Irish nursing home residents. During the first wave, as of May 6th 2020, two-thirds of all Covid-19 Irish deaths occurred in residential care settings with more than half occurring in nursing homes. Sadly, during the recent third wave and despite the strident efforts of the Department of Health, the HSE, the Health Information and Quality Authority and nursing home staff, the pandemic has been responsible for a further 1,000 nursing home deaths.

In February 2021, more than one in three Covid-19 related deaths reported by the Department of Health were associated with nursing home outbreaks. These figures are not unique to Ireland; this has been a trend across Europe where until recently, the heaviest death toll from Covid-19 has been amongst residents in care homes/nursing homes.

Many Irish families whose loved ones have died are now asking questions. Despite two extensive nursing home reports published last year and policy changes including the implementation of recommendations made by an expert nursing home panel, some families remain angry and distressed.

Concerns centre around the poor communication between nursing home staff and relatives during the recent third wave, the proportionality of the restrictions introduced, including in some cases infringements on human rights, and the absence of safeguarding legislation that would establish an agency with the task of protecting adults at risk.

A number of families whose relatives have died are taking legal action against nursing homes and state agencies and others are demanding a public inquiry. The Taoiseach has said that any public inquiry will have to be delayed until the pandemic is over. A deafening national silence surrounds the recent RTÉ Prime Time Investigates programme that looked at practices in Irish nursing homes during recent times.

Frontline staff

There are about 570 registered nursing homes in Ireland and about 32,000 frail older people live there. Having spent much of my working life employed in ageing and dementia services, I can say with no hesitation that most nursing homes have dedicated care staff who often work long hours, are not always well paid and who strive to deliver personalised care sometimes in inappropriate congregate settings. Many care staff get to know their residents so well and so personally and care for them as they would care for their own family members.

When a resident dies, they too can often experience significant grief and loss. Many of these frontline staff were at risk during the pandemic, and some sadly lost their lives.

There are no winners or losers when it comes to Covid-19 and this blame game achieves little and will not return to life loved ones lost to the pandemic. However, as a society it is incumbent that we investigate further what went wrong during this recent third wave, to learn more and to avoid such tragedies recurring. The personal is political and the private troubles of distressed and bereaved family members must become a public concern.

They must be brought forward for discussion, not hidden and suppressed. What happens inside nursing homes is relevant and connected to all of society. This is not about “us” and “them”– but rather about all of us playing our part to ensure that frail older people are treated fairly and with dignity, compassion and respect.

Suzanne Cahill is an adjunct professor of social work and social policy at Trinity College Dublin and honorary professor of dementia care at the Centre for Economic and Social Research in NUI Galway