The State's nursing home regulator has told Minister for Health Stephen Donnelly it is "extremely concerned" about reports that nursing homes battling Covid-19 outbreaks were being asked to admit new residents.

Health Information and Quality Authority chief executive Phelim Quinn told Mr Donnelly in a letter last month that he was also concerned that nursing homes "may struggle to cope during crisis periods" this winter because the HSE has not been able to provide the same level of supporting staff in this wave of the coronavirus pandemic as during the first three waves.

Mr Quinn also told the Minister there was “confusion” regarding the testing of staff and residents in nursing homes where there were confirmed cases of Covid-19.

Hospital Report

The State’s health service watchdog set out its concerns about the capacity of the nursing home sector to cope with the fourth wave of infections over the coming winter in a letter dated October 19th that was released under the Freedom of Information Act.

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Hiqa was responding to a letter dated October 14th from Mr Donnelly in which the Minister asked the regulator about its plans to monitor the nursing home sector this winter.

At the time, there had been 64 new Covid-19 outbreaks notified in nursing homes and community hospitals between June and September, with more than 1,000 linked infections.

Reduction in outbreaks

The rollout of third doses in the booster vaccine programme to people aged 65 and over in residential care facilities has since led to a reduction in the number of new weekly outbreaks.

In his October 19th letter, Mr Quinn said nursing home operators had recently reported requests to admit residents while their care facilities were “still in outbreak”, albeit to an area in the nursing home not currently affected by the outbreak.

“Admitting residents to a nursing home in outbreak may place the incoming resident at risk of contracting the virus and increase the pressure on a nursing home as it works to contain an outbreak,” he said.

“In addition, anecdotal reports link outbreaks in some nursing homes to recently admitted residents. The residents were vaccinated and tested negative prior to admission but tested positive on re-swabbing following admission.”

Mr Quinn said Hiqa was “extremely concerned” about the capacity of the HSE to provide support to nursing homes where “small stand-alone nursing homes are severely challenged” to maintain staff levels during outbreaks and when agency staff were not available as a contingency.

“Increasingly, the HSE have not been able to provide the same level of staffing supports as during waves one, two and three,” he wrote.

Testing ‘confusion’

Previously nursing homes supported by the HSE could keep providing good-quality care to residents, he wrote, but he expressed concern about what was facing nursing homes in the months ahead.

“As we approach winter, we are concerned that without the support of the HSE, many nursing homes may struggle to cope during crisis periods,” he said.

This could result in Hiqa’s chief inspector “having to resort to cancelling” the registration of a nursing home, “in which case the HSE will have to become the registered provider”, he said.

Mr Quinn also noted the “confusion” around testing where one nursing home with 180 beds dealing with an outbreak up to October 15th had not had all its staff and residents tested while another had all 153 residents and 164 staff tested within three days of the onset of an outbreak.

He said Hiqa “fully endorse” the need for a collaborative approach between the regulator and the HSE to “inform the supports required” for nursing homes over the coming months.