Coronavirus: Health watchdog warned about danger to care homes in March

The State's health watchdog warned the Department of Health and the HSE in late March about 212 residential care facilities for the elderly deemed "at risk" in the Covid-19 pandemic.

The Health Information and Quality Authority (Hiqa) also told the department and the HSE at this time that there did not appear to be “a national governance and aligned operational arrangements within the HSE to clearly articulate the national response and support for the residential sector”.

Following up on questions asked at Tuesday's Oireachtas committee, Hiqa told the committee in a letter sent on Friday that on March 30th it sent the department and the HSE 12 "attachments" in which it named care facilities "deemed to be at risk".

Mary Dunnion, Hiqa's chief inspector, told Social Democrats co-leader Róisín Shortall that it sent lists of care facilities to the department and the HSE in February and March that it would consider to be at high risk in a Covid-19 outbreak.

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Hiqa provided further information to the committee on Friday, including correspondence dating back to March 30th in which it identified “at-risk” older person care facilities.

It withheld the names of the facilities in the information sent to the committee on Friday.

At the time of Hiqa’s correspondence, there were 38 Covid-19 clusters in residential care facilities, two weeks after the first cluster was identified in a residential care home. The number of clusters in care facilities have since risen to 468.

Borne the brunt

Nursing homes and residential care facilities have borne the brunt of the pandemic, accounting for 1,032 or almost 63 per cent of the 1,645 deaths from the disease in the State.

In a “framework of information” sent to the department and the HSE on March 30th, Hiqa named 212 elderly care homes that were “non-compliant with more than one of the key regulations”.

The regulator said the “physical premises in which a nursing home is accommodated may significantly increase the risk by contributing to the spread or failing to contain Covid-19”.

“Compliance with key regulations provides an insight into the number of centres that may be a concern,” Hiqa said in its framework.

“Key regulations in older persons include those focused on infection control, residents’ rights (in the context of adequate personal space), access to belongings, risk management, end-of-life care and premises.”

A separate appendix listed the number of residents in each home and the non-compliant regulation “which may potentially challenge a service to safely manage residents with Covid-19”.

The regulator said that at a regional level nursing homes “require access to a single point of contact within the HSE to a support structure” that would provide advice on how to manage if it had a Covid-19 case, and provide access to personal protective equipment.

Elsewhere in the framework document, Hiqa said that most private nursing homes had reduced the number of residents in communal rooms to a maximum of four but more often three or less.

Sleeping area

It said that many of the HSE-run or HSE-funded homes “continue to have larger numbers of residents accommodated in one sleeping area”.

An appendix, already sent to the department and the HSE earlier in March, sets out a list of nursing homes “where the premises pose a significant risk in the context of the spread and/or management of Covid-19”.

The chief inspector advised that “at a minimum no further residents are admitted to these nursing homes”.

Hiqa also raised concerns around staffing issues at nursing homes.

Separately, on Friday night the HSE said that the decision to limit Covid-19 testing at nursing homes and other care facilities as clusters spread in late March was due to reduced testing capacity.

The health service was responding to the emergence of a memo issued by the HSE on March 21st instructing the heads of its community healthcare organisations across the country at the time to avoid seeking tests for other care home residents if the facility already had a Covid-19 case.

The HSE's national director for community operations, David Walsh, said in the memo that if a home had a confirmed Covid-19 case, it should be "assumed that all residents presenting with symptoms are Covid positive" and that "multiple re-referrals" for tests "should be avoided".

A HSE spokeswoman said that the direction in the memo “reflected the public health advice at that point in time” and “took into account the overall national capacity to analyse Covid-19 tests”.

The public health advice “evolved as the understanding of the disease developed and the national capacity to analyse Covid-19 tests increased”.