Coronavirus: HSE advised nursing homes last month to manage their own cases

Infected residents should be moved to hospital only if it would ‘confer additional benefit’, guidance said

 French firemen transport an elderly person to the nursing home. Photograph: Sebastien Nogier/EPA

French firemen transport an elderly person to the nursing home. Photograph: Sebastien Nogier/EPA

 

Nursing homes were advised by the HSE to manage Covid-19-infected patients in their own facilities and only transfer them to hospitals where it would “confer additional benefit”.

The HSE advised nursing homes in a guidance note on March 25th to discuss in advance the transfer of a sick patient with a senior clinician or GP and that this decision “should be made in conjunction with the person, their families and their advanced care plans”.

“In general, residents in residential care who are coronavirus, also known as Covid19-positive, should be managed in their facilities,” said the note.

“Transfer to hospital is only appropriate where this will confer additional benefit.”

The guidance note circulated to nurse-led residential care facilities said the elderly care homes should “ensure as far as possible that discussions with residents and families reflecting care preferences including at end of life have been identified, documented and updated”.

The HSE warned nursing homes to be aware that “significant and rapid clinical change” can be a feature of Covid-19 in some older people and so they should have “timely discussions”.

The HSE said it will update the infection control guidance for nursing homes early this week to take account of what residential care facilities are experiencing.

Prof Martin Cormican, the HSE’s national lead for infection control and antimicrobial resistance, said that the guidance for infection control in nursing homes would be updated “early next week”.

He said at the HSE’s weekly briefing on Sunday that there would be some changes in detail informed by the experience of health officials coping with issues arising in nursing homes.

The HSE was “trying to make sure as much as possible that the guidance we are giving is tailored and suited for the practicalities of what people are doing,” said Prof Cormican.

Scale of cases

The scale of coronavirus cases in nursing homes has come into focus due to a five-fold increase in the number of clusters of infections in residential care homes for the elderly in the space of just over a week, rising to 50 on Sunday from nine on March 24th.

A cluster is two or more laboratory-positive Covid-19 cases in an institution, according to the HSE.

The Government announced a series of measures on Saturday to assist nursing homes cope with the coronavirus outbreak, including financial support of up to €72 million, the appointment of national and regional infection control teams and temperature screening of staff twice a day.

The nursing home sector welcomed “that the focus has shifted to nursing homes now where our most vulnerable are living” after planning by the Government for the hospital system and wider society had gone for months.

‘Continued priority testing’

Nursing Homes Ireland, the group representing the sector, said continued priority testing had to be given to residents and staff in nursing homes and timely access to personal protective equipment (PPE) “must become the norm”.

Tadhg Daly, chief executive of Nursing Homes Ireland, said nursing homes could cope with residents infected with Covid-19 in their care “if they have the right supports” from the Government, the HSE and other State agencies.

“We can cope, but we do need the right PPE and assistance with staffing,” Mr Daly said.

He said that the availability of PPE had been “mixed and very inconsistent” and depended on a “postcode lottery” and the region the nursing home was in.

“There are a number of nursing homes across the country that would require more support; there is no doubt about that,” said Mr Daly.

He said private nursing homes moved quickly to prepare for the arrival of the pandemic in Ireland by closing nursing homes to visitors on March 6th ahead of public nursing homes.

On March 10th the State’s chief medical officer, Dr Tony Holohan, said the restrictions were not necessary and could affect the mental wellbeing of residents.

Health officials wanted “to avoid introducing measures like that that have that kind of social impact before they are really necessary,” he said at a briefing.

There are about 440 private nursing homes and 120 HSE-run nursing homes in the country with about 30,000 residents.