Medical officers for nursing homes urged by Oireachtas committee

Acknowledgement that a lack of statutory clinical oversight in private nursing has been “one of the biggest weaknesses” exposed by the Covid-19 health crisis has been welcomed by an organisation supporting older people and patients.

Sage Advocacy singled out the observation by the Oireachtas Covid-19 committee on Friday. The committee published an interim report setting out a series of recommendations on nursing homes whose residents were disproportionately affected by the outbreak.

The document calls for the appointment of a designated medical officer in every nursing home. Sage executive director Mervyn Taylor said his organisation had highlighted a two-tier approach to the long-term support and care of older people which was "biased towards congregated settings".

“We have to urgently address the complete lack of clinical oversight of nursing homes and ensure that measures are put in place to integrate private nursing homes into the wider framework of health and social care,” he said.

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“The firm recommendation of the Oireachtas Committee in support of a single tier system of social care for older people is to be celebrated.”

The report contains 19 recommendations. These include that health authorities take steps to ensure adequate staffing and infection control is in place ahead of any second wave.

It says no patients should be discharged from hospitals to nursing homes with substandard infection control and that, more broadly, there is a need to develop independent living models for older people.

Committee chairman Michael McNamara said the fact nursing home deaths have accounted for 56 per cent of the overall total shows the extent to which the older and most vulnerable were disproportionately affected.

“The committee is strongly of the opinion that the lack of statutory clinical oversight of care for residents in the private nursing home sector is one of the biggest weaknesses exposed by Covid-19,” he said.

The process focused on whether residents in nursing homes were adequately protected and the extent to which the crisis has highlighted the need for a different model of care – particularly one where more people would be cared for at home or in their communities.

“It is evident that, if there is a second wave of the virus, different measures will be taken,” said Mr McNamara.

“We know, for instance, that the discharge of patients from acute hospitals to nursing homes has been tightened up through testing and isolation procedures, which is welcome. However, the fact that the HSE still facilitates the placement of older persons in a nursing home with known infection control risks is, in the view of the committee, indefensible. This practice must end.”

This committee is due to continue its work in September once it has examined a report by the Health Information and Quality Authority (Hiqa) on the impact of Covid-19 on nursing homes. It will also look to a forthcoming Expert Advisory Panel study.

‘Absolutely vital’

Mr McNamara said it will then be in a position to determine whether a public inquiry is necessary to examine the fate of residents from March to May 2020.

Nursing Homes Ireland chief executive Tadgh Daly said the report "finds the public health authorities were slow to respond to the threat".

He said it was “absolutely vital” that recommendations for a comprehensive system of testing and tracing among nursing home staff continues along with stockpiling of personal protection equipment.

In a broad criticism of official planning for the sector, Mr Daly said questions remained as to why nursing homes “were not a bigger priority in the preparations for the pandemic”.

“The Committee needs to set a roadmap for Government to support a long-term sustainable model of care for older people in Ireland,” he said.

The Irish Nurses and Midwifes Organisation said it supported the committee's recommendation that staff ratios needed to be better regulated and based on the number of patients and their specific needs.