Early action helped nursing home group manage Covid-19

One of the country’s largest nursing home groups has expressed surprise that State health officials criticised private homes for introducing early visitor restrictions before the first Covid-19 death.

Brookhaven will have all five of its homes reopened to visitors this week – with strict physical distancing and Perspex screens – after moving earlier than many other homes to introduce restrictions in mid-February, two weeks before the first confirmed case in Ireland.

The group, which runs Talbot Lodge nursing home in Malahide, Co Dublin, and homes in Stradbally, Co Laois; Ballyragget, Co Kilkenny; Moycullen, Co Galway; and Castlebar, Co Mayo, attributes its management of the pandemic to early action and intervention.

On March 10th, chief medical officer Dr Tony Holohan questioned the decision of private homes to close to visitors four days earlier before restrictions were "really necessary".

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"We were surprised at the time that this was the advice of NPHET [the National Public Health Emergency Team] given the known vulnerability of the over-60s to the virus, and the international experience of the effects of the virus on the elderly," said Tim Murphy, chairman of Brookhaven.

On March 11th, the State announced visitor restrictions in long-term care homes. The first Covid-19 death was announced that day.

Brookhaven says it had one Covid-19 death in its home in Abbeybreaffy near Castlebar, and is challenging the HSE over its estimate in an internal list compiled last month – and published by The Irish Times – that the home had two confirmed and probable deaths from the disease.

Tested positive

According to the group, the deceased resident had visited a local hospital whilst in palliative care, and tested positive after they died at the home in early April.

The group had a resident in Teagleach Uillinn in Moycullen who tested positive for Covid-19 in the mass testing of homes but was asymptomatic.

In both cases the homes imposed strict isolation, and the group says it limited the disease to these two cases across 380 residents in the five homes.

Mr Murphy said the group was alerted to the risks posed by the virus to older people and in congregated settings such as care homes from tracking international media reports in January and February about how the disease was being transmitted and how it could “go global”.

“We basically decided that if this is going to be an issue we can’t understand how it is going to happen. We have got to do everything possible to manage the problem. It was impossible to predict what was going to happen,” he said.

The group recognised that nursing homes and hospitals used foreign agency staff who tend to live with each other. Therefore on February 14th, Brookhaven directed that any of its 380 staff who had travelled abroad, including to Northern Ireland, to self-isolate and not to come to work for 14 days.

The group felt it had to be “extra careful” with Talbot Lodge as it was a 112-bed facility near Dublin Airport with lots of traffic “in and out”, says Mr Murphy.

In addition, the group started stockpiling personal protective equipment in February.

Angry reaction

On February 26th, Brookhaven banned visitors that had been to any destination outside of Ireland in the previous four weeks, before banning all visitors on March 6th. The group received an angry reaction from some relatives of residents at the time.

“They are thrilled and delighted now. They have come up and said we were wrong, and you protected our loved one,” said Mr Murphy.

He believes Tadhg Daly, the chief executive of Nursing Homes Ireland, which represents private nursing homes (80 per cent of the sector), should have been a member of NPHET from the outset. "It's not too late for this to happen given the expectation of a second Covid-19 wave."

Mr Murphy is unsure whether there will be a second resurgence, but, as with the group’s cautious approach before the first confirmed Covid-19 case in February, is not taking chances.

“We are going on the basis that there will. I think that is the right thing to do: to prepare for the worst. I think that is what we have to do.”