‘Light-touch regulation’ raises its head again with regard to nursing homes

If any good is to come from the current crisis it should be that we give greater priority to the care of older people. We could start, for example, by getting on with providing statutory care in people’s homes so they are not “forced” into nursing homes because that is where the financial supports are.

For now, though, we urgently need to find out what went wrong in our nursing homes during the pandemic. The number of unexplained deaths in these homes so far this year has jumped by over 880 compared to last year, and the vast majority are associated with Covid-19 infections.

How many of these residents died needlessly because no one shut the door to stop the virus entering their vulnerable environments?

Hundreds, arguably, given the inflated share of care home deaths as a proportion of overall Covid-19 deaths in Ireland.

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Compare what happened in nursing homes with another high-risk, enclosed setting, prisons, where temperature checks, cocooning of older inmates and quarantining were implemented. There have been no cases, let alone deaths, among prisoners.

Experts have been appointed to review what happened in nursing homes, but it is not difficult to identify the many causes even now. The special committee on Covid-19’s hearings on Tuesday shed some further light, but the extent of what one TD called “pass the parcel” was depressing.

‘Isolated’

Nursing Homes Ireland (NHI), whose members are paid hundreds of millions of euro every year to look after older people under the Fair Deal scheme, claimed to have been left "isolated" despite a voluminous trails of correspondence with the HSE and Department of Health officials.

The emails and letters did at least show the private nursing home owners were sounding the alarm about the approaching tsunami. But given the scale of the emergency, and their distance from the levers of power, it clearly took too long for their warning to be properly heeded.

HSE officials boasted about the “unprecedented level of support” it has provided to nursing homes, but were unable to provide an up-to-date figure for deaths there or a breakdown of deaths between public and private homes.

Neither did they answer a question as to whether any of these deaths could have been avoided.

They pleaded it was not until late March that scientific research pointed to the specific threat posed by asymptomatic transmission in care homes.

NHI’s beef was that it was left out of the committees where all the big decisions were being made.

The interests of older people at the National Public Health Emergency Team were supposed to have been represented by the regulator, the Health Information and Quality Authority (Hiqa) , but as Fianna Fáil's Stephen Donnelly pointed out,there was no mention of nursing homes at the first 11 meetings of NPHET, notwithstanding Hiqa's presence at them.

And when the subject was raised at the 12th meeting in mid-March, the context was NPHET’s desire to reverse a blanket restriction on visitors that private nursing homes had just imposed.

NPHET was forced to do a U-turn and impose its own visitor restrictions days later as the situation deteriorated.

‘High-risk’ homes

Meanwhile, we learned that Hiqa has yet to inspect a single nursing home with cases. Imagine UN arms inspectors not wanting to go to Iraq, or radiological experts in full protective gear not visiting the site of a nuclear accident.

It seems to have contented itself in the early days of the crisis by providing the HSE with a list of “high-risk” homes, though today it is unable to correlate the performance of these homes with case numbers and deaths in them.

It seemed the right time to bring out the phrase “light-touch regulation”, as in our last national crisis.