Nursing homes are pushing for coronavirus-vaccinated residents and visitors to be allowed in-person visits with rapid antigen testing for visits by those yet to be vaccinated as part of a “vaccine bonus” for the sector.
The HSE is looking at the possibility of easing visiting restrictions in nursing homes as infection rates decline in care homes and the vaccine rollout in care homes nears completion bringing immunity to residents.
The National Public Health Emergency Team (Nphet) will consider changes to visiting in nursing homes on Thursday as they weigh up a possible “vaccine bonus” for care facilities that have experienced months of restrictions on visitors.
Visits to nursing homes are restricted under the most severe Level 5 lockdown restrictions to critical or compassionate grounds where residents are distressed or at the end of their lives.
The vast majority of residents and staff in care facilities have been vaccinated, with almost 100,000 people receiving their first dose and 65,000 receiving their second as of last weekend.
"Where there is a critical mass of people vaccinated in a nursing home, there is a greater opportunity for visits in that environment," said Sarah Lennon, executive director of Sage Advocacy, a group that represents older and vulnerable adults.
She called for “a nuanced approach” to the restarting of nursing home visits where both the nursing home resident receiving a visit and the visitor have both been vaccinated.
“It is about balancing out the risks. That seems to be one of the least risky,” she said.
The HSE's clinical lead on infection control, Prof Martin Cormican, said the health service planned to introduce "a progressive improvement in opportunities" for nursing home visits.
The US Centres for Disease Control and Prevention issued new guidelines this week permitting fully vaccinated people to meet each other indoors without wearing masks.
In the United Kingdom, where the vaccine rollout is more advanced, nursing home residents are permitted to nominate one person for regular visits but they must be tested using the rapid lateral flow antigen test at every visit to prevent the spread of infection from the community into the home.
Nphet has long resisted the use of antigen testing as a means to prevent transmission.
"We are saying that antigen testing has a role to play in reopening visiting at nursing homes. It is not the silver bullet but we need to move cautiously," said Tadhg Daly, chief executive of Nursing Homes Ireland, which represents the private nursing home owners.
“We need to set out a road map of how it is done. There needs to be a graduated approach so that over the coming weeks we can further ease restrictions.”
He suggested that visiting could restart with one nominated visitor for each resident for the first couple of weeks with antigen testing as one of several measures to help minimise the risks.
Ms Lennon said she hoped that visits would not be restricted to one nominated visitor as in many cases siblings were keen to see parents and this restriction was “causing family distress”.
Susan Cliffe, deputy chief inspector of the nursing homes regulator, the Health Information and Quality Authority, said that restarting visits was urgently required for nursing home residents given the length of time that they have spent alone under lockdowns during the pandemic.
“Attention must be addressed to this now because many of these people have been isolated in their nursing homes and isolated from their families for long periods of time,” she said.
She urged homes not to limit compassionate visiting to end-of-life situations if safeguards are taken and visitors are protected, and called for window visits to be facilitated where possible.
“Some providers are not moving as quickly in that direction as we would like to see,” said Ms Cliffe, noting the reduced infections and the benefits of vaccinations across nursing homes.
“As a nursing homes come out of an outbreak, we would expect to see as a basic minimum of window visiting starting and compassionate visiting as well.”