One in five care home nursing directors plan to quit after Covid-19

New study shows severe strain of the pandemic on directors of nursing at care homes

One in five directors of nursing at residential care homes are actively planning to leave their jobs following the stress of dealing with the Covid-19 pandemic, a new study reveals.

The research, published by Trinity College Dublin, found that a further 28 per cent of directors of nursing at care homes are considering leaving their posts.

Nursing homes and other residential care settings have been disproportionately affected by the pandemic given the effect of the coronavirus disease on older people in congregated settings.

Almost 90 per cent of the 6,228 deaths from Covid-19 during the pandemic have been among those aged 65 years and over.

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Of 3,718 deaths linked to outbreaks, 37 per cent were in nursing homes with a further 4.3 per cent in community hospitals, long-stay units or residential institutions.

The academic study, entitled “Experiences of directors of nursing in preparing for and managing Covid-19 in care homes for older people,” has called for better supports for nursing home staff and further integration of care homes into the wider healthcare system.

It has recommended tailored psychological supports to help reduce staff “burnout” and treat nursing home staff coping with post-traumatic stress in the wake of the pandemic.

‘Constant concern’

A survey of 122 residential care homes found that more than 35 per cent experienced significant financial challenges that may affect their future viability.

More than half (54 per cent) of nursing homes experienced at least one Covid-19 outbreak.

Directors of nursing detailed their “constant concern” about the welfare and protection of nursing home residents and staff during the pandemic. It showed the “blurred lines” between working hours and personal time, rendering the directors of nursing on “relentless alert”.

The study found that directors of nursing had to comply with rapidly changing public health guidance, complete documentation, identification and management of infection control in care homes, contain Covid-19 outbreaks and manage staff shortages.

At the same time, they had to develop “careful” strategies to ensure residents could still connect with their family and friends through virtual means and deal with the “unintended consequences” of restrictions, such as the loneliness of residents and isolation. They also had to manage “the challenges in delivering end of life care in pandemic times,” the study said.

Directors of nursing expressed disappointment at how the care sector was characterised in “media and political narratives as incidences of sub-standard care, outbreaks and high mortality rates” without balanced discussion and positive experiences in the care sector being included.

Professor Amanda Phelan, professor of ageing and community nursing at Trinity College's School of Nursing and Midwifery, said that the pandemic had a "major personal and professional impact" on directors of nursing.

“They provided nursing and psychological care for fearful residents, managed outbreaks and navigated staffing challenges due to attrition or staff self-isolating,” she said.

Healthcare system

The report showed that a “more coordinated, supportive and integrated approach” was needed to centralise private and voluntary nursing homes in the wider Irish healthcare system.

Tadhg Daly, chief executive of Nursing Homes Ireland, which along with The All-Ireland Gerontological Nurses Association (AIGNA) provided funding for the study, said the report showed how nursing home care is at a "critical crossroads" against the backdrop of Covid-19.

He said that the pandemic “must represent a defining moment in gerontological care” and that the State has to recognise the need for and value the specialised care in nursing homes.

Dr Catherine Buckley, president of AIGNA, said the burden of ensuring staff and resident safety while meeting regulatory standards "fell mainly on the shoulders of directors of nursing".

“As someone who was also in the trenches, managing a nursing home for a short time outside of my substantive post, I can empathise with the experiences of these directors of nursing,” she said.

Simon Carswell

Simon Carswell

Simon Carswell is The Irish Times’s Public Affairs Editor and former Washington correspondent