The residents of nursing homes and other residential care institutions who have Covid-19 should be kept in the homes if there is no “clinical or other advantage” to them being moved, according to the national team overseeing the coronavirus crisis.
With approximately one in five of all cases of the disease arising in long term residential care (LRTC) settings, the National Public Health Emergency Team (NPHET) has come up with six policies aimed at keeping people in the homes to the greatest extent possible, while preventing the spread of the virus within LTRCs and onwards into the wider community.
Ireland has about 29,000 people in nursing homes and more again in homes for the disabled and those with mental health conditions. The World Health Organisation has identified LTRC residents as being particularly vulnerable to coronavirus, also known as Covid-19.
Age, the high prevalence of underlying medical conditions, and the high level of physical contact involved in their care, all contribute to making the residents vulnerable.
The infection clusters that have developed in nursing homes have created an urgent need to develop “focused and enhanced measures” to address LTRCs, according to a document drafted by the NPHET for circulation to the institutions.
Among the measures to be put in place are “teams of last resort” that will be ready to go into individual LRTCs for short periods to ensure service delivery.
Some homes have been experiencing staff pressures and each time a case of Covid-19 breaks, it creates increased staffing pressures because of the care regimes that have to be put in place.
The six categories of measures contained in the circular address new national and regional teams to oversee LRTCs; staff screening and prioritising for testing for Covid-19; transmission mitigation; the provision of personal protection equipment and oxygen; training; and preparedness plans for infection outbreaks.
Transmission mitigation measures include the provision of transport and new residential facilities for staff, and minimising staff working in multiple LRTCs or between institutions where there are cases of the virus and where there are not.
As well as prioritising LRTC staff for Covid-19 testing, the NPHET has also recommended that LRTC staff have their temperatures taken twice a day.
On training, the emergency team has recommended that sufficient staff get training in infection prevention control, personal protection equipment use, oxygen delivery, pallitative care, end of life care, and “pronouncement of death”.
The team has recommended that each institution plan for the cohorting of patients (those with and without Covid-19), surges in infection, and for the promotion of communication with families and residents.
The chief executive of Nursing Homes Ireland, Tadhg Daly, has said the private and voluntary nursing home sector, which looks after 25,000 people, is in need of significant financial support.
The issue is not addressed in the NPHET document, but following a meeting with the Minister for Health, Simon Harris, earlier this week, Mr Daly said the minister had committed to bringing forward a "package of financial supports" before the end of the week.