Urgent reform needed to protect care homes from another Covid-19 wave

Healthcare regulations are “outdated” and are no longer robust enough to protect nursing home residents in the event of another Covid-19 wave, the State’s health watchdog has said.

In a new report calling for urgent reform of regulations protecting older and vulnerable people, the Health Information and Quality Authority (Hiqa) said a number of regulations, particularly covering older people, were “not wholly effective” and large numbers of people were in receipt of care services such as homecare and day services that were “entirely unregulated at present”.

The Covid-19 pandemic had raised questions about how the State cared for the vulnerable and created a “suitable moment” to reflect on what has been learned from regulation by Hiqa over the past 12 years and “to chart a path forward” to strengthen the regulation of care, it said.

“Practices that were previously acceptable are no longer robust enough to safeguard the wellbeing of residents in the event of a further wave of Covid-19,” the regulator said in the report.

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Hiqa said the pandemic had “not in itself signalled the need for regulatory reform; rather it has shone a spotlight on an issue that was already in need of urgent consideration”.

The regulator said that although the pandemic had "exposed further weaknesses in the regulations given the significant impact it has had on nursing homes in Ireland, we cannot lose sight of the fact that these weaknesses have been present for a significant period of time".

More than half of the 3,948 deaths from Covid-19 have been nursing home residents.

“The pandemic has only served to highlight the critical importance of the need for regulatory reform,” said Hiqa in the report entitled The Need for Regulatory Reform.

Complexities

The report highlights the complexities of regulating a sector that is constantly evolving and how Covid-19 “adds many layers of complexity”.

The regulator said there was “no overarching social care policy or legislation” outlining the State’s role in the social care needs of elderly and more vulnerable people within the population.

The absence of clarity on the State’s responsibility had led to irregularities in care, it said.

Care regulation had adopted a “one size fits all” approach and should instead move to the regulation of service, the watchdog recommended.

Hiqa warned in the report about concentrating a large number of care facilities within a small number of providers where, should a nursing home group fall into liquidation, it could result in anxiety for residents and families when alternative care facilities had to be found.

The regulator described the “complex and changing ownership” behind large nursing home groups as a “very real and genuine concern for the Irish social care sector”. It has experienced some difficulties recently identifying who is the responsible legal entity behind a care service.