Nursing home deficiencies subject of Hiqa concern at start of April

Staffing levels and nursing skills ‘not commensurate’ with Covid-19 care needs

Hiqa’s Mary Dunnion: “The lack of direct relationship of the HSE with the private sector has highlighted a challenge to effectively project the specific needs of nursing homes during the Covid-19 outbreak.” Photograph: Tom Honan

Hiqa’s Mary Dunnion: “The lack of direct relationship of the HSE with the private sector has highlighted a challenge to effectively project the specific needs of nursing homes during the Covid-19 outbreak.” Photograph: Tom Honan

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Just over a fifth of nursing homes were fully compliant with all regulations on care and welfare of residents last year, the State’s health service watchdog warned health officials in early April.

The Health Information and Quality Authority told the Department of Health on April 9th that 124 public and private nursing homes – or 23 per cent of the 580 care homes in the country – were “at risk” and would potentially need some level of additional support from the Health Service Executive.

Mary Dunnion, chief inspector at Hiqa, said in a risk assessment that the HSE had tried to help care homes “when the need has arisen” with more than 50 staff being deployed, on-site infection control advice, psychological support for staff and increased personal protective equipment (PPE).

“However, the lack of direct relationship of the HSE with the private sector has highlighted a challenge to effectively project the specific needs of nursing homes during the Covid-19 outbreak,” said the health regulator in a risk assessment document provided to the department.

The document was in correspondence sent by the department to the Oireachtas Covid-19 committee in response to issues raised in the Dáil about information provided by Hiqa.

Skills and competencies

Hiqa’s chief inspector raised concerns in the document about staffing levels in nursing homes, saying there was “no nationally mandated staff ratio for the nursing home sector” and that most care in private homes was provided by healthcare assistants supervised by registered nursing.

“In a large number of private nursing homes their established staffing levels, skills mix and competencies are not commensurate with what is required to deal effectively with the escalating care needs of residents during a Covid-19 outbreak,” she wrote.

“Importantly, the private sector is unable to safely sustain a quality service when staffing levels are depleted by staff self-isolating while awaiting Covid-19 testing and/or results.”

At the time the risk assessment was shared, there were clusters – each defined as two cases or more – in 130 nursing homes. This has since risen to more than 250.

The nursing home sector has been at the frontline of the Covid-19 pandemic, accounting for about 55 per cent of the more than 1,670 deaths from the coronavirus disease in the State.

Testing and tracing

A HSE briefing sent to the committee shows that some €80 million has been spent so far on testing and tracing, including €33 million on testing kits and reagent, €23 million on lab testing, and €14.5 million paid to GPs referring people forward under a government reimbursement scheme.

The briefing document on the State’s Covid-19 testing and tracing model also shows that if the State were to require 15,000 tests to be completed per day, every day, then the projected costs of this model would be “in the region of €450 million”.

The HSE document states that its performance on testing has improved since a backlog of about 35,000 people awaiting swabbing emerged in the early days of the crisis.

The committee will on Tuesday hear that more than 500 inspectors are being deployed to check whether workplaces are adhering to social distancing and other safety rules as the country reopens.

Department of Business secretary general Dr Orlaigh Quinn will tell the committee today that the inspectors are being deployed to help Health and Safety Authority officials who have carried out 1,015 inspections since the lockdown began to be lifted on May 18th.

Some 858 inspections have been carried out to check compliance with the Government’s Return to Work Safety Protocol and the construction industry accounts for about half of these. The inspections have found high levels of compliance and employers taking a “responsible” approach.