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Fintan O'Toole: A preventable tragedy is unfolding in care homes

It is not too late but the Government must act now to save care workers

This crisis is terrible for everybody. But within the big disaster is a very specific tragedy. It is unfolding quietly, mostly out of sight and little remarked. It affects, as always, people who are economically marginal and therefore invisible. But it is preventable and it is not too late to limit the damage it will do.

It needs an urgent and sustained concentration by Government on a very particular group of people: those who work in care homes and in residential institutions for people with disabilities. These people are, with good reason, feeling frightened and abandoned. Without a co-ordinated emergency response, very many of them will both contract Covid-19 and spread it to other vulnerable people.

When we think of the “front line” in this struggle, we think of hospitals and intensive care units, of doctors and nurses. And so we should: these are our saviours. But there’s another front line.

While we are all quite properly aware of the need to protect the hospital staff, the plight of care workers has a much lighter grip on the collective imagination

It lies in a sector of our society that has historically been neglected: the places where we house elderly people and people with severe disabilities. The hospitals and ICUs have, in this crisis, a kind of dark glamour – they radiate a desperate heroism. But nursing homes don’t.


The people who live in them and the carers who mind them are glimpsed only in society’s peripheral vision. Thus, while we are all quite properly aware of the need to protect the hospital staff, the plight of care workers has a much lighter grip on the collective imagination.

The State quite literally does not know what is happening in these places. We do know that there are at least 135 clusters of Covid-19 infection in nursing homes. But there are 460 private nursing homes with 25,000 residents, and a further 5,000 people in homes directly managed by the HSE.

In addition there are 2,500 residents in units for people with intellectual disabilities. There are good reasons to believe that many more people are dying in these places than the official figures can capture.

The economist Seamus Coffey has pointed out, for example, that the increase in the number of deaths being recorded on is much greater than the published statistics would suggest.

But here are two clear truths about this social twilight zone. One is that even before the coronavirus, there were serious problems with infection control. The other is that the people who are most hands-on in these environments – changing nappies, cleaning up body fluids – are generally female and poorly paid. Many of them are immigrants.

This is work you do when you’re trying to get a foothold in the economy. It is work people tend to do because they don’t have other options.

A sense of how vulnerable these workers are comes from an expert who told me of one home he knows where staff are leaving to work for Aldi instead because “you get an extra €2 an hour and a face mask”.

The evidence is not just anecdotal. Last week, a survey by Nursing Homes Ireland found that 178 nursing homes had lost more than 700 healthcare assistants. Some homes have lost as many as a third of their staff, either to Covid-19 itself or to defections. But where does that leave those who are still working in the system and those who depend on them?

If it is both safer and more lucrative for a carer to get a job in a supermarket, what becomes of those who need their care?

There is also a very specific problem for migrant care workers. Low-paid migrants who come to places where rents are high, have to share cramped accommodation. It is not unusual for up to eight carers to share a house.

Each of them in turn is caring for a dozen vulnerable clients. The mathematics are grimly obvious. Firstly, they are much more likely to spread the virus to each other.

When this is all over, we may have time to reflect on the price we pay for neglect and exploitation

Secondly, they have nowhere to self-isolate if they catch it. If you wanted to create a Garden of Eden for the virus, here it is, a perfect circle in which carers can spread it to their clients who spread it to their carers who pass it on to other carers and back again on this merry-go-round from hell.

Bear in mind, too, that it is common for nurses who have come from countries like the Philippines to have spouses who work in care homes – the hospital system is not sealed off from this problem.

This circle has to be broken. When this is all over, we may have time to reflect on the price we pay for neglect and exploitation. But in this immediate emergency, what is required is a specific and urgent Government plan for carers.

A key part of that is surely getting these workers out of cramped accommodation so they can maintain social distancing and self-isolate when necessary.

This can be done. There are dozens of hotels all over the country lying empty. Pat McCann, chief executive of Dalata, the largest chain in Ireland, said on RTÉ last week that hotels can be reopened within 24 hours if needed.

They are needed, desperately and, quite literally, vitally.

For once it is no exaggeration to say that this is a matter of life and death.