Oireachtas Committee on Covid-19 calls for immediate nursing home sector reform

The Special Committee on Covid-19 Response is calling for immediate action and reform of the nursing home sector, to protect the older population, in the event of a second wave of the virus, in an interim report published today.

An urgent review of current regulations and standards relating to the care of older people in nursing homes, a workforce and infection control plan, and strengthened governance and oversight of private nursing homes are among the wide-ranging recommendations in the Committee’s report.

Committee Chairman Michael McNamara TD said the impact of Covid-19 in Ireland has been most profound on the residents of our nursing homes. He said the fact that their deaths accounted for 56% of the overall total shows the extent to which our older and most vulnerable population was disproportionately affected.

“The Committee is strongly of the opinion that the lack of statutory clinical oversight of care for residents in the private nursing home sector is one of the biggest weaknesses exposed by Covid-19. The Committee recommends the Department of Health urgently review clinical oversight and governance arrangements for private nursing homes. The Committee is strongly of the opinion that we need to strengthen clinical oversight of individual nursing homes, both public and private, by requiring a designated medical officer be appointed to each nursing home,” Deputy McNamara added.

The appointment of designated medical officers to nursing homes is among 19 recommendations made in the Interim Report on Covid-19 in Nursing Homes.

Other recommendations include:

•The Department of Health in conjunction with the HSE and HIQA take immediate steps to develop a plan that will ensure that staffing levels and infection control procedures in the nursing home sector are adequate to meet any possible second wave of Covid-19.

•The Department of Health urgently reviews current regulations and standards relating to the care of older people in nursing homes to assess whether they fully/adequately protect patients’ health and welfare in discharging patients to nursing homes which have been determined by HIQA to be non-compliant with infection control requirements. The Committee further recommends that no patients are discharged from hospitals to any nursing home which fails to meet infection control requirements and that no arrangement should be made by the State to place any older person in such homes under the Fair Deal Scheme.

•The HSE and HIQA ensure that all nursing homes are adequately stocked and supplied with PPE in the months ahead.

•The Department of Health develops an integrated system of long-term support and care spanning all care situations with a single source of funding, and the Department should work closely with the Department of Housing to develop models of independent living, supported housing and sheltered housing to cater for the wide range of housing preferences among older people.

The Committee examined whether residents in nursing homes were adequately protected and the extent to which the Covid-19 crisis has highlighted the need to move to a different model of care where more of our older population are looked after at home or, at least, in their communities, rather than in congregated settings.

Deputy McNamara said: “It also allowed a review from which it is evident that, if there is a second wave of the virus, different measures will be taken. We know, for instance, that the discharge of patients from acute hospitals to nursing homes has been tightened up through testing and isolation procedures, which is welcome. However, the fact that the HSE still facilitates the placement of older persons in a nursing home with known infection control risks is, in the view of the Committee, indefensible. This practice must end.”

This Committee intends to return to this issue in September when it has examined the HIQA report on the impact of Covid-19 on nursing homes and the forthcoming Expert Advisory Panel report on the issue. Deputy McNamara said the Committee will then be in a position to determine how best to continue the investigation and whether a public inquiry is necessary to examine the impact of Covid-19 in nursing homes from March to May 2020.

The Committee held three meetings in relation to the issue with engagement with Government Departments, State bodies, the World Health Organization as well as representatives of the nursing homes sector. Representatives from Sage Advocacy provided an insight into concerns of residents and families during the Covid-19 crisis.

The Committee also received 20 written submissions from medical experts, organisations and groups advocating for the rights of older people during its examination of the issue.

The INMO has backed a call from the Oireachtas COVID response committee for regulated levels of safe staffing in nursing and midwifery.

The interim report recommended that: “Regulations regarding staffing and staff ratios in nursing homes need to be strengthened in order to protect patient health and to prioritise the setting of nurse to patient ratios in line with best practice.”

The INMO backed the recommendation, calling for the scientifically based Safe Staffing Framework to be funded and rolled out across all nursing services in the country.

The Framework, which has been trialled successfully in Irish acute hospitals, sets safe staffing numbers for nurses and healthcare assistants based on the number of patients and their specific needs.

When trialled, it was found to reduce costs, virtually eliminate the need for agency staffing, improve patient outcomes, drastically reduce patient mortality, and improve staff and patient morale.

INMO General Secretary, Phil Ní Sheaghdha, said: “The Oireachtas committee is absolutely correct in its recommendation on staffing. For decades, staffing levels in the Irish health service have been based on historical levels.

“A ward would have staff based simply on what they have had previously, rather than patient needs. Whether we are facing a second wave or not, Ireland needs to set staffing levels based on evidence, not history.

“We have a framework to do this. The system has been proven to work. It is government policy. It has Oireachtas backing. Now it’s time to actually fund and implement it.

“I’m grateful to the Oireachtas committee for listening to the INMO and our members in making their recommendations.”

The INMO also backed recommendations in the Oireachtas interim report which called for:

•a review of staffing and employment practices (including pay) in private nursing homes

•a shift towards independent living for the elderly, away from congregated care settings where appropriate

•at minimum no reduction in public or voluntary health service capacity.

Sage Advocacy has repeatedly warned that the current ‘pass the parcel’ approach to taking responsibility for the lives of people in nursing homes and private congregated care settings is ‘’inherently dangerous and has been shown to be so”.

The organisation - which is a support and advocacy service for vulnerable adults, older people and healthcare patients - therefore welcomes the acknowledgement in the Oireachtas Committee’s interim report that the “lack of statutory clinical oversight of care for residents in the private nursing home sector is one of the biggest weaknesses exposed by Covid-19’’.

Mervyn Taylor, Executive Director of Sage Advocacy, said : “In our submission to the Special Commitee we highlighted that we currently have a two-tier healthcare system and a two-tier siloed approach to the long-term support and care of older people, which is biased towards congregated settings.

“There has to be learning from the experience of Covid-19 and we have to urgently address the complete lack of clinical oversight of nursing homes and ensure that measures are put in place to integrate private nursing homes into the wider framework of health and social care.

“We believe it is time to shed a tier and set about building Sláintecare; a single tier national health service with an integrated system of social care focused on home and a much wider range of options between home and nursing homes. The firm recommendation of the Oireachtas Committee in support of a single tier system of social care for older people is to be celebrated.’’

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