The Health Information and Quality Authority ("HIQA") is an independent statutory authority established to promote safety and quality in the provision of health and social care services for the benefit of the health and welfare of the public.
On 21 July 2020, HIQA published a report on the impact of COVID-19 in nursing homes in Ireland.
The Report notes that there are currently 576 registered nursing homes in Ireland, with approximately 32,000 residential places. It notes that 80% of the nursing home beds in the State are privately run.
The Report also notes that there is considerable variation in the type of nursing home accommodation available across the Country with many of the newer nursing homes providing single en-suite bedrooms and ample communal and outdoor spaces for residents. However, some of the older facilities, many operated by the HSE, rely on multi-occupancy rooms (where residents share bedrooms and share toilet and bathroom facilities) with limited communal day space.
The Report notes that while the first confirmed case of COVID-19 in Ireland was on 29 February 2020, the first confirmed case of COVID-19 in a nursing home in Ireland was reported on 13 March 2020.
The Report highlights a number of challenges faced by nursing homes at the early stages of the pandemic in March 2020 including:
- Scarcity of personal protective equipment ("PPE");
- Unavailability of staff due to self-quarantine and self-isolation requirements; and
- Access to testing and confirmation of test results.
While the Report notes that many of the issues encountered in nursing homes have now been resolved, it highlights the need for all nursing homes to meet new physical environment regulations aimed at providing residents with more living space, dignity, comfort and safety, which are due to come into effect from the end of 2021.
The Report also notes that while nursing homes provide nursing care, they are predominantly based on the social care model. Accordingly, the staff in these settings would not have the same knowledge and experience of infection prevention and control as staff in the acute care sector, nor would they have access to the same expertise in this area.
The Chief Inspector of HIQA, noted the following key concerns in the Report:
- The absence of clinical governance in most nursing homes;
- Staffing levels, especially to enable staffing to be organised to care for residents in separate, self-contained groups;
- Maintaining staffing levels in the event of sudden and unplanned absences;
- The availability of resources such as PPE, access to specialist expertise and support;
- The layout of centres and their ability to separate the location of healthy and ill residents or isolate residents as required; and
- The history of non-compliance with relevant key regulations, such as governance and management, premises, personal possessions and infection prevention and control.
In the Report, the Chief Inspector expressed the view that:
"… the impact of the outbreaks of COVID-19 in nursing homes was exacerbated by the absence of senior management on site, as a result of contracting the virus themselves. As such, it was alarming that some registered providers had failed to demonstrate sufficient preparation for such an eventuality."
While the Report considers the practical challenges faced by nursing homes from a risk management perspective, it also highlights the significant impact of social isolation and loneliness on nursing home residents as a result of the cocooning, social distancing and visiting restrictions put in place as a result of the COVID-19 pandemic.
The Report commends nursing home staff for making every effort to comfort residents and ensure that they could receive visitors when it was safe to do so.
The Report also notes what while visiting arrangements, social activities, care practices and the physical environment of nursing homes have changed as a result of the COVID-19 pandemic, all of which are necessary from an infection prevention and control and public health perspective, there must also be a recognition of the negative impact these measures have on residents’ wellbeing and capacity to socialise and engage with the community.
In April 2020, HIQA developed and published a "Regulatory assessment framework of the preparedness of designated centres for older people for a COVID-19 outbreak" and a self-assessment in response to the challenges faced by nursing home in light of COVID-19. These assessments were aimed exclusively at assisting those nursing homes that were as yet free from COVID-19.
There were a total of 189 compliance assessments carried out in 189 nursing homes free of COVID-19 between 29 April and 26 May 2020. It is of note that of the 189 nursing homes assessed, 6% were regarded as being "Not compliant" in terms of staffing and 7% were "Not compliant" in terms of risk management. While overall, 96% of the 189 nursing homes were regarded as "Compliant".
The Report concludes that wider reform of the regulatory framework in this area is now necessary arising from this programme of assessments and continued monitoring of nursing homes during the course of the COVID-19 pandemic. In particular, the Report points to alternative services such as assisted living and homecare which would enhance the experience of many older people in the latter stages of their lives.
In the Report, HIQA also calls for the closer integration of nursing homes into community health programmes, with a particular need for gerontology services and the clinical oversight that this support would provide.
The Report is available to view in full here.
Written by: Sinéad Taaffe,Treasa Walsh and Tom Clarke.
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