Urgent questions about the devastation Covid-19 has caused in nursing homes

In January alone, 369 nursing home residents died as a result of Covid-19. This brought the overall number of Covid-19-related deaths in the sector to 1,543 people.

Despite the introduction of the vaccination programme to nursing homes, this figure will continue to rise over the short-term at least.
Speaking before the Joint Oireachtas health committee on 2 February, health officials admitted there had been a five-fold increase in the number of outbreaks in the sector from the middle of December to the end of January. At the time of writing, there were 193 outbreaks in nursing homes across Ireland.

Even before the current surge, the pandemic had devastated nursing homes. While the response of the State to the early days of the Covid-19 crisis was widely positive, the failure to limit the spread of the virus in residential settings for older people drew strong criticism.

There have already been reports published on the issue. The nursing homes expert panel published a document in August containing recommendations on what needs to change in order to better safeguard older people in long-term residential care facilities. At the recent health committee meeting, Assistant Secretary at the Department of Health Dr Kathleen MacLellan said a second progress report is being finalised and “early progress” has been made on the recommendations.

She pointed to the additional funding allocation for the provision of integrated infection prevention and control, which has been made to the HSE. There has been advanced planning for testing the safe staffing framework. Additional inspectorate staff for HIQA was sanctioned to support increased frequency of inspections, while serial Covid-19 testing has also been rolled out.

Last October, the special Dáil committee on Covid-19 recommended a public inquiry into Covid-19 deaths in nursing homes. In its final report, the committee said despite devoting more meeting time to this single issue than to any other, it was “unable to get satisfactory answers” as to why such a high number of residents of nursing homes died after they contracted Covid-19.

The committee noted the focus on preparing acute hospitals for the oncoming pandemic in February and March 2020 meant there was a failure to recognise the level of risk posed to those in nursing homes.

It recommended that an inquiry should examine the discharge of patients from acute hospitals to nursing homes at the beginning of March. Other issues to be included in the inquiry were staffing difficulties and a shortage of personal protective equipment in nursing homes, and the recommendation by the national public health emergency team on 10 March that visitor restrictions to nursing homes were premature.

Any such inquiry would now have to account for the recent wave of deaths throughout the sector. This is not a crisis of the past, but one
that is still being experienced by nursing homes across the country. The decision to reopen the country before Christmas and the greater transmissibility of the new variants are both factors that have led to the current crisis. But they are not the only reasons.

The vaccination programme is being rolled out across residential settings, which will hopefully succeed in protecting residents from the devastating effects of the virus. But the programme should not distract us from asking why more safeguards were not put in place before this surge of Covid-19.