‘Limited’ capacity to deploy geriatricians and IPC clinicians to nursing homes

Limited capacity to deploy geriatricians and infection prevention and control (IPC) clinicians to respond to Covid-19 outbreaks in nursing homes was discussed at the 6 October meeting of the HSE national crisis management team (NCMT).

The meeting heard of seven outbreaks in nursing homes that were “of concern and being monitored”. Three outbreaks were of “particular significance and HSE are providing support (IPC advice, geriatrician advice)”.

“HSE pinch point is the lack of capacity for geriatricians and IPC clinicians to respond, its manageable at the minute but there is limited capacity for HSE to deploy ‘boots on the ground’ in those specialties,” continued the minutes, obtained by the Medical Independent (MI) following a Freedom of Information request.

An NCMT meeting later that month, on 20 October, heard that the “increasing” level of nursing home outbreaks was “concerning”.

Reference was made to concerns about the capacity to staff nursing homes where their own employees were self-isolating.

“There are clear indications that agency staff are unwilling to go into LTRC [long-term residential care] settings if they are known to be Covid positive. HSE staffing banks across acutes and community (as established previously) may be required again.”

 At a meeting on 22 September, LTCFs were described as “high priority and are being monitored closely”.

“Covid response teams are proactively engaging with the nursing home sector. Correspondence is due to issue today to NHI [Nursing Homes Ireland] and HIQA advising them of the HSE supports that are available such as IPC advice. Some tensions remain around the role of the HSE in private nursing home facilities as the HSE have no statutory functions or powers specific to this sector.”

At a NCMT meeting on 15 September, it was noted NHI had employed Consultant Geriatrician Prof Dermot Power as a Clinical Lead. This was described as a “step along the way in improving overall clinical governance within this sector. The connections established between the HSE and nursing homes remain in place and HSE have outreach teams who can assist with advice from geriatricians and microbiologists.”

During the meeting, CEO Mr Paul Reid requested that acute operations “remain vigilant in monitoring the current situation and provide geriatric supports where required at the earliest possible point”.

The meeting minutes also referred to “issues” having arisen regarding the willingness of some nursing home staff to continue participation in ongoing testing. “This has been raised with Directors of Nursing,” according to the minutes.