'We have been here before – boots on the ground is what is needed in nursing homes'


The coronavirus entered Nightingale nursing home quietly, then struck with force.

Nearly every staff member and resident would become infected.

They needed help, fast, which is why Patricia McGowan, the director of nursing at the Co Galway home, phoned the HSE.

“Their first response to us was, well, get agency staff,” she said of the events of this week.

“We tried to get agency staff. It was part of our contingency plan that if we couldn’t redeploy staff to different shifts, we would get on to agency staff.

“We tried and they just aren’t out there and that’s what we told the HSE.”

When two agency healthcare worker sourced by the HSE didn’t turn up at the long-term care facility on Thursday, it’s response, according to Ms McGowan, was “don’t panic, leave it with me”.

“We don’t have that luxury, we can’t leave it with them,” she said. “We are looking after vulnerable people who have Covid-19. We need help to keep them alive.”

The first case had been detected when a resident attended Portiuncula hospital after falling ill.

A test there detected the infection. Subsequent screening of all staff and residents revealed that 14 staff and 26 out of 28 residents tested positive.

One resident died on Wednesday and by Thursday a further two were gravely ill and had to be admitted to hospital.

On the same day, the two agency support staff failed to show up and Ms McGowan took to the airwaves on RTÉ’s Liveline begging for help.

“It was a crisis situation at that point,” said Dr Martin Daly, a local GP who cares for some of the residents.

“The staff were overwhelmed, in desperation and crying out for assistance.”

The situation that unfolded in Nightingale during the week, said Nursing Homes Ireland chief executive Tadgh Daly, “came as a shock”.

“It was disturbing to hear that level of distress and I know how much worry it creates for residents and families,” he said.

“What’s important, as community transmission rates increase, is that homes needed consistent and constant support from public health teams and local HSE teams.

“What we have to do now is make sure the tragedy that we saw in March in April is not repeated. That’s a responsibility on everybody.”

As a rash of new infections seeps back into long-term care homes, there are fears the frantic scenes in Nightingale will become more frequent.

Despite promises to protect the vulnerable this time around, Covid-19 is shifting, from the highest case numbers in the 20-39 age group over the summer to increasing cases in older people.

On Thursday, chief medical officer Dr Tony Holohan warned nursing homes cannot be protected from outbreaks unless the public comes together to bring down rising levels of community transmissions.

Few places represent the awful consequences of the first wave of Covid-19 more than nursing homes.

Of the country’s nearly 1,900 coronavirus deaths, 60pc have been residents of nursing homes and long-term-care facilities.

“During the first wave the surge came in the nursing homes and that’s where the deaths occurred,” said Prof Jack Lambert, professor of medicine and infectious diseases at Dublin’s Mater Hospital.

“We have done a good job of controlling the nursing homes this time but there are outbreaks occurring, unfortunately, because people let down their guard.

“You have to go back to the basics. Are hands being washed? Are masks being worn? Are staff adhering to infection control protocols? If we let these things slip, the virus finds a way in.”

At present there are more than 33 open outbreaks in nursing homes, with reports emerging yesterday that Moate Nursing Home in Westmeath has 11 residents and four staff who have tested positive for the virus.

In relation to Nightingale, HSE officials insisted rosters at the facility were covered for the next three days and specialist support was being provided.

However, the incident raised alarm bells about staffing levels across an increasingly strained health service.

“The whole health service is struggling with staffing,” said Mr Daly. “But the point we would make is that despite all those challenges – and there are challenges for everyone involved – we need to prioritise.

“Any nursing home and hospital needs to be prioritised in terms of staffing, and deployment of whatever resources that are there needs to be focused on those areas.”

Nursing Homes Ireland, said Mr Daly, had been fielding calls all week from members expressing concern about losing healthcare workers to contact tracing and community swabbing.

“Look, people move jobs for a variety of reasons,” he said. “They move from private to public and vice versa.

“What we would be saying is that in a national emergency during a global pandemic, the recruitment of people who are already engaged and working in the front line shouldn’t be countenanced. By all means in six months’ time when we are out the other side of this, but people who are already on the front line should be left where they are in my mind.”

Concerns over staffing levels and allegations of poaching of nursing home staff were raised during the first wave. Several months on, it’s a case of déjà vu said Prof Lambert.

“We have been here before,” he said. “Boots on the ground is what is needed.”

A HSE spokesperson insisted: “The HSE does not want to deplete any health services employees in the private or public sector and is not targeting staff from nursing homes.”

Much has been learned since the first wave hit nursing homes.

Serial testing, which detected cases among staff in a Donegal nursing home recently, is helping identify asymptomatic cases.

PPE supplies are good, say nursing home operators, and staff have a greater of understanding of how the virus operates.

Problems emerge, it seems, once a facility goes into crisis mode.

If situations like the one in Nightingale are to become part of dealing with the latest wave of Covid-19, drawing on the expertise of agencies outside the HSE may need to be considered.

“Perhaps the concern might be that it might reflect badly on the HSE and be seen as some sort of failing,” said Dr Daly.

“But in fairness to the HSE, it’s facing an unprecedented demand on resources too.

“I really think there should be some sort of emergency protocol to go to a nursing home in a situation where the have extended all of their resources in looking after their residents.

“This is an unprecedented challenge, and no one could have envisaged the level of care and the volume of care that would be required to give to what was 95pc of residents in Nightingale.

“I think it does behold the Department of Health, the HSE and the State to come up with some sort of emergency planning, which might include not just nurse and healthcare workers, but chefs and cleaners.

“Perhaps there is a role for the Defence Forces, who have responded in other jurisdictions where there have been famine and disease outbreaks. Given what is happening it should be considered.”

Source: Irish News