Covid and non-Covid dementia residents shared room at care facility

The Health Service Executive allowed coronavirus-infected residents with dementia in a Co Cork care home to share the same room with residents not infected with Covid-19, newly released records reveal.

Emails between the HSE and the health watchdog, the Health Information and Quality Authority (Hiqa), show the regulator twice raised concerns in April about Covid and non-Covid residents with dementia sharing a multi-occupancy room at Clonakilty Community Hospital, which is run by the HSE.

Two weeks after the regulator first raised concerns on April 17th, the HSE admitted there were residents with no symptoms in the same room as residents who were “positive or suspected positive”.

The HSE's chief officer in the Cork-Kerry area, Ger Reaney, replied by letter on May 1st saying the residents in the shared room had dementia and "it has not been possible to appropriately accommodate them elsewhere while maintaining infection control".

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The correspondence, which had identifying information on individuals and the homes redacted, was released by HIQA to The Irish Times following a request made under the Freedom of Information (FoI) Act. This newspaper has independently established the identity of the homes and the individuals in the correspondence.

The west Cork facility, which last year had 43 residents with dementia out of 103 living at the home, was among more than 400 care facilities that had to battle outbreak of coronavirus.

The HSE confirmed that 10 residents at Clonakilty Community Hospital died during the outbreak of the virus.

Hiqa contacted the HSE on April 17th after receiving unsolicited information from a concerned relative that the health service was not implementing infection-prevention control guidelines in managing Covid-19 outbreaks in residential care facilities.

Multi-occupancy room

Susan Cliffe, Hiqa's deputy chief inspector, wrote to Mr Reaney raising concerns about accommodating residents that had not yet tested positive for Covid-19 and Covid-positive residents in the same multi-occupancy room.

“This puts vulnerable residents at serious risk of contracting the virus,” she wrote.

She said where the single-room capacity of a care facility was exceeded and it was “necessary to cohort residents in a multi-occupancy room”, only residents diagnosed with Covid-19 could be “cohorted together” and probable Covid-19 cases should not share with them.

“The risk of cohorting probable cases in multi-occupancy areas is much greater than that of cohorting confirmed positive residents together, as the suspect cohort is likely to include residents with and without Covid-19,” she wrote.

She asked that the HSE set out within three days the risk assessment undertaken and what action was being taken to protect residents “who have not yet contracted Covid-19”.

In the absence of detailed response beyond “holding emails”, Ms Cliffe wrote to the HSE again on April 27th saying she remained concerned about the situation at the care facility.

“This situation continues to put vulnerable residents at risk,” she said.

Mr Reaney, in his May 1st reply, told Ms Cliffe that an outbreak control team was managing the home and “every opportunity to cohort patients in line with the guidelines was followed, along with reducing beds and maximising use of [a] limited number of single rooms”.

‘Safe option’

He told her that “managing an outbreak was a fluid situation” and that the health service “made optimal use of the option of cohorting cases within the limitations of available rooms”.

A consultant geriatrician visited on April 17th and 24th and confirmed Covid-positive residents were being managed “in line with best practice and that no different action was recommended”.

He rejected a suggestion of “assigning residents of different gender with dementia in the same room”, saying it was not considered a “safe option”.

The 129-bed Clonakilty Community Hospital was one of 19 publicly funded community and nursing home facilities that Hiqa warned the HSE and the Department of Health in mid-March about being "centres of concern" and at "high risk" for the spread of Covid-19 due to the multi-occupancy rooms and shared facilities.

The HSE’s Cork Kerry Community Health said in a statement yesterday that from the first confirmed case of Covid-19 at Clonakilty on April 5th a consultant geriatrician, a public health consultant and the infection and prevention control team regularly visited to provide expert advice.

“Their expert advice and guidance was followed at all times,” the HSE said.

It described the outbreak as “an extremely difficult time for residents, for their families, for the community and for the staff caring for the residents” and that the hospital “continued to provide both compassionate and high quality care to all residents at all times.”

“At all times, every possible precaution was taken to keep residents and staff safe,” it said.

The statement said that management of the outbreak included “cohorting” which involved keeping residents with Covid-19 or suspected of having Covid-19 separate from other residents.

“This worked well and was key to containing the outbreak,” the HSE said.

“It is not possible to give a full breakdown of each resident’s location on particular dates, but at all times the advice of the consultants in public health and geriatrics who were engaged in the outbreak control team and on site was followed,” said the health service said.

The HSE said that “significant extra supports” were “quickly put in place” to support staff, including additional staff being redeployed to the community hospital, experienced nurses coming in from hospitals in Cork and Kerry, and clinical support from hospitals in the south west.