‘People are dying’ – private nursing homes’ plea for State help

Two of the nursing homes worst hit by coronavirus appealed directly to then minister for health Simon Harris for help as they fought severe Covid-19 outbreaks in March and April.

The private homes – Tara Winthrop in Swords, Co Dublin and Dealgan House in Dundalk, Co Louth – struggled to cope with outbreaks prompting them to make desperate, late-night pleas for help.

Newly released emails show the depth of the crisis in some nursing homes, the sector most affected by the Covid-19 pandemic accounting for 985 or 56 per cent of the 1,738 Covid-19 deaths.

Joe O'Donovan, chief executive of Tara Winthrop, one of the first nursing homes in Ireland to experience a Covid-19 outbreak, told senior State health officials on the weekend of March 20th-21st the facility "cannot contain the outbreak without support directly on our units" and management at the nursing home "no longer have the resources to manage the outbreak".

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The situation reached crisis point at Dealgan House over the Easter weekend in April, when a director warned in an email to the HSE that if the home’s residents were to have “a fighting chance of survival, the home needs to be virtually turned into a hospital”.

Both homes recorded multiple cases of coronavirus and deaths related to the disease, running to more than 20 confirmed or suspected Covid-19 deaths at each care facility.

A quarter of the residents at Dealgan House died.

The appeals for help are contained in emails released by health service regulator, Health and Information Quality Authority (HIQA), to The Irish Times under the Freedom of Information (FoI) Act. The records were redacted of information identifying individuals and the homes. This newspaper has independently established the identity of the homes and the individuals in the correspondence.

Covid-19 swept through Tara Winthrop three weeks before Dealgan House.

‘Immediate threat’

In an email sent at 11.15pm on Friday, March 20th, to HSE officials, Mr O’Donovan said the large Swords home needed an additional 12 staff the following day to cover symptomatic staff calling in sick and 11 staff to cover the shortfall on the Sunday.

“I cannot highlight enough the immediate threat…at the home from Covid-19,” he wrote.

In addition to the extra staff, Mr O’Donovan appealed for personal protective equipment (PPE), the results of swab tests, swabs for further tests and “one single contact in public health”.

He warned that without further supplies of PPE, the home would breach minimum requirements “of the most recent HSE guidance note on PPE”.

He had not received a response by the following day so he escalated his concerns.

At 1.53pm that Saturday, he forwarded his previous night's email to the same recipients and this time copied the then minister for health and other Department of Health and HSE senior officials.

The situation at the north Co Dublin home “continues to get more serious by the hour” with more staff out sick, he said.

Mr O'Donovan referred to a newspaper article published that day reporting then taoiseach Leo Varadkar telling a private Fine Gael parliamentary party meeting that in Italy nursing homes residents were not going to the hospital when Covid-19 hit but to the morgue, and that Mr Varadkar did not want that to happen here.

“It has and is happening,” Mr O’Donovan wrote in his email that Saturday afternoon.

He said: “I need the following now: acknowledgment of receipt of email, one senior point of contact in public health has decision-making authority; [and] immediate staffing support for carers, nurses, cleaners and catering.”

Mr O’Donovan signed off, saying: “Again, I appeal for your immediate attention to this critical situation for a high-risk vulnerable group.”

At 5.40pm, he sent a follow-up email expressing relief that “six personnel” had arrived to help and these were “crucial to us containing the outbreak and protecting the residents”.

“We no longer feel unheard and unsupported,” he wrote.

In a call with a Tara Winthrop staff member the following week, Hiqa noted that it was told that the number of staff calling in sick was increasing daily to the point that the Swords nursing home was “considering asking relatives to come and assist with caring” for the residents they were related to.

The crisis was just as grave at Dealgan House when it hit three weeks later, at the Easter weekend.

Direct appeal

Fintan Farrelly, one of the home's owners, emailed the State's chief medical officer Dr Tony Holohan late on April 11th saying he would not normally make a request "through this channel" but "as it is Easter Saturday and the situation is so urgent, I'm appealing directly to you".

“In our nursing home, people are dying and we are struggling terribly with staff absences. Many of these staff were tested weeks ago and have had no result,” he wrote.

The privately owned nursing home did not know which residents were infected until they had symptoms and that “in a number of cases, the residents have passed away within hours of showing the first symptoms”, he said.

They “desperately” needed mass testing of all staff and residents with next-day results, he told Dr Holohan, “so that we can get a clear picture of the situation and get the outbreak under control”.

Mr Farrelly alerted Mr Harris to his concerns the next day, telling the then minister for health in an email at 8.47pm on Easter Sunday that the nursing home required extra nurses from the HSE to work day and night shifts.

“I fear that when the history of Ireland’s Covid-19 pandemic is written, the failure to adequately support nursing homes during the month of March and up to the current time, will have resulted in multiple avoidable deaths and will be identified as the greatest tragedy of the pandemic,” he wrote.

“We are said to be ‘all in this together’ but we feel strongly that Ireland’s most vulnerable and concentrated group, the over 25,000 residents of our nursing homes, have been and continue to be neglected by your department and the HSE. We cherish our elderly people and feel they are being badly let down by the State.”

The staff had been “decimated”, he wrote, and said some who were self-isolating had not received test results, so they could in fact be “unnecessarily absent from work, thus exacerbating desperate staff shortage”.

“It was not our experience that healthcare workers were prioritised for testing and it appears that prioritisation only applied to the HSE,” he wrote.

Mr Farrelly said the home was desperately short of nurses “and on occasion have only had one nurse on night duty, dealing with 80 residents, some of whom are very ill”.

“Our experience is that the support promised from the HSE is not forthcoming and I ask you why not?” he said in his email to the minister.

‘Dire straits’

Mr Farrelly said he was “very disturbed” to hear that while Dealgan was “in dire straits and our residents are dying” a local hospital in Co Louth was “practically empty of patients and is fully staffed” and nurses were told to take leave “due to an insufficient workload” and “will be called if necessary”.

“This beggars belief!” he wrote.

On Monday, April 13th, Mr Farrelly emailed a HSE official with a long list of what the home required, including nurses and healthcare workers.

Dealgan’s residents “deserve a chance to fight this virus” at the home, he said, and the only alternative was to sent them to a local hospital.

“This is not our wish nor that of families, nor I’m sure that of the HSE,” he wrote.

Four days later, the Royal College of Surgeons in Ireland (RCSI) Hospitals Group stepped in and temporarily took over the management of the Co Louth nursing home.

A spokesman for Dealgan House said this week the Covid-19 outbreak was closed and they had not had a new outbreak since May. The 84-bed capacity home had 22 Covid-19 deaths.

Tara Winthrop said on Wednesday that it had 18 confirmed and five suspected Covid deaths at the facility, which has 140 beds.

A spokesman for the home said a further five asymptomatic staff tested positive two weeks ago as part of the HSE’s weekly testing of all nursing home staff but they had isolated, recovered and returned to work. All residents subsequently tested negative, he added.

The spokesman said close liaison with Mr Harris, his department and the HSE from March “enabled learnings from this experience to inform and improve the measures taken subsequently to help cope with outbreaks across the nursing home sector”.

He said the Swords nursing home was “working tirelessly to protect the residents and the staff and continue to work, on a daily basis, with the experts in the HSE, Department of Health and Hiqa to fight this virus”.