At a meeting of the Dáil’s special Covid-19 committee on Tuesday, TDs heard that while the coronavirus pandemic took hold across Irish society, nursing homes were left without a timely plan.
Key State organisations left the sector "isolated", the committee heard. The head of Nursing Homes Ireland (NHI) Tadhg Daly said he was left "exasperated by the lack of engagement".
Documentation running to hundreds of pages now paints a picture of a sector struggling to be heard behind the scenes.
A timeline of unfolding events suggests that it took more than a month for a specific plan to be put in place by which stage there were 22 outbreaks in nursing homes.
February 28th
NHI head Tadhg Daly writes to senior officials in the Department of Health seeking "urgent" guidance for the sector after the first confirmed case of coronavirus on the island of Ireland.
On February 27th, a HSE briefing heard that there is an “adequate stock” of personal protective equipment. In his letter to officials, Mr Daly says he notes the statement from the HSE but he says “this is not the case for our member homes”.
March 4th
Daly again writes to senior officials in the Department of Health and asks for an "express commitment" that the needs of the private and voluntary nursing home sector are addressed by the National Public Health Emergency Team (NPHET). The department says the sector will be "encompassed" within the scope of the work of a team assessing the needs of vulnerable people. A Dáil debate on the Covid-19 crisis is held the next day, there are only two specific references to nursing homes.
March 6th
Daly tells the HSE about “increasing queries from members” about “safe and appropriate discharges from acute hospitals to nursing homes”. He says there is an “immediate requirement on the HSE to outline the procedures for discharge”. He says that communication is important or “this may get out of control”. That day, visiting restrictions are introduced in more than 400 private and voluntary nursing homes across the country. A meeting of NPHET is held the next day. Nursing homes are not discussed.
March 9th
Daly writes to the secretary general of the Department of Health Jim Breslin and Minister for Health Simon Harris raising concerns that workers from the nursing homes sector are being recruited to tackle Covid-19 elsewhere in the health service. This would be at the "severe detriment" of people in the nursing home sector and could "endanger older people". On the same day, Daly again asks the department for guidance on admissions from hospitals.
March 10th
Guidance on the transfer of patients between healthcare facilities is issued but by March 12th, NHI calls for more stringent measures, clarity around PPE and raises concerns about contingency arrangements should staff become ill. Daly says that there is "no specific practical guidance" for nursing homes on places such as the HSPC website. Publicly, chief medical officer Tony Holohan says restrictions on nursing home visits are not yet necessary. This is reiterated at a meeting of the NPHET on March 10th where "it was agreed that the current practice of restricting visitors to nursing homes was not required and this would be kept under review".
March 12th
After an announcement that schools and colleges will close, Daly seeks clarity from the department about how nursing homes will maintain staffing levels. The NPHET meets again but there is no mention of nursing homes, staffing or visiting restrictions.
March 13th
In a letter to Kathleen McLellan, the chair of the vulnerable person’s sub-group on NPHET, Daly says the recently issued HSE guidance contains “no practical guidance to nursing homes on how to reduce the risk of transmission” and says “no information” has been provided in relation to personal protective equipment.
“We are receiving constant queries from nursing homes with regard to how they can access such equipment and no assurance is coming from our health services in this regard.” He requests “immediate engagement”. He is told by McLellan that “work is going” on guidance. Pharmacists are told on this day that they will be given PPE but that stock is “limited”.
March 15th
NHI reports to health officials that its members still cannot get access to PPE. Pubs are closed on this day. At a meeting the next day, the NPHET talks about the need for social distancing in playgrounds and hairdressers. Concerns about nursing homes and personal protective equipment are not discussed.
March 17th
Daly writes to Harris with a plea for the Minister to desist from “targeting the recruitment of staff from the private and voluntary nursing home sector”.
March 18th
While Daly praises the “round the clock” engagement, he says there are “pressing issues”. He says there are now confirmed cases of Covid-19 among nursing home residents and yet the provision of PPE is “challenging to say the least”.
Delays in testing also have “cataclysmic consequences”. He requests a urgent meeting with the department and the next day also requests an urgent meeting in a email to the Minister for Health. On this day, Harris tells the public that while some countries choose not to prioritise testing, Ireland will “test, test, test”. He says “older people should not be worried – it is an uncertain time, but we are going to mind you”.
March 24th
NHI makes a submission on funding needed for the sector and again requests a meeting with Harris. Two days later in the Dáil, Labour’s Duncan Smith says he has heard of frontline nursing staff having to wash PPE in sinks and baths for reuse. The NPHET meets on March 24th and agrees sweeping new restrictions across society. Nursing homes are not discussed.
March 30th
A meeting is held between the nursing home representatives and Harris on March 30th. The next day the NPHET meets and agrees “that the growing number of clusters of Covid-19 infections in nursing homes and residential healthcare settings... requires an immediate and targeted focus”. On this day, it emerges that a total of 22 outbreaks of coronavirus have been reported in nursing homes across the State.
