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Families need answers from nursing homes on relatives’ final days, expert says

Brigid Doherty, a member of the expert panel on nursing homes, gave evidence to an Oireachtas committee.

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Brigid Doherty, a member of the expert panel on nursing homes, said the lack of information about residents’ deaths has been frustrating for families (Oireachtas TV/PA)

Brigid Doherty, a member of the expert panel on nursing homes, said the lack of information about residents’ deaths has been frustrating for families (Oireachtas TV/PA)

Brigid Doherty, a member of the expert panel on nursing homes, said the lack of information about residents’ deaths has been frustrating for families (Oireachtas TV/PA)

Families whose loved ones died in care homes during the coronavirus pandemic cannot grieve until they get answers about their final days, an Oireachtas committee has heard.

Brigid Doherty, a member of the expert panel on nursing homes, said the “lack” of information about residents’ deaths has been frustrating for families.

She told the Special Committee on Covid-19 Response that there is a “huge gap” in information on how care was provided in the final weeks and days of care home residents’ lives.

Ms Doherty warned that the huge issue will have implications for the grieving process.

Ms Doherty is a member of the expert panel which made 86 recommendations on Covid-19 and nursing homes. The report was published last month.

She also called for an independent advocacy service to investigate complaints or issues raised about nursing homes.

We need to keep an eye on these recommendations and make sure that those recommendations are implementedDavid Cullinane

The committee was told that any complaint regarding care in a nursing home is dealt with by the home, which Ms Doherty said was not “very satisfactory” for families.

“The HSE safeguarding services does not have the legislative authority to investigate complaints in private nursing homes,” Ms Doherty told the committee.

“Residents in nursing homes do not have that support as they would do if they were in hospital or at home.

“We do need an independent advocacy service for nursing homes and I understand that is being explored, but we need a process of investigation that is independent of the nursing home provider, whether that is private or public.

“The lack of information is frustrating for families, Covid has highlighted this even more, it has brought it to the fore because families were not able able to visit residents.

“People will not begin to grieve for their relatives until they get the answers.”

Chairman of the expert panel, Professor Cecily Kelleher, said its recommendations reflect that systematic reform is needed in the way care is delivered in the future.

This and other issues that arose during the crisis lay the basis for the disaster. Brid Smith

He added: “It was clear from a range of stakeholders that healthcare staff worked tirelessly for the residents and all parties, including carer staff, now require a range of supports.

“Great value was placed on the services stood up to cope, especially Covid-19 Response Teams.

“These supports must be sustained and regularised over the next 18 months. This is a multi-factorial challenge and we must be action driven.”

Sinn Fein’s David Cullinane said the report needs to be reviewed “on a regular basis” by the health committee, when it is established.

“We need to keep an eye on these recommendations and make sure that those recommendations are implemented,” Mr Cullinane added.

“Can I propose that in our final report that is one of the recommendations that we make? This can’t be a report that sits on the shelf or that is cherry picked. We have to really get under the bonnet of it.”

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Signs in relation to Covid-19 at the entrance to a nursing home in Dublin (Brian Lawless/PA)

Signs in relation to Covid-19 at the entrance to a nursing home in Dublin (Brian Lawless/PA)

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Signs in relation to Covid-19 at the entrance to a nursing home in Dublin (Brian Lawless/PA)

Ms Doherty also told the committee there is an issue around staffing levels in care homes as there is no statutory requirement for the number of staff or the skill mix in nursing homes at any one time.

“HIQA (Health Information and Quality Authority) do not have powers, and regulations say it is down to the (care) provider to state the level of staff. That needs to change,” she added.

“The Department of Health is commencing the framework for safe staffing and skill mix – it is crucial that happens sooner rather than later, otherwise it’s very difficult to assess whether or not there is an appropriate level of staff.”

Meanwhile in a separate sitting of the committee, Roisin Shortall, co-leader of the Social Democrats, said the report identified low-paid care staff who were often living in poor quality accommodation and overcrowded settings.

She added: “Given the growth of the virus in Dublin and potential impact on nursing homes, what exactly is happening with that issue on unsatisfactory housing conditions because it seems that is the source of much of the spread of infection?”

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Dr Kathleen MacLellan, Assistant Secretary, Department of Health.Picture is sreenshot from Oireachtas/TV.

Dr Kathleen MacLellan, Assistant Secretary, Department of Health.Picture is sreenshot from Oireachtas/TV.

Dr Kathleen MacLellan, Assistant Secretary, Department of Health.Picture is sreenshot from Oireachtas/TV.

Sandra Tuohy, assistant national director at the Services for Older People, said the HSE has been providing private hotel accommodation for staff who need to self-isolate.

She said there are hundreds of care home staff who are using the accommodation.

Ms Shortall added: “That and so many other issues arising from the recommendations underline the totally precarious nature of the funding model for nursing home care.

“It is so delicately calibrated to maximise profit, on the one hand for a return on investment and then to limit the financial exposure for the State.

“Neither of which have to do with care for older people.”

It also emerged during the committee that more than 4,500 people who have been approved for home care are still on waiting lists.

Ms Tuohy said she hopes to have the waiting list cleared by the end of October.

Solidarity-People Before Profit TD Brid Smith said: “I firmly believe that the key issue is not the cause of the policy that worsened the impact of Covid-19 on our nursing homes, it was the decision taken in the 1990s to contract out the care of our elderly to private for-profit nursing homes.

“I believe some of the points made by the panel backs up that view.

“The fact that 80% of all beds are in the private sector and that in that sector we see long hours of work, precarious employment, low pay as well as a skills shortage and a push to cut costs, that’s why we saw the early restrictions on the use of PPE.

“This and other issues that arose during the crisis lay the basis for the disaster.”

Dr Kathleen MacLellan, assistant secretary at the Department of Health, said they are “unfortunately” seeing a gradual change in the epidemiological situation and nursing homes have “not remained unaffected”.

“Since the start of pandemic and as of 10th September 2020 there have 281 clusters in nursing homes,” she added.

“Over 85% of these clusters are now closed with 39 remaining as open clusters. The open clusters are in areas of high community Covid-19 transmission – 27 in the east of the country, 10 in the Mid-west and two in the North East.”

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