Staff in nursing homes should be prevented from working across multiple sites, an expert report has recommended.
The wide-ranging report into nursing homes also stated that adequate single-site employment contracts should be put in place to support this.
The Covid-19 Nursing Homes Expert Panel also recommended that all new residents are tested for Covid-19 before their admission, and that all nursing homes should prove a sufficient standard of infection control measures.
As part of the plan to improve nursing homes, it has also been recommended that infection control training should be mandatory for all grades of nursing home staff.
The four-person expert panel, formed in May this year, published a total of 86 recommendations across 15 different themes in the report.
Each nursing home is responsible for and should have an emergency supply of personal protective equipment (PPE) and other Covid-19 related equipment in the event of a cluster, the report added.
Minister for Health Stephen Donnelly described the report as “200 pages of wisdom”.
He said the impact of Covid-19 has been “utterly devastating” for those living and working in nursing homes.
200 pages of wisdomMinister for Health Stephen Donnelly
More than half of Covid-19 deaths in Ireland have been nursing home residents.
“Many residents didn’t have visitors for months, families had to watch and try and communicate with their loved ones through windows,” Mr Donnelly added.
“The panel’s recommendations recognise that systemic reform in the delivery of care for older persons is needed.”
The panel visited three nursing homes and spoke to a number of residents and their families for the report.
Professor Cecily Kelleher, chair of the panel, said there are “key questions” around representation and advocacy of older people.
“A large part of this report is planning for future care for older people,” she added.
“It was clear that healthcare staff worked tirelessly for the residents and all parties require supports and this includes terms and conditions in work, issues around occupational health and other supports, and psychological support and issues around bereavement.
“The recommendations reflect systemic reform is needed into how care is delivered.
“We have found there is no firm definition of the skill mix required in the nursing and therefore the framework for safe staffing and skill mix needs to be prioritised and urgently developed to apply across all nursing homes.
“We know older people have suffered the most. We talk about centenary and the fact that we have 100 years of the State of the Republic of Ireland, many of the people affected by this were the citizens and taxpayers who helped to create this State.
GPs, along with their colleagues in public health, community geriatricians and nursing home staff, have provided an exceptional service to vulnerable patients despite the challenges posed by the Covid-19 crisisDr Denis McCauley, IMO
“We owe it to them now to have a healthcare system that is fit for the 21st century.”
Professor Cillian Twomey said: “I don’t think we can overstate and exaggerate the extent to which relatives, residents and staff have been through the mill.
“The nursing home sector is familiar with people dying, it’s a fact of life, but they were completely unprepared for the volume of death that occurred.
“The nursing home I visited, what really hit home was in the space of a 12-hour period, three people died. In the next 12 hours another two died. This does not happen and for the professional staff, it was utterly shocking.
“If there is anything that we learn from the last number of months that we should take seriously, it is that we must never allow the system to go back to where it was in those days.”
The Irish Medical Organisation (IMO) welcomed the publication, saying that a new framework is required for the medical care of patients in nursing homes.
Dr Denis McCauley, chairman of the GP committee of the IMO, said: “We welcome the expert panel’s acknowledgement of the vital need to recruit more GPs, address longstanding capacity issues, and empower GPs to work more effectively in the community and in nursing homes.
“GPs, along with their colleagues in public health, community geriatricians and nursing home staff, have provided an exceptional service to vulnerable patients despite the challenges posed by the Covid-19 crisis.
“However, it must be noted that the system for the provision of medical care for nursing home patients was not adequate prior to Covid-19 and was made all the more challenging by the impact of the pandemic.”
Alone, the organisation which supports older people, said it welcomed the report but added that it would like to see “immediate action” to safeguard thousands of vulnerable older people.