Despite providing specialised care to thousands in communities across the country, private and voluntary nursing homes have been outliers in our health service for many years.
For years, the sector, through NHI, has advanced to successive health ministers and governments that the State is failing the care needs of residents in private and voluntary nursing homes.
Sadly, it has taken the national tragedy of COVID-19 for the State to seriously assess the role of nursing home care within our health services.
‘Integration with, and oversight from, the wider healthcare sector was strongly advocated for by many of the respondents,’ the Covid-19 Expert Panel presented to Government. It recommended greater integration of nursing homes at HSE Community
Healthcare Organisation level be fulfilled within 18 months.
A list of warnings has gone unheeded. A series of reports stated the Fair Deal scheme is not fit for purpose, with fees not commensurate with costs to provide 24/7 specialised care to residents. The State has turned a blind eye.
Last August, the independent regulator of nursing homes highlighted discriminatory practice.
‘Residents of centres for older people should not be in any way disadvantaged by virtue of living in a nursing home, and services they could have availed of free of charge in the community should equally be available to them on moving to live in a nursing home,’ Hiqa stated.
‘The chief inspector has raised this issue at a national level with the HSE and also informed officials in the Department of Health.’
It was not raising a new issue. Six years previously, health policy analyst Sara Burke delivered a disconcerting report on national radio. She revealed an unpublished HSE audit had found the vast majority of nursing home residents did not have access to public health services, despite their right to such.
She reported ‘a hierarchy of access’, saying: ‘If one is a medical card holder in a private nursing home, one may or may not access HSE provided services.’
The 450 private and voluntary nursing homes provide highly specialised care to 25,000 people with high-dependency, multiple healthcare needs.
On Friday, we published the findings from a consultative process undertaken of NHI member nursing homes regarding learnings from COVID-19. It reiterated the desire within the sector to achieve greater integration in our health services. As we learn harsh lessons from COVID-19, this must become a health service priority.
The country is now on a precipice. Our nursing homes are better supported to manage COVID-19. A new relationship with day-to-day engagement with local public health teams is in place. Access to PPE is satisfactory and serial testing is being undertaken.
However, pressure points present.
Staffing is the key challenge. There is a shortage of healthcare staff across the health service, acute and community. Nursing homes are losing valuable staff to the HSE.
The backdrop is private and voluntary nursing homes are ultimately funded by the State through the Fair Deal scheme, with the fees payable for residents availing of specialised care in these homes a national average 66% below those payable to HSE counterparts.
It is a remnant of the long-standing legacy whereby the State, through the NTPF, fails to have in place a funding model that appropriately assesses and encompasses the reality of care costs, staffing and beyond, to provide nursing home care.
Analyses of the scheme independent of NHI inform of such, with the recent damning report by the Comptroller and Auditor General the latest exposé.
Yet governments have kept our sector at arms-length. COVID-19 shone a spotlight that compelled the State to take a more serious look at the supports required. The virus is no less lethal now than in March.
We know that within hours it can move from person to person in residential settings where people are in relatively close proximity. Continued focus on the sector through engagement between Government, department, public health officials and NHI must continue. The critical supports for our sector are short- and medium-term.
We reiterate our call for the HSE and its agencies to desist targeting workers from the sector. Loss of key staff has a critical impact in respect of loss of expertise and continuity of care. A unified approach is required for COVID-19.
We absolutely respect the right to change employment, but targeting staff for immediate transfer must desist and we require a pause as we move into winter with COVID-19 threatening the lives of residents.
The provision of data is vital in engagement between the State health authorities – the HSE – and nursing homes. There is need for constant updates on the COVID-19 patterns in individual communities to ensure nursing homes are constantly informed of Covid cases within their surrounds.
Over 30,000 staff work in private and voluntary nursing homes. They are tested every two weeks. Where COVID-19 cases escalate in particular communities, there is need to consider more timely testing of these staff, with once-a-week a minimum requirement.
As the public health experts have stated, if the virus is prevalent within our communities it is definite it will emerge in our nursing homes.
There is a need for rapid turnaround of testing for our staff. Delays deter an emergency response that may be required if a staff member tests positive.
All of us have a role to fulfil. The people in our nursing homes are our most vulnerable to the virus. Recent research by a team of gerontologists found one-third of COVID incidences in nursing homes were asymptomatic.
Quashing the spread of the virus in the community correlates with lessening the risks of it in nursing homes, as we saw in summer, with clusters in nursing homes closing as the virus was suppressed in the community.
Medium-term, nursing homes can no longer be treated as outliers. Residents must be afforded access to community care services that they are entitled to.
The collaborative working relationship that has been established between nursing homes and health experts such as gerontologists, public health, GPs and allied health must become reality. Staffing challenges will escalate minus State planning.
We must have a staffing complement to meet escalating demands across all health services.
‘We need to look at how we can rebuild our relationship based on mutual respect because we’re all in this together,’ then Minister for Health Simon Harris informed private and voluntary nursing home providers at our annual conference last November.
We’re inter-dependent in terms of how we succeed, or indeed in terms of how we fail, and failure is not an option,’ he added.
Lamentably, it’s taken the tragedy of COVID-19 for the State to look at its treatment of the sector. A new standing for our nursing home residents, staff and providers must emerge.
By Extra Reporter -26/10/2020