FURTHER questions have been asked about the transfer of patients from acute hospitals into nursing homes during the first wave of Covid-19 in this country, with Clare TD Michael McNamara repeatedly pressing experts about accountability for decision-making in the early months of the pandemic.
An expert report finalised last month, shows that Clare had the highest incidence in Munster of Covid-19 cases in nursing homes during the first wave of the pandemic. Clare had 176 cluster-related cases in nursing homes, while Limerick had 78, during the same time-frame.
Another interim report on the situation was published by the Dáil Special Committee on Covid-19 and, its chairperson, Deputy McNamara said last week’s hearings will inform the recommendations of its final report, which could include a call for a public inquiry into the issue.
With close to 1,000 Covid-related deaths in Irish nursing homes in the first wave of the pandemic, the World Health Organisation (WHO) has said that Ireland, as a whole, was on the higher end of the scale in terms of nursing home deaths. Nursing homes here accounted for 62% of Covid-related deaths, while the international average was 25%.
During two sessions with members of the Expert Panel on Nursing Homes, Deputy McNamara questioned witnesses intensively as to decision-making around discharging acute hospital patients to nursing homes.
He also questioned the practice of sending people into nursing homes which have failed inspections by the Health Inspection and Quality Authority (HIQA), and asked if Panel members agreed with his committee’s recommendation that there would be a GP lead assigned to every nursing home.
“Was there an unusual level of people discharged, at that time, from the acute units into nursing homes?” the Independent TD asked Professor Cillian Twomey.
The retired geriatrician replied, “There was. At the time, we were looking at the television screens as to what was happening in Italy, Spain and so on and there was a real concern that the acute hospital system would be overrun.”
When asked about the accountability for decision-making, Dr Kathleen MacLellan, Assistant Secretary at the Department of Health denied there was any directive on the issue. “There was certainly no directive given that all hospitals would be emptied into nursing homes,” she said. “There was a considered approach whereby for older people in our hospitals who were ready for discharge, could be safely discharged and would be more appropriately managed in a nursing home setting that this would happen in as safe as possible a way.”
Dr Siobhán Kennelly National Clinical Advisor and Group Lead, Older Persons told Deputy McNamara that given what was happening in Italy, Spain and elsewhere in the acute hospitals in February and March, a number of considerations had to be balanced.
“Two facets of these hospital discharges were very much being balanced at the time,” she said. “These were the risk to older people who would be inappropriately in hospital and exposed to risk of infection and the need for them to be cared for in a more appropriate place.”
Dr Kennelly said there was no “substantive link” between transfers from hospital and wholesale transmission of Covid-19 into nursing homes. “It seems that local community transmission of Covid-19 and staff transmission rates probably played a more important role in terms of how infection was introduced,” she said.
On the issue of transferring patients from nursing homes to acute hospital settings, Deputy McNamara also posed a number of questions.
“Who gave the direction that people were not to be transferred from community hospitals and nursing homes to acute hospitals?” he asked.
Dr Kennelly insisted, “There was never any such direction given. There was very clear guidance, given that all decisions about transfer were to be clinically based using appropriate clinical judgment. There was never any directive around people not being transferred from private nursing homes or community hospitals.”
Deputy McNamara also noted that in his committee’s interim report, one of the key recommendations is that the discharge of patients into nursing homes which have failed inspections by the Health Information and Quality Authority (HIQA) under the Fair Deal scheme, should cease.
Despite assertions from Dr MacLellan that HIQA has “significant powers” up to and including closing sub-standard nursing homes, Deputy McNamara insisted that “the HSE is sending patients into and paying for facilities which have repeatedly failed HIQA inspections”.
The testimony provided to the committee, as well as additional documentation sought, will now feed into the Final Report on Covid-19 in Nursing Homes, which is to be presented to the Dáil at the end of September or early October.