Covid-19: HSE official noted ‘inadequate’ preparation in nursing homes

Senior HSE officials privately raised major concerns about coronavirus hitting nursing homes in late March, with one flagging their “totally inadequate preparation” and another saying it could be “the biggest live risk” facing the health service.

The correspondence reveals tensions between the HSE and the Department of Health during a crucial period in the pandemic, and was released to The Irish Times under the Freedom of Information act.

The HSE appealed for an “urgent” €60 million in extra funding to help private and voluntary nursing homes fight Covid-19 in a March 27th email to the Department of Health.

A financial support package was announced more than a week later, by which time the number of clusters in nursing homes had risen from 22 to 57.

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Correspondence from David Walsh, HSE national director of community operations, warned officials "this crisis is not in the future, it is happening now". The funding proposal would amount to a payment of €250 a week per resident for nursing homes.

In response, department officials said a survey of 15 nursing homes had indicated the cost of extra coronavirus preparation measures would only need to be €68 a week per resident. This would cover regular deep cleaning, extra personal protective equipment (PPE) and additional staffing requirements.

Mr Walsh told the department the nursing homes surveyed had no confirmed cases and said: “I pity them when they arrive, based on their totally inadequate preparation.”

Feedback

The senior HSE figure said feedback they were receiving was the resources required to fight outbreaks were “very considerable”. Agency staff were only being supplied to nursing homes “at double cost where available at all”, he said.

Nursing home residents were the most vulnerable group in the country, he added. “A failure to protect them, as has happened in other countries, would be a matter of great public concern,” Mr Walsh wrote.

The “absence of a co-ordinated approach” between the HSE and private nursing homes would have “most serious consequences”, he told department officials.

The coronavirus would go on to have a devastating impact on the nursing home sector over the following weeks, resulting in 977 of the 1,736 Covid-19 deaths in the State.

On March 28th, HSE chief operations officer Anne O'Connor emailed chief executive Paul Reid to state the financial support was needed "with immediate effect", and was possibly the health service's "biggest live risk."

Then-minister for health Simon Harris would announce a €72 million support package for nursing homes a week later, on April 4th.

Outbreaks

Separately, correspondence shows several nursing homes warned the HSE that outbreaks were so bad providers feared they would have to cease operation and transfer residents elsewhere.

In an April 24th email, one nursing home said staff shortages had reached a “critical” point where a nurse had to offer to sleep in the facility and be woken if needed, to cover a shortage one night.

“Our staff cannot sustain double shifts much longer”, and previous pleas for extra personnel had generated no response, they wrote.

“I will not neglect the residents and if we do not get staff I will be asking you to find alternative accommodation for them,” the provider said.

Another nursing home provider emailed Mr Harris on April 1st over an “extremely critical” outbreak, warning their limited availability of PPE for coronavirus wards was “extremely dangerous to staff and residents”.

Staffing levels were “unsafe and we urgently need more support,” they wrote. “If we do not get additional personnel and the other measures outlined, we cannot provide safe care and will have no choice but to transfer out residents to the acute hospitals,” they wrote.