Nursing Homes Ireland (NHI) provides a list of resources for guidance and advice to assist in navigating the current COVID-19 (Coronavirus) crisis which is currently presented to nursing homes and the wider public across the country and beyond.
Below you will find helpful information and links from sources like Health Service Executive, Health Protection Surveillance Centre, as well as guidance issued by Nursing Homes Ireland to its Members and to the public regarding visiting restrictions which are necessary to safeguard the well-being of Residents in nursing home care.
Please click on a row below to access relevant information and guidance.
We remind our engagement with the Department of Health and HSE with regard to COVID-19 is continual. We will continue to provide Members with support and advice as appropriate. Members will be increasingly aware of the global spread of Coronavirus (COVID-19). The following briefing has been prepared with the most up to date advice. You will appreciate that this is a continually moving issues and Members should keep up to date with all public information. The primary sites for information are the dedicated Coronavirus section on the HSE website and for healthcare professionals via the HPSC (Health Protection Surveillance Centre) Website.
Please find provided within this advice with regard to:
- What is the virus?
- How is the virus spread?
- Nursing Home Precautions
- Nursing Home Planning
- If a person becomes unwell/ Suspicion of COVID-19
- Further Resources
- Accessing PPE Equipment
- NHI Resources
- HSE Infographic – Prevention
- HSE Infographic – What to do if you are at risk
What is the virus?
A coronavirus is a type of virus. As a group, coronaviruses are common across the world. Typical symptoms of coronavirus include fever and a cough that may progress to a severe pneumonia causing shortness of breath and breathing difficulties.
Generally, coronavirus can cause more severe symptoms in people with weakened immune systems, older people, and those with long-term conditions like diabetes, cancer and chronic lung disease. This clearly includes many individuals who live in nursing homes. The older population is therefore a particular community of concern. Novel coronavirus (COVID-19) is a new strain of coronavirus. It is also called Coronavirus. Currently, there is no vaccine and no specific treatment for infection with the virus and the HSE advises that the flu vaccine does not protect against coronavirus.
Nursing Home residents, the majority of them being over 65, are an at-risk group, as are those who have a long-term medical condition – for example, heart disease, lung disease, diabetes or liver disease. As such members will be employing clinical judgement and every precaution to protect the health of residents, and indeed the health of our valued home staff.
How is the virus spread?
It is believed that coronavirus is spread in sneeze or cough droplets.You could be at risk of contracting the virus if you:
- come into close contact with someone who has the virus and is coughing or sneezing
- touch surfaces that someone who has the virus has coughed or sneezed on
Because it’s a new illness, it is not know how easily the virus spreads from person to person, or, if someone can spread the virus before they show symptoms.
Nursing Home Precautions
Nursing homes are strongly urged to ensure sterilising hand gel is at the entrance door and every visitor is informed of requirement to use it prior to moving around the nursing home.
All visitors are asked to:
- wash your hands properly and regularly with soap and water or an alcohol-based hand rub
– after coughing or sneezing
– after toilet use
– before eating
– before and after preparing food
– if you are in contact with a sick person, especially those with respiratory symptoms
– if your hands are dirty
– if you have handled animals or animal waste
- cover your mouth and nose with a tissue or your sleeve when you cough and sneeze
- dispose of used tissues into a bin and wash your hands with soap
- follow the travel advice from the Department of Foreign Affairs if travelling to a country or region with a spread of COVID-19.
Providers should consider providing residents, visitors and service users with information in relation to hygiene and transmission. Together with what actions your nursing home may need to take in the event of an instruction to self-isolate or any other escalation of the disease.
Nursing Home Planning
- Providers should develop their own operational resilience planning. This will relate closely to plans which should already be in case in relation to any major incident. The distinction being that there may be factors limiting the ability of staff to travel to work if there is any instruction to self-isolate.
- We are liaising with the HSE with regard to specific recommendations with regard to planning for COVID-19 and emergency measures to be undertaken and expect to circulate guidance imminently.
We will continue to liaise with the HSE and will update you of further developments.
If a person becomes unwell/ Suspicion of COVID-19
- Contacts of the unwell person: If you become unwell or have been in direct contact with an affected individual, the advice from the HSE is not go to your GP or ED. Phone them first. If you do not have a GP, phone 112 or 999.
HSE has provided comprehensive guidance on infection control guidance and can be viewed here.
View also HSE Telephone Risk Assessment here.
Accessing PPE Equipment
Contact your local Community Healthcare Office to request equipment. Information on accessing PPE equipment can be found in NHI update to Members here.
Information is also available from:
Please remind all family members that they can best protect themselves from COVID-19 by regular and vigorous hand-washing and good respiratory hygiene. It is also worth noting that, as an EU member state, Ireland is following the advice of the ECDC (European Centre for Disease Prevention and Control).
NHI is available to provide assistance and support to people affected by any case that arises. You may need clinical, HR or advice with regard to communications. You can call NHI at 01 4699800 and a listing of staff support is available here.
HSE Infographic – Prevention
HSE Infographic – What to do if you are at risk
6th March 2020
For the protection of nursing home residents, NHI has confirmed that visiting restrictions are now in place in nursing homes nationwide. No non-essential visiting, children or groups will be allowed.
All visitors are asked to contact prior to attending. Visitors should only seek to attend in urgent circumstances and the management reserve the right to impose full restrictions where necessary.
We urge prospective visitors to nursing homes to be cognisant and understanding of the measure that is required in the interest of resident and staff safety. Older people and people in nursing homes with pre-existing medical conditions are particularly vulnerable if they contact the virus. The virus presents an unprecedented situation for our nursing homes and the care provided within them. Nursing homes are imposing the visitor restrictions in the best interests of residents and staff. We thank people for their understanding and patience during this period of unprecedent challenges presented by Covid19.
Nursing Homes Ireland is monitoring the evolving situation on an ongoing basis and is in continuous contact with the Department of Health, National Public Health Emergency Team (NPHET), HSE and all relevant health authorities.
HSE Contacts for Accessing PPE Equipment:
CHO 1: ( Donegal, Sligo/Leitrim/West Cavan, Cavan/Monaghan): John.email@example.com – 071
CHO 2: (Galway, Roscommon, Mayo) firstname.lastname@example.org (Breda Crehan-Roche)– 091 775404
CHO 3: (Clare, Limerick, North Tipperary/East Limerick ): email@example.com )Maria
Bridgeman) – 061 464445
CHO 4: (Kerry, North Cork, North Lee, South Lee, West Cork) – firstname.lastname@example.org – 021 492
CHO 5 (South Tipperary, Carlow/Kilkenny, Waterford, Wexford) – email@example.com &
SECH.COVID19@hse.ie (Kate Killeen White) – 056 7784121
CHO 6 (Wicklow, Dun Laoghaire, Dublin South East) – firstname.lastname@example.org – 01
CHO 7 (Kildare/West Wicklow, Dublin West, Dublin South City, Dublin South West) –
email@example.com (Ann O’Shea) – 045 882 597
CHO 8 (Laois/Offaly, Longford/Westmeath, Louth, Meath) – firstname.lastname@example.org (Pat Bennett) –
057 93 59787
CHO 9 (Dublin North Central, Dublin North West) – email@example.com (Mellany McLoone) –
01 890 8759
Access to PPE equipment – HSE contacts
NHI in continuous engagement with senior officials in the Department of Health and HSE re PPE equipment. HSE informed all Chief Officers “it is vital the HSE monitors and supports colleagues in private and voluntary nursing home sectors”. It has instructed each CHO:
- “Public, Private and Voluntary Nursing Home Centres in your area should be immediately afforded a link to public health and also to a named person in your services so you can support and monitor centres with potential or confirmed outbreaks of Covid-19.
- “Requests for PPE to support such centres should be made through the normal channels of procurement to manage demand and to ensure that any centres (across the spectrum) with suspected or confirmed Covid-19 cases are provided with an initial level of PPE to support their task to contain an outbreak and maintain where possible residents in their own settings. You will be aware that guidance has been issued in relation to same, along with guidance in relation to the appropriate use of PPE.
Reduce risk of exposure as much as possible
The absolute minimum number of staff required to provide care should engage with the patient. If communication by telephone or similar device is adequate no one should enter the patient space. When entry into the patient room/space is necessary no more than one person should enter the room unless there is task that requires two people. Try to plan ahead for the person who enters the patient space to complete as many tasks as possible on a single visit to the patient space. Apart from the need to husband available stocks of PPE exposure of the least possible number of people for the shortest possible period of time is a sound principle for reducing the risk of acquiring COVID-19.
If you can avoid exposure do not use PPE
If the circumstances are such that you can maintain a distance of 1 to 2 m from the patient at all times use of PPE provides no additional risk reduction unless an aerosol generating procedure is being performed.
Substituting Items of PPE
Surgical Masks – In some instances a surgical mask with a specification somewhat different from that usually used may be available. Options may include use of FFP2 masks in situations in which they are not strictly required or the use of any surgical mask that is fluid repellent, fully covers the nose and mouth and can be tied appropriately for ease of removal it can be accepted as suitable for use in the current circumstances.
Gowns – If gowns are not available disposable aprons provide substantial protection. The value of a plastic apron is less if staff are not bare below the elbows as long sleeves are easily contaminated.
Extended use of PPE
If there are a number of COVID-19 patients to be seen in sequence try to identify one person who can perform the essential tasks in the patient room space. If that person dons gown, mask, eye protection (if required) and gloves they must change gloves and perform hand hygiene between patients but otherwise may wear the same set of PPE as they move directly from one COVID-19 patient to another unless the PPE is soiled or damaged.
This practice does not reduce protection for the healthcare worker and in the context of a sequence of COVID-19 cases is unlikely to represent a significant risk to the patients. If a plastic apron is worn over the gown and is changed after each patient this reduces the potential for carry over of non-COVID-19 related infectious organisms from patient to patient.
Reprocessing of PPE
Eye Protection – Reprocessing of plastic eye protection has already been performed in a number of hospitals. This is not ideal but is reasonably practical and can be done with very low risk. The use plastic eye protection may be collected for central processing by cleaning and disinfection or where this is not possible can be wiped with a disinfectant wipe and allowed to dry. If the item is damaged or visibly soiled it should not be re-processed.
Surgical Masks and Respirator Masks – There are a number of options for reprocessing of surgical masks. At the present time it may be prudent to collect used surgical masks in a clean and dry container so that reprocessing may be performed if necessary. One relatively simple option that has been reported as effective for some types of mask is heating in a hot-air oven at 70°C for 30 minutes. Other options may provide a higher degree of assurance, the process should be documented and monitored as carefully as practical to ensure that the intended temperature is achieved for the specified period of time.
Conserving and Optimising Use
Each site is requested to identify on person who will take responsibility for managing and allocating PPE and to record the distribution. Management and protection of stock is paramount in the current time. It is appropriate to conduct visits to units/wards with higher than expected demand to assess if there are options to reduce use by minimising exposure and ensuring that PPE is not used in situations where there is no exposure.
Distribution of PPE
The HSE has secured a line of supply for PPE from China which will involve multiple deliveries from China on an on-going basis. They have also established a National PPE Response Team who will manage all inbound and outbound deliveries. This will involve daily scheduled stock deliveries to points of care.
During these unprecedented and testing times, Nursing Homes across the country have had to suspend or restrict visits in the interest of protecting residents. You will be aware, you and colleagues have been ensuring that residents are not being completely isolated and activities programmes are being tailored to mitigate against this. Nursing Homes Ireland issued a survey last week to ascertain what activities are taking place during this crisis for the benefit of nursing home residents. Nursing Homes are also ensuring that residents can contact their families during a time when visiting restrictions are necessary to safeguard the well-being of residents in Nursing Home care. We now advise of activities presented by nursing homes to support residents.
Contact with families
• Phone calls
• Video calls
• Writing clubs for Residents to write to family and friends
• Interaction on social media
• Screening of Cheltenham Festival and sweepstakes
• St. Patrick’s Day celebrations and preparations (decorations & cards)
• Easter preparations (bonnets, flower arrangements and decorations)
• Themed evenings
• Daily newspapers being read to Residents
• Daily updates on virus
• Conversations with Residents to ascertain reaction to virus and discussion to ease worries
• Hygiene demonstrations
• Card and board games
• Bowling and ball games
• Reminiscence therapy
• Sonas activities
• Snoezelen Room (multisensory environment)
• Foot spa
• Bird watch
Music and film
• Interactive music sessions
• Screening of movies, documentaries, classic films and playing of music for Residents
• Screen of nature, historical programmes
• YouTube karaoke
• Streaming of Mass services
• Prayer groups
• Daily Rosary
Food and drink
• Cheese and wine parties
• Ice-cream parties
Arts and crafts
• Painting and drawing
Reeling in the Years
Evin Ryan, an architecture student in UCC has created a folder with every single episode of Reeling in the Years, covering the years 1962 – 2009.
Tips for nursing home restrictions
21 idea for group activities in your care home
Potential offered by nursing homes to provide rewarding employment
On St Patrick’s Day, Nursing Homes Ireland appealed to people within our hospitality and retail sectors to look for opportunities that will present in providing care to older people during the Coronavirus emergency.
Staffing needs will arise for nursing homes in meeting the care needs of older people, with the disciplines in nursing homes being wide-ranging. Roles on a temporary basis that may interest people could include those of healthcare professionals including nurses and physios, healthcare assistants, catering, activities, ancillary or administrative support. NHI has informed Minister for Health Simon Harris of the unparalleled challenges COVID-19 presents with regard to healthcare staffing which will similarly present for nursing homes across the country.
Tadhg Daly, NHI CEO said: “We’re in the midst of a national health emergency and are facing up to challenges that have never been presented to us before. A nursing home has to meet all the care needs of people who require specialised and highly dependent services on a round-the-clock basis. Nursing homes are preparing as best they can to meet the unprecedented challenges that will face them in the coming weeks and possibly months. One considerable concern is to ensure a staffing complement is consistently available to meet the day-to-day social care needs of nursing home residents especially at a time of emergency and with visitor restrictions. Irish people have a tremendous ability to support one another during difficult times and this has never been more required. Nursing homes will need that resilience and flexibility from within their communities in the weeks ahead and opportunities will likely present for roles to be filled.”
NHI has urged people who feel they can contribute to care of older people to present such to nursing homes by way of outlining their skillset in a short email and to present their CV with it. A list of email addresses for nursing homes is available at www.nhi.ie and queries or CV’s can also be submitted to firstname.lastname@example.org.
Short, medium and long-term contracts can be offered by nursing homes, as well as flexible working arrangements.
Mr Daly said: “As per all health services, nursing homes are under huge pressure with visitor restrictions at present so we ask people to contact their local nursing by way of email. A listing of Nursing Homes Ireland Members is available from our website. We thank people for their support of our sector during this national health emergency.”
He concluded: “Working with older people can bring satisfaction that cannot be achieved in other jobs. Nursing homes are community settings with very special residents and staff. These highly regulated, healthcare settings provide excellent opportunity to enhance people during these challenging times.”
Dedicated recruitment portal arriving in coming days – we need your HR emails!
We’ve received a phenomenal response to the recruitment drive we launched St Patrick’s Day. Our message was for people who had lost their jobs and felt they could fulfil a role in an NHI Member home to get in contact with us. Hundreds of CVs from across the country have been submitted to NHI. To support interested applicants, NHI is rolling out a dedicated recruitment portal in the coming days. This will allow applicants upload their CVs online and identify with the nursing homes in their locality. This will support Member nursing homes in receiving applications from candidates. We advise, while applications may present for roles that do not require filling, Members have informed NHI they are looking to be flexible in their staffing arrangements during the emergency that presents.
Please find provided HSE guidance: Infection Prevention and Control Guidance incl. Outbreak Control in Residential Care Facilities (RCF)
The Guidance informs regarding:
- General Measures to reduce the risk of accidental introduction of COVID-19 into a Healthcare setting
- Common Symptoms and Signs indicative of possible COVID-19 illness
- Clinical Investigations supporting diagnosis of COVID-19
- Clinical Monitoring and management of patients with suspected or confirmed COVID-19 status in RCF
- Decision algorithm in regards to escalation reflecting anticipatory guidance
- Infection Prevention and Control Management for differing scenarios:
Be aware that within the changing nature of the epidemic clinical guidance regarding management may change quite quickly and keep updated with relevant sites at www.hse.ie and www.hpsc.ie, the HSE states.
Nursing Matters/ Care Monitor video resources for Infection Prevention and Control Training can be viewed here
View HSE Guidance Document (25th March): Preliminary Clinical and Infection Control Guidance for COVID-19 in nurse-led Residential Care Facilities (RCF) here
Guidance on decontaminating medical gas cylinders potentially contaminated with COVID-19 can be viewed here.
This pack can now be downloaded online here https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/partner-resources/
The starter partner pack contains:
· The most up to date posters on Coronavirus COVID-19 (please display and share these with your teams and service users, and please replace any previous posters with the updated version)
· Videos on Coronavirus COVID-19 that you can share and display
HSE are working on content for a variety of needs, and we will be adding more videos, materials and translations so this partner pack can act as a source of helpful information and resources.
Social Media Accounts:
If you/ your organisation is not already doing so, please follow the following sources on twitter and re-tweet messages relating to Coronavirus COVID-19:
Looking after mental well-being:
HSE are aware that many people may be feeling a sense of anxiety and stress at this time. In this regard we are also developing information and resources to support mental well-being and promote resilience during these challenging times. We will be sharing this with you when these are developed.
Our collective efforts are critical, we need to do this together, as one community. HSE will be asking everyone to play their part, to help each other. Slowing the spread of this disease protects everyone, but it particularly protects those who are most at risk.
The HSE has shared with NHI Interim Guidance for Coronavirus – Healthcare Worker Management By Occupational Health. This document aims to outline the role of Occupational Health (OH) in preparing for and managing potential coronavirus exposures. It presents interim guidelines, which will be updated as new evidence-based information becomes available.
While specific for HSE workers, the guidance is also applicable for private and voluntary nursing homes. It provides guidance regarding and tools to support:
- Fitness for work concerns
- Management of HCW Contacts Exposure in the Workplace
- Management of HCW Close Contacts (Workplace Contact)
- Management of Casual Contacts
- Health care workers returning from any International Travel
- HCW on Self Quarantine Returning to Work Due to Essential Service Needs
- Management of Symptomatic Contacts
- Close Contact Symptom Monitoring Chart
- Template for recording Important Contact Details
- Healthcare Worker COVID-19 Close Contact Information Leaflet
HSE issued guidance on funeral arrangements for deaths occurring in residential care settings during this health emergency. HSE Guidance document can be viewed here.
Irish Association of Funeral Directors Advice:
Covid-19 has been categorized by the World Health Organisation as a level 3 contagious disease. It can be contracted through close proximity to the virus holder through breathing infected air particles and from touching infected surfaces.
We have been advised by the Dublin City Coroner that COVID-19 can last for several days after death.
All funeral directors and their staff are expected to follow HSE/PHA guidelines on proper hygiene routines;
- Regular hand-washing
- Sneezing and coughing etiquette
- Avoiding touching the face with unwashed hands
- Keeping regularly-touched objects and surfaces cleaned and disinfected.
Where possible funeral directors should have alcohol scrub dispensers in their facilities
For Republic of Ireland Funeral Directors
Should a funeral director or a staff member believe they have the symptoms (breathlessness, coughing, temperature, fever), then they should contact their GP by phone and self-isolate at home, following the guidelines as prescribed by the HSE.
For Northern Ireland Funeral Directors
Should a funeral director or a staff member believe they have the symptoms (breathlessness, coughing, temperature, fever), then they should contact NHS 111 and follow the guidance provided.
Until clear advice is provided by the relevant health authority the IAFD recommends that all funeral directors should take extra precautions and follow the current hygiene guidelines.
During the current outbreak of COVID-19 IAFD recommend that in cases where the cause of death is unknown or the possibility of death from COVID-19 has not been ruled out, funeral directors and their staff removing the deceased person should use ALL protective personal equipment (PPE) i.e. gloves, facemasks, gowns, aprons, covering suits and boots and should remove the deceased in a body bag.
If you are unsure, treat as a death by COVID-19 – see recommended protocols below.
Arranging the funeral of someone who has died from COVID-19
We are currently awaiting guidelines form the relevant health authorities, but the IAFD are recommending that the following protocols are followed in the event of arranging a funeral for someone who has died from COVID-19.
These protocols are to ensure that infection does not spread from the deceased or from their close family and friends who may be infected from contact with the deceased or each other:
- Ideally take funeral instructions over the phone only
- Relatives of the deceased should not be permitted to attend the funeral director’s offices or funeral homes
- In the event of a Covid-19 death, the Dublin City Coroner has confirmed that there will be no post-mortem examination required, provided the deceased had been previously diagnosed as having contracted the disease. (Funeral directors should check with their local coroners to confirm if the same policy applies in their areas)
- Clearance will be ascertained in the normal way – through the GP or attending hospital doctor. In the event of a suspected Covid-19 death, where the deceased was not diagnosed, then this is notifiable to the Dublin City Coroner. (Funeral directors should check with their local coroners to confirm if the same policy applies in their areas)
- Funeral directors and their staff removing the deceased should use ALL protective personal equipment (PPE) i.e. gloves, facemasks, gowns, aprons, covering suits and boots
- The deceased should always be removed from the place of death in a body bag which is not re-opened
- Removal vehicles should be hygienically cleaned after the removal of remains and all gloves and other disposable equipment should be disposed of safely
- Where possible the deceased should be removed to a designated area within the funeral directors’ facilities (or those of an out-sourced provider) – e.g. an isolated cold room
- The deceased should NOT be embalmed
- The deceased should be placed in the selected coffin and the coffin closed
- Public gatherings such as a Church Services, gatherings at funeral homes, residences, crematorium chapels etc. should not take place
- The deceased should be brought straight to the crematorium or cemetery for committal
- The family should be advised that they may have a Memorial Service at a later date
- Transport for families (e.g. limousines and saloons) should not be provided
- HSE/PHA advice should be applied to any public gathering in funeral homes, churches, crematoria etc.) i.e. no shaking of hands or hugging, sneezing and coughing etiquette should be adhered to etc.
- Where possible hand sanitisers for use by the public should be provided at funeral homes and other venues
- Tissues and a safe method for their disposal should be provided at funeral homes and other venues
- Display the attached “COVID-9 The Facts” poster in the staff and public areas of your premises
- Circulate the attached “Guidance for workers dealing with the general public” to all of your staff
You will appreciate guidance is constantly being updated and we would recommend you check local health authority websites for the most up to date information. We will continue to provide updates as and when we have further information.
All of the above can be also found on the IAFD website under links
Healthcare Direct have provided a presentation on effective respiratory management; the slides can be viewed here.
Dr. Daniel M. McCartney, Lecturer in Human Nutrition & Dietetics at TU Dublin has provided a paper on the importance of Vitamin D in enhancing resistance to respiratory infections including Covid-19, which can be viewed here. A non-technical summary of this document can also be viewed here.
A comprehensive list of supports for employers and employees affected by Covid 19 can be downloaded here.
Guidance is provided with regard to:
- COVID-19 Employer Refund Scheme
- COVID-19 Pandemic Unemployment Payment
- Self-Isolated workers whose employers do not supplement/top-up the State Illness Benefit payment
- Workers who are requested to stay at home by their employer (COVID-19)
- Workers who need to take time off work to care for a person affected by COVID-19
Advice is also provided with regard to Revenue, banking and housing.
The HSE has provided guidance with regard to cocooning and how it is applicable for nursing homes. This guidance document on cocooning can be viewed here.
Click here to view one page HSE guidance document on anticipatory prescribing in palliative care in COVID-19 related circumstances
The site contains:
- HSE Interim Clinical Guidance to provide consistent advice to the clinical community in response to the Covid-19 pandemic. This is based on best available knowledge at the time of completion, written by clinical subject matter experts (SMEs) working with the HSE. These SMEs have both expertise and experience of treating patients for the specific health conditions covered by the guidance.
- Research evidence summaries prepared by the HSE National Library Evidence team and other stakeholders.
- Facility to request additional published Covid-19 evidence in relation to specific clinical questions
- Links to point of care tools and educational resources
The content of the site is not meant to replace clinical judgment or specialist consultation, but rather strengthen clinical management of patients and provide up-to-date and relevant guidance. The guidance is iterative in nature and will be updated as the situation changes.
This guidance must be read in conjunction with National HSE Infection Prevention and Control (IPC) Guidance for Possible or Confirmed COVID-19
To enable easy access through your mobile/tablet devices insert and save https://hselibrary.ie/covid in your device.
HPSC Guidance Document giving advice about preventing the spread of COVID-19 in settings for vulnerable groups such homeless, travellers, refugees/ asylum seekers and others. The measures outlined are mainly focused on congregate settings or facilities managed by staff and can be applied in direct provision centres, hostels, hubs or residential settings including those without clinic or in-house nursing, medical or healthcare support.
List of useful websites for resources