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Integration and clinical partnerships with nursing homes must become Government priority, according to new NHI Gerontologist

Wednesday July 15, 2020

Tuesday 14th July 2020: Integration between community medical and healthcare professionals and nursing homes must be prioritised by the Government, new NHI Gerontologist Dermot Power has warned. 

Professor Dermot Power, a specialist in geriatric medicine, issued the advice following the announcement that he has been appointed as the new Nursing Homes Ireland Gerontology Expert. 

He suggested that COVID19 has presented the necessity for Government to assess if a strategy is required to better integrate nursing homes with medical settings. 

Professor Power suggested there is a requirement to assess the model of care for nursing homes.  “It should be realised nursing homes are very specialised healthcare settings, meeting complex and high-dependency physical and cognitive care needs of our most frail, whilst also providing vital rehabilitative and palliative care within our communities. Integrated partnerships with community medical and healthcare professionals will support clinical pathways into and out of acute hospitals, to the advantage of both the nursing home in terms of clinical support and the acute hospital in terms of structured discharge pathways.”

This strategy would require a paradigm shift by the State accompanied by changes in regulation, commissioning of services and an appropriate allocation of significant resources, he said.

Professor Power said he is aware, through his long-standing role as a public health gerontologist and engagement with NHI, that access to professionals proves very challenging and, in some instances, unattainable over prolonged periods for nursing homes. Engagement between gerontologists and clinical leads in the community is infrequent. More particularly the heralded agreement reached between GPs and the Government in April 2019 did not encompass GP services for nursing home residents.

In his new role, Power will provide expert gerontological advice to Nursing Homes Ireland, while retaining his geriatrician, physician and teaching roles with the Mater and UCD.

Professor Power stated that COVID19 has highlighted the fact that the relationship between community medical and healthcare professionals and nursing homes is too inconsistent, fractured and unstructured. He said: “Residents in nursing homes have multiple and diverse medical and health conditions. They are amongst the most frail and vulnerable and access to timely specialised clinical care is critical to support them in their day-to-day living and quality of life. Yet access to medical, clinical and healthcare supports in the community is inconsistent which can have a detrimental impact upon the health and wellbeing of people in our nursing homes. As a more assured COVID19 footing presents, the new Minister for Health should initiate a process that will promote enhanced integration between community healthcare professionals and private and voluntary nursing homes. With these settings providing 80% of nursing home care, a new dynamic must be introduced to our methods of delivering healthcare for those availing of care within these homes. Greater and formalised collaboration between medical and healthcare professionals with nursing homes in their locality should become a core focus to support healthcare delivery. Nursing homes have significant clinical expertise but there is requirement for structured clinical partnership at local level to be greater utilised to address the varied medical, health and social care needs of residents. This will also entail assessment of priorities, obligations and resourcing for community healthcare professionals.”   

NHI CEO Tadhg Daly described the thought leadership advice presented by Professor Power “as an opportunity for the State” and said there is a necessity for a separate contract that recognises GP obligations to nursing home residents. The HSE is on record stating resourcing challenges result in residents in nursing homes being deprioritised in garnering access to community healthcare professionals. The regulator HIQA has stated delays and lack of prioritisation for nursing home residents in accessing GMS services have significant consequences for residents’ health and wellbeing and lead to their deterioration.