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Nursing homes residents require enhanced access to geriatricians & allied health services

Friday October 23, 2020

23rd October 2020: Nursing Homes Ireland today states enhanced access for nursing home residents to geriatricians and allied health services must become a headline priority for our health services. The recommendation follows a consultation process undertaken on behalf of the organisation that derived the views of 129 nursing homes in the Covid19 landscape. Nursing homes have stated some €4 Billion allocated in the Budget for healthcare next year must go towards enhancing nursing home residents access to geriatricians and allied health services.

NHI has stated the initial allocation of €40m in Budget 2021 for implementation of the Covid19 Nursing Homes Expert Panel recommendations must focus on better integration of nursing homes within our health services. Given the enhanced focus on the nursing home sector, NHI also reiterated its call for nursing home staff, operating on the Covid19 frontline, to not be targeted by the HSE.  The consultation presents requirement for a collective, unified approach, entailing the provision of immediate and essential support for healthcare providers when Covid19 emerges. Feedback from nursing homes is the critical support is particularly required around staff in the unfortunate situation with staff unable to fulfil duties due to isolation.

Recommendations derived from the consultation undertaken for NHI by Gerontological Nursing Expert SM Consulting include:

  • There is a need to ensure residents with medical cards in private and voluntary nursing homes are afforded access to geriatricians and all allied health services from the State to ensure equity of access for all citizens.
  • The collaborative working arrangements set up during the pandemic to align and support private and voluntary nursing homes into the general governance and management structures of the HSE (specifically the contacts with the local CHO office) should continue indefinitely to improve cohesion between service providers and improve the lived experience for all in receipt of services.
  • The gerontological expertise and the unique voice of those who work in private and voluntary nursing homes must be better recognised and involved at all relevant levels of decision making about the sector
  • The supportive nature adopted by HIQA inspectors during the regular phone calls and the regulatory assessments of the preparedness of nursing homes should be embedded in the inspection process to maximise the opportunities for identification of learning points that can be applied to the whole sector. In addition, there is an urgent need for HIQA to publish updated ‘Assessment and Judgement’ or regulatory frameworks for post-outbreak inspections so that nursing homes who have experienced an outbreak are assured of fairness and transparency in the inspection process.
  • Recognising the resultant trauma and residual emotional and psychological impact for nursing home staff following the management of an outbreak, it is essential that the necessary supports are made available to staff e.g. employee assistance programmes, counselling and/ or psychotherapy services

Tadhg Daly, NHI CEO states: “This extensive consultation reiterates the demand amongst private and voluntary nursing homes across the country for greater integration with our public health services. Nursing homes have identified a redefined working relationship with gerontologists and public health experts are principle priorities for the nursing home model going forward. This is a core recommendation advanced by the Covid19 Nursing Homes Expert Panel and the initial €40m allocated in Budget 2021 for implementation of its recommendations must focus on such.  The Covid19 crisis is underlining a long-standing weakness in our health services; the disconnect between private and voluntary nursing homes and public health services. The pandemic effectively enforced a redefined working relationship that nursing homes now believe must become the norm and must be prioritised by Government. To support effective implementation of such, the State must assess resourcing of gerontological and public health care at community level.”

The consultation also informed nursing homes have strived for years to ensure the model of care is conducive to the regulatory requirement of nursing home care being homely. However, they stated this presents severe challenges for implementing strict infection prevention and control practices, with some respondents stating they reluctantly changed what had become a new and lauded way of providing care that is of immense benefit to residents in a Covid-free environment. “We have spent 11 years trying to become more homely and person centred and now we have to change and become a more clinical environment in order to try to keep this virus out of our homes,” one respondent informed.

Mr Daly adds: “While nursing homes provide person-centred environments, there is an evident challenge in reverting to an increased clinical focus; yet, when the pandemic occurred, this was necessary.”

Tadhg Daly, NHI CEO, is available for further comment. Media interviews will be facilitated by Michael McGlynn, NHI Communications and Research Executive, who can be contacted at 087 9082970.

Note for the Editor

Recommendations derived from the consultation

  1. That the gerontological expertise and the unique voice of those who work in private and voluntary nursing homes, is recognised and involved at all relevant levels of decision making about the sector
  2. That guidelines provided for the sector are in line with both the timing and content of international recommendations. A defined list of ‘must do’ preventative or ‘best practice’ measures that are sector-specific should be created and supported by posters, etc as per the national Covid campaign.
  3. The collaborative working arrangements set up during this pandemic to align and support private and voluntary nursing homes into the general governance and management structures of the HSE (specifically the contacts with the local CHO office) should continue indefinitely to improve cohesion between service providers and improve the lived experience for all in receipt of services.
  4. That the serial testing programme for staff in nursing homes continues to be undertaken regularly for the foreseeable future, with improved timelines for results for all staff
  5. The high level of residents receiving the influenza vaccine should continue into the 2021 season with a concerted effort required to increase the uptake of the vaccine among staff. Providing direct access for private and voluntary nursing homes to the ‘cold chain’ supply of vaccines or providing access following consultation with a nominated GP is preferable.
  6. Given the intensive nature of rehabilitative supports that is now required for residents that have recovered from COVID-19, there is a need to ensure residents with medical cards in private and voluntary nursing homes are afforded access to geriatric and all allied health services from the State to ensure equity of access for all citizens.
  7. Recognising the resultant trauma and residual emotional and psychological impact for nursing home staff following the management of an outbreak, it is essential that the necessary supports are made available to staff e.g. Employee Assistance Programmes, counselling and/ or psychotherapy services
  8. The supportive nature adopted by HIQA inspectors during the regular phone calls and the regulatory assessments of the preparedness of nursing homes should continue in post-COVID-19 inspections to maximise the opportunities for identification of learning points that can be applied to the whole sector. In addition, there is an urgent need for HIQA to publish updated ‘Assessment and Judgement’ or regulatory frameworks for post-outbreak inspections so that nursing homes who have experienced an outbreak are assured of fairness and transparency in the inspection process.
  9. To account for time lost when all efforts were concentrated on the pandemic, HIQA should provide recognition and allowances during any regulatory activity when assessing individual nursing homes’ regulatory compliance or continuous quality improvement. In particular, in relation to items such as training and staff development, implementation of actions in previous compliance plans or annual review reports, etc.

Read the Executive Summary here.