By: Michael O’Farrell – Investigations Editor.
PATIENTS transferred into nursing homes from hospitals hit by Covid-19 sparked fatal outbreaks among vulnerable residents, nursing home operators have claimed.
Despite the risks associated with these transfers, the Health Service Executive emptied as many hospital beds as possible in this fashion as it prepared to deal with the pandemic.
Hospital patients were deemed eligible for transfer to care homes even if they were showing symptoms and had been identified as close contacts of others who were Covid-positive.
‘Definitely it was a big contributory factor,’ Nursing Home Ireland’s CEO Tadhg Daly told the Irish Mail on Sunday.
‘Quite a significant number of nursing home cases would have been transferees,’ he said.
It comes as it was announced that 52 more people have died from Covid-19, bringing the total number of deaths in Ireland to 1,063.
Another 377 new cases were also confirmed yesterday, bringing the total number of people known to have the disease in Ireland to 18,561, the Health Protection Surveillance Centre said.
Health Minister Simon Harris tried yesterday to dampen expectations that life would return to normal on May 5, when the current severe lockdown is due to expire, even though the rate of spread of Covid-19 continued to slow.
‘I’m being honest and blunt with people. I think the week beginning May 5 is not going to be a big bang moment in terms of the lifting of restrictions,’ he said.
The MoS can also reveal that up to five million pints of beer are expected to be disposed of due to the lockdown, an indication of the financial impact that the current restrictions are having on the bar and hospitality industry.
It was also confirmed yesterday that there have been 21 deaths in St Mary’s Hospital in Dublin’s Phoenix Park, while a nursing home in Dealgan, Co. Louth has had 17 deaths.
The revelations that the HSE may have made the general outbreak in nursing homes worse by trying to free capacity in hospitals will throw fresh pressure on health chiefs.
The MoS understands that, in some cases, hospital patients were transferred to one nursing home for a respite period of two weeks before then being moved to a second home – thereby increasing the chances of virus spread.
Last night, health watchdog Hiqa (the Health Information and Quality Authority) confirmed it was ‘aware of incidents where [there were] residents transferred from acute healthcare facilities to nursing homes and who later tested positive for Covid-19’.
A spokesman said: ‘We have raised this issue with the HSE and escalated a number of specific issues to them.’
Hiqa also said it was aware of instances in which ‘asymptomatic residents transferred from a nursing home to a hospital and were found to be positive when tested in hospital’.
One operator of a nursing home in Dublin – which suffered doubledigit Covid-19 fatalities after accepting hospital transfers – said they believed their fatal outbreak was sparked by transfers.
‘We went into lockdown two weeks before anyone else and got kicked for it,’ the operator said.
‘Then the HSE transferred people from hospitals to us – and most of them subsequently tested positive.’
In all, the operator said four of the seven transfers received prior to the outbreak at the home were found to be positive.
In another instance, operators of a nursing home in the West – which has so far avoided infection – told the MoS they refused to accept a hospital transfer who was displaying obvious symptoms. The patient later died of Covid-19 in hospital.
‘When this epidemic is under control, all stakeholders will have to look at the lessons learnt in terms of transfers and indeed supports for nursing homes in the event of another outbreak,’ said another provider whose multiple facilities have suffered double digit Covid fatalities.
In another case, confirmed by the MoS, three patients transferred to temporary step-down wards on the campus of Our Lady’s Hospice in Harold’s Cross, Dublin, were found to be Covid-positive.
Two of these patients subsequently died from the virus at the hospice and more than a dozen staff had to self-isolate.
In addition to its palliative care operation, the hospice campus also contains an 89-bed nursing home – Anna Gaynor House – which escaped infection from the transfers.
Approximately 20 patients, transferred from St James’s Hospital and St Vincent’s Hospital, are being cared for on the hospice campus.
‘We made beds available to two of the acute hospitals as a “step down” for some patients who no longer need acute care,’ a spokesman confirmed.
‘These patients are not on track to enter our residential unit, Anna Gaynor House.’ The hospice declined to comment – for reasons of confidentiality – on its Covid-19 cases but said it was ‘observing all Health Protection Surveillance Centres (HPSC) guidelines for healthcare workers.’
‘There are a wide range of measures in place to protect residents, patients and staff across all units and our staff are working hard to do the best they can at this difficult time,’ the spokesman said.
The HSE’s operational guidelines for hospital transfers – issued on March 10 – identified transfers as a risk to homes.
‘There is a concern that patient movement may result in the introduction of the disease from an acute hospital to a residential care facility,’ the document reads.
Nevertheless, the guidelines go on to confirm that hospital patients can be deemed eligible for transfer to care homes even if they are showing symptoms and have been identified as close contacts of others who were Covid-positive.
This is in accordance with separate guidelines updated by the HPSC on April 7.
These guidelines advise that symptomatic transfers from hospitals to residential settings should be accommodated in single en-suite rooms and treated as if they were Covid-positive.
Last night, the HSE said transfers from hospitals to nursing homes was a routine practice.
However, a spokesman confirmed that emergency Covid-19 funding had allowed the transfer from hospital of ‘some 400 patients across the country who were awaiting the availability of a placement’.
The spokesman added that any Covid-positive hospital patient must test negative twice before a transfer to a nursing home or other residential care setting can happen.
Today’s revelations follow mounting concern in recent weeks about how health authorities across the world were blind to the risks posed to care home residents as they intensified all their efforts on the acute sector.
Inquiries have now been ordered in the US, Canada, France, Italy and Spain. The authorities here are facing criticism for not heeding the experience of nations that were hit before the virus came to Ireland.
On Thursday – with data showing that up to half of all Covid-19 deaths in Europe have been in long-term residential facilities – the World Health Organization described the care home crisis as an ‘unimaginable human tragedy’.
Britain’s National Health Service came under fire yesterday for its ‘reckless’ policy of transferring hospital patients to nursing homes regardless of whether or not they were still infectious.
In Ireland – where the latest figures indicate 48.1% of probable and confirmed Covid-19 deaths were nursing home residents – the authorities are scrambling to respond adequately.
According to a Nursing Homes Ireland survey released on Thursday, more than 100 nursing homes were missing hundreds of essential nursing and healthcare staff due to Covid-19.
There are now outbreaks in 198 of the country’s 540 private and public sector nursing homes and the HSE has deployed Covid Response Teams to the worst-affected homes.
HSE operational plans advise that these response teams ‘minimise hospitalisation except where clinically indicated,’ – a policy that has drawn some criticism from families and nursing home operators concerned that hospital treatment is being denied in some cases.
Another concern raised this week involved a HSE circular which has banned the use of Azithromycin – a drug some homes claim to have used to control outbreaks.
The circular – issued on April 10 – restricts the use of Azithromycin to hospitals only ‘to support the safe use of this agent and ensure continuity of supply’.
Some operators, who believe the drug saved lives at their nursing homes, told the MoS their patients were being denied the medicines they needed – on top of being afforded access to hospital treatment.
In response to MoS questions about Azithromycin, the HSE said it had published guidelines about the drug’s use and was ‘working centrally to maintain stocks for clinically indicated patients as per the national guidance.’
