Ms Susan Cliffe:

I thank the Deputy. I will start with the issue of temporary agency staff. That is a key concern for all providers at the moment. They are moving towards independently staffing their own centres where possible. Where agency staff are in use, they tend to be allocated to one nursing home. That has done a lot to minimise the crossover of staff between nursing homes. The question of how to staff nursing homes safely is really exercising providers, whether they are publicly or privately funded. Many nursing homes are also availing of alternative accommodation arrangements to secure their staff and ensure they are as safe as possible from Covid-19.

We are aware of one nursing home in Cloyne that is currently participating in a trial of a rapid Covid-19 test. Work is ongoing in the sector, but I am not aware of the results. Isolation rooms continue to be an issue. This does not pertain so much in the private sector, which has largely done the heavy lifting on improving premises. It is a key issue in some centres with large numbers of multi-occupancy rooms. We have worked with some providers on arrangements to offset the lack of isolation rooms, but other providers are essentially keeping rooms in their centres vacant to be able to afford isolation.

We spoke earlier about the contingency assessment planning framework we published towards the end of April. This is the kind of information that fed into that. As we engaged with providers during the 150 contingency assessment inspections we carried out, staffing and how to respond to a case or suspected case of Covid-19 emerged as key issues. Some providers are challenged by this, particularly if there are large numbers of cases which must be isolated in different parts of the nursing home. They are very cognisant of this issue and are drawing up a plan A, a plan B and a plan C to be able to deal with it.

People moving from hospitals to nursing homes are now largely tested prior to transfer. About three versions ago, the HPSC guidelines required all residents admitted to a nursing home to be isolated for 14 days. They had to be cared for separately to the rest of the nursing home residents on arrival. That presents some difficulty for residents but it is deemed to be the safest way to manage this. The risk is not so much the residents with Covid-19, because if the management knows a resident is coming who has or is recovering from Covid-19, precautions can be taken. The risk comes from residents coming from the community and acute care facilities where infection has not been recognised.

The practice of isolating residents for two weeks on arrival in a nursing home has largely mitigated that risk.

Regarding the availability of PPE, when we started calling nursing homes on 13 March and we saw we could have the greatest impact as an interface between nursing homes and the HSE or the Department, PPE arose clearly as a key issue, meaning both access to PPE in the event of a diagnosis and security of supply as providers went through the process of caring for residents with PPE. This interaction with the HSE at community healthcare organisation, CHO, level resulted in the setting up of the HSE crisis management teams, which did Trojan work once they were up and running. Those crisis management teams have members for PPE, assisted payments, oxygen and anything else that has been recognised as an issue to date.