Thursday, 21 May 2020
Covid-19 (Health): Statements
Fergus O'Dowd (Louth, Fine Gael)
I welcome the Minister and I acknowledge the tremendous work being done by him, his Department, the HSE, nursing home owners and employees and everybody in the country. I also welcome the Minister's commitment to set up an international best practice assessment of how matters have evolved in our nursing homes. This assessment will examine: the fact that 54% of all deaths from Covid-19 in Ireland have taken place in nursing homes; the measures we have adopted so far, some of which have worked and some have not; and will consider international experience on approaches and identify any further best practices. Given the fact that this virus will more than likely return, it is important and proper that the Minister has limited the time for which this committee will sit. It will only sit until the end of June or July so that it will have real proposals to work on.
The committee needs to consider not only what will happen in the future but also what happened in the past. I represent the constituency of Louth, where Dealgan House Nursing Home is located. Sadly, a large number of people died there. I acknowledge the question Deputy Ó Murchú asked in this regard but I have a different one: why did the HSE go there in the first place? I am not asking when it is going to leave. It can leave only when it knows exactly what happened in the nursing home, what the problems were and how they are being addressed. It can leave only if it is absolutely satisfied all the people who live there, and their families, are safe and well. We need to get to the bottom of that.
I am not referring to Dealgan House Nursing Home disrespectfully because it got an exemplary report from HIQA at the last public inspection. The last set of published data on all nursing homes shows that only 123 of the 581 nursing homes in Ireland were fully compliant with all regulations. That is an absolutely unacceptable number. As regards governance and management, 32% of the nursing homes, public and private, exhibited non-compliance. Regarding infection control, 18% of the small, limited number that were examined – 251, I believe – were non-compliant. Therefore, there are important issues to be addressed.
We do not want to apportion blame but get to the facts so families who have lost loved ones can have closure. Closure is the most important thing for families. One of the big problems they face is that they do not get to say goodbye to their loved ones. That creates great trauma for them. Nursing homes and hospitals have different configurations of buildings and different arrangements but it should be possible for every single family to say goodbye, in the appropriate and proper place, to their loved one. This, above all, is crying out to be addressed. Friends and relatives of bereaved families see a beautiful ceremony but it is a sad one. That it may be attended by fewer than ten people causes great emotional distress for the families and their relatives and friends. We can act only according to the best possible advice, and I acknowledge death is cruel at any time, but death is exceptionally cruel when families must endure what is happening now. I am not blaming anybody but just believe we need to have the best possible advice, given in the best possible way, to end this. I understand the reason for limiting the number who may attend a funeral to ten. I am not disagreeing with the guideline and I would only work with and support public health advice on any of these matters, but it needs to be determined whether there are ways in which people could participate at a distance. People love to be with their families, loved ones and friends at a time like this. I hope we can do more on this.
We must look to the future. We need to move away from the nursing homes model. It represents a failure right around the world. Covid-19 is rampant and affects most people who are over a certain age and in nursing homes, but it is a fact that home care is under-supported and undervalued. Having people live in their homes must be our priority, along with the provision of services to their homes, notwithstanding the existence of Covid. Preparing staff to provide this service must be a top priority. If we cannot visit people in their homes, the community setting should be the next priority. I refer to where people can live in small bungalow-type accommodation in which they can be looked after. There are examples in this country. The system should be in place to support home care. There should be a deal for people in home care in addition to those who must go to nursing homes, which I accept has to happen.
I appreciate that the Minister will be happy to reply to these points. We need to examine the role of HIQA. It has not just an inspection regime - in fact, I think it may not have enough inspectors - but also retraining and upskilling programmes. It is all very well to talk about inspecting a nursing home if there are problems in it but we need to make sure staff are trained to the highest possible degree. There needs to be greater interaction between the HSE and private nursing homes on upskilling and helping everybody to get through these difficult times.
At the end of the day, we need to make sure the staff needed in nursing homes are there. The level of dependency - high, medium or low - of residents in nursing homes determines the ratio of doctors to residents. Occupational therapy and speech therapy services must also be provided. It is not good enough to have residents warehoused as, unfortunately, they can be in many respects. They pay high fees and in many cases get very little other activities for that money.