Simon Harris (Wicklow, Fine Gael)
Link to this: Individually | In context | Oireachtas source

As this is an operational matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Since COVID-19 first emerged in China in December 2019, the Government has taken decisive actions in response to this virus, advised by the National Public Health Emergency Team (NHPET). People living in Long-term Residential Care facilities are particularly vulnerable populations in the context of Covid-19 and have been identified by the World Health Organisation (WHO) to be at a higher risk of being susceptible to infection from this disease and for subsequent adverse outcomes.

This is most likely due to their age, the high prevalence of underlying medical conditions and circumstances where high care support with the activities of daily living is required in collective high physical contact environments. These are characteristics of LTRC in Ireland that make them a high-risk centre for Covid-19 outbreak and contagion across residents and staff. The approach by Government has been public health led in line with data, evidence and best practice as it emerges, through advice from the NPHET. The response to COVID-19 in LTRC is based on preparedness, early recognition, isolation, care and prevention of onward spread. This involves case recognition, testing, contact tracing and examining disease patterns including mortality. The actions and measures we have taken in Ireland to support nursing homes and their residents have been taken, and have evolved on foot of, epidemiological data and guidance from the WHO and the European Centre for Disease Prevention and Control (ECDC). These measures have been both society wide (e.g. cocooning), as well as focused specifically on residential facilities.

The scope of LTRC covers older people, disability and mental health residential care settings. LTRC facilities provide long-term care and short stay, transitional care and respite support either through the State, the voluntary sector or privately. On 10th March 2020 Interim Guidance on Transfer between Care Facilities was circulated and through HIQA was circulated directly to all LTRC registered centres. On the 11th March 2020 the WHO declared COVID-19 a pandemic and the following day the European Centre for Disease Control (ECDC) published its 6th update to its Rapid Risk Assessment (RRA), 12th March 2020, including new guidance in relation to the implementation of social distancing measures and prevention and control priorities in relation to inter alia LTRCs. On the same day as the ECDC update, NPHET recommended that Ireland move to “delay phase” and social distancing measures were recommended and announced, including:

- Visiting restrictions in long-term care facilities;

- Individuals who have symptoms should self-isolate for a period of 14 days;

- Staggered breaks in work and greater remote working etc.

The Government's COVID-19 Action Plan was published on 16th March 2020 and included key actions relating to the protection of vulnerable groups in community settings, including long-term care settings, through maintenance of existing services and enhanced support actions.

Preliminary Clinical and Infection Control Guidance for COVID-19 in nurse-led Residential Care Facilities (RCF) was published by the HSE and circulated to the nursing homes sector on 17th March 2020. The document provides guidance on general measures to reduce the risk of accidental introduction of COVID-19 into a LTRC, procedures to be followed for clinically suspect residents; guidance on clinical investigations and monitoring and on IPC. The document also provides detailed step-by-step instructions across a range of scenarios.

As the disease has progressed, a range of enhanced measures for nursing homes have been recommended by NPHET which are now being implemented by relevant agencies.

Each HSE CHO Area Crisis Management Team (ACMT) has prioritised the needs of all long-term care residents within their areas and has also offered very significant support to the nursing homes in their areas, particularly those with COVID 19 outbreaks. Guidance on the set up of COVID Response Teams was issued on 9th April to support all LTRCs within a CHO area and 23 COVID Response Teams are now in place across the 9 CHO areas. These teams are actively supporting all centres with outbreaks in their area through operational guidance and infection prevention and control (IPC) and Clinical support by Geriatricians etc, and in the most at-risk centres, staff are being deployed or sourced to ensure ongoing safe service delivery.

The establishment and provision of accommodation supports for staff who are living in congregated arrangements has been implemented with approximately 2,000 beds occupied per week.

To support designated centres HIQA set up an Infection Prevention and Control Hub providing support to providers and staff via email and phone. This support, guidance and advice includes:

- outbreak preparedness

- outbreak management advice (for example, resident placement, cohorting and special measures where isolations is not possible, transmission and standard precautions)

- understanding HSE advice and its applicability to specific centres

- general support on infection control issues.

Overall a significant package of measures has been adopted to date, including:

- HSE COVID Response Teams across the Community Health Organisations, to provide support and expert guidance to all long-term care residential settings;

- The provision of staffing, PPE, Oxygen, training and other supports to nursing homes;

- The €72.5m COVID-19 Temporary Assistance Payment Scheme;

- A Mortality census;

- HIQA risk assessment of all nursing homes;

- HIQA regulatory assessment framework of the preparedness of designated centres for older people for a COVID19 outbreak;

- Health Protection Surveillance Centre guidance;