The Nursing Home Expert Panel Report confirms the requirement for more stringent regulation of the nursing home sector
The Report published on the 19th August last noted that as of 27th June 2020, there were 252 clusters of COVID-19 in nursing homes and of those COVID-19 cases in nursing homes 422 were hospitalised. Sadly, there were 971 deaths related to COVID-19 in nursing homes which represented 56% of all COVID-19 related deaths.
The Report noted the Health Information and Quality Authority’s (HIQA) earlier Report Analysis of Excess All-cause Mortality in Ireland published in July 2020 that the officially reported COVID-19 related deaths may be an overestimate on the basis that some of those deceased persons included in the COVID-19 related death figures were close to end of life independently of the virus. However, HIQA’s view on the ‘over cautious’ recording of COVID-19 related deaths in nursing homes misses the point having regard to HIQA’s remit. If COVID-19 brought forward a nursing home resident’s death arising from inadequate infection control provision, notwithstanding other health conditions in a resident, then that is unacceptable and could have been more than likely avoided if infection control was fit for purpose in some nursing homes. HIQA is the statutory body which has responsibility for the oversight and enforcement of infection control in nursing homes and to date according to its own website does not inspect all nursing homes annually, nor does it appear from its own published reports to assess infection control at all inspections. It is therefore no wonder that the Nursing Home Expert Panel has recommended the watchdog carry out more inspections of nursing homes annually.
The Expert Panel Report noted that HIQA’s regulations were outdated and they did not capture the issues around infection, prevention and control. Specifically, it noted the opinion of the Chief Inspector at HIQA that the current regulations on infection, prevention and control in nursing homes is not commensurate with what is required to manage a COVID-19 outbreak. It is not understood why this admission on the part of HIQA only came to light recently. Why weren’t the regulations adequate to manage infection, prevention and control prior to the COVID-19 outbreak? While the Report does not address that issue, it does recommend that the regulations need to be enhanced including to give full effect to all recommendations set out in the Expert Panel Report.
Overall, the 212-page Report contains over 80 recommendations for the Nursing Home sector to implement and recommends a closer relationship between relevant stakeholders including HIQA, the HSE and nursing homes.
It is unfortunate that the remit of the authors of the Report did not go so far as to address who is accountable for the 971 deaths in nursing homes. It is also disappointing that the Report’s recommendations are not obligatory and so it is up to the various stakeholders to decide whether they want to implement them or not. Unfortunately, the Leas Cross 2006 Report author Prof Des O’Neill, Consultant Geriatrician, noted that many of the recommendations made in the 2020 Expert Panel Report were already made in the Leas Cross report 14 years ago. It is hoped that the Expert Panel Report’s recommendations will not be another missed opportunity and it remains to be seen whether the 2020 Report’s recommendations, if implemented, will result in better outcomes in infection control in nursing homes to minimise avoidable deaths occurring in residential care settings.
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