Sage Advocacy is a support and advocacy service for vulnerable adults, older people and healthcare patients. In 2019 we received 1,570 referrals for advocacy and dealt with 3,964 information and support issues. Some 46% of our work related to people living in the community, 27% related to nursing homes and 23% to acute hospitals. Because of the range and depth of our work across all regions of the country, particularly with people whose decision-making capacity is in question, Sage Advocacy is in a position to provide useful insights into the response to Covid-19.
Sage Advocacy has already made a detailed submission to the Oireachtas Special Committee on Covid-19 Response and presented evidence directly before the Committee on 26th May. The detailed recommendations from this submission from part of this submission.
In February of this year Sage Advocacy published a discussion document: Delivering Quality Medical in Irish Nursing Homes Current Practice, Issues and Challenges. It is worth quoting from the section on nursing home staffing; experience and skill sets of nurses. “While nursing homes strive to have an adequate complement of suitably trained and qualified nursing staff available at all times, in practice, there can at times be difficulties in recruiting nurses with relevant experience. The point was made that nursing home staff may not have the exposure, experience and training available in acute hospitals. It was also suggested that skills sets of nurses working in nursing homes may have gone down in recent years with a concomitant fear of making decisions in potentially crisis situations. Some GPs believe practical and staffing deficits in private nursing homes are contributing to the problem, as many private nursing homes are understaffed and existing staff are sometimes inexperienced in respect of handling complex healthcare needs. GPs have complained of receiving numerous and often times unnecessary calls from inexperienced staff with regard to patient care in nursing homes, which one GP described as being ‘majorly disruptive’ to their daily working schedule”.
Sage Advocacy is currently bringing together feedback and reflections from staff, volunteers, supporters, service providers, service users and their families and members of the public and we hope to have this ready for publication by the end of July. In the meantime, and based on our observations and experience of the impact of Covid-19 on the nursing home sector to date, the core message to the Expert Panel on Nursing Homes can be summed up in the fourth recommendation in our submission to the Oireachtas Covid-19 Committee.
“Integrate private nursing homes into the wider framework of health and social care, ensure clear responsibilities for oversight over all congregated care facilities for older people at both regional and national level and arrangements for intervention and re-deployment of relevant staff across sectors in line with future pandemic planning”.
We make this recommendation because it is not at all clear to us who is ultimately responsible for clinical care in nursing homes and there are no HIQA standards with regard to the levels and skills of nursing care and with regard to clinical governance and the level of medical cover in many nursing homes. The significance of these points has been reinforced most graphically for us in recent days when Sage Advocacy had to send a fourth Notice of Concern to HIQA about the care of a resident in a nursing home. The person concerned had seriously infected (and possibly infested) wounds related to a medical condition and other evidence of neglect. We sought the intervention of the HSE who were able to pursue the issue because the person concerned was transferred to an acute hospital. However, neither HIQA or the HSE seemed able to effectively intervene in the nursing home to investigate such a situation and ensure that all other residents are safeguarded.
Sage Advocacy considers that some of the issues raised for nursing homes by Covid 19 can best be addressed as part of the planning for the six new health and social care regions to be established under Sláintecare and through the further development of housing policy. Regardless of any such developments in the short to medium term a series of specific actions is required and an implementation framework developed around them.