Left To Die: Nursing Home Timeline

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From top: a Dublin Nursing home; The Citywest emergency ICU facility; Taoiseach Leo Varadkar (centre) with HSE CEO Paul Reid (left) and Minister For Health at the Citywest opening; DrTony Holohan, Chief Medical Officer for the Department of Health and chairman of The National Public Health Emergency Team (NPHET); from left: Mr Reid with Dr Colm Henry (right) Chief Clinical Office, HSE arriving for a Covid 19 Committee meeting in Leinster House on June 6

There are approximately 440 private nursing homes and 120 HSE-run nursing homes in Ireland with around 30,000 residents.

More than 1,680 patients were approved for transfer from acute hospitals to private nursing homes in March (1,363) and April (324), the height of the pandemic.

This was as emergency ICU facilities and private wards secured by the government lay empty.

According to the most recent data, 943 people have died in nursing homes from Covid-19 with a further 5,371 who are Covid-19 positive.

This policy was replicated in seven European countries and five states in America, most notably New York, where before a u-turn, 4,300 recovering Covid-19 patients were sent to nursing homes in the state.

Below is a timeline of events as they pertain to residents of nursing homes in Ireland from the  the beginning of the virus until this week. Any additions or corrections will be made (just leave a comment).

February 19, 2020: The CEO of the HSE Paul Reid meets with representatives of nursing homes to discuss Covid-19 preparedness. On April 16, Minister for Health Simon Harris informs the Dáil that this meeting occurred and said:

“I am told by local HSE staff that there was an unprecedented level of engagement by individual HSE officials with nursing homes.

That is not to say in any manner or means that enough has been done. We need to do more.

This is a pandemic in which we take actions every single day. We then take another set of actions and then another set. That is what we are doing.”

In respect of the same February 19 meeting, CEO of the HSE Paul Reid told the Oirecachtas Covid-19 committee on May 19:

“Specifically, on the meeting with Nursing Homes Ireland, I would meet and discuss with Tadhg Daly on a reasonable basis throughout this whole process – in the pandemic over the last few weeks. There have been very good relationships between Nursing Homes Ireland and the HSE throughout this period.

“On the Deputy’s question of 19 February specifically, I can remember the meeting clearly. I have met a wide range of stakeholders since I took over the HSE. That was my first meeting with Nursing Homes Ireland. It was my first meeting with Tadhg Daly and its chairperson, Maurice Pratt. It was really geared towards an informal welcome and discussion…

“We had a brief discussion about how this may impact on Ireland. There was a very brief discussion between both of us. I would be doing it an injustice and indeed the HSE an injustice to say it was an in-depth discussion because we were just learning at the start of this – 19 February was very early stages.”

February 28: Chief Medical Officer Dr Tony Holohan confirms the first case of Covid-19 has been detected on the island of Ireland, involving a woman who travelled through Dublin Airport on her way home to Northern Ireland from northern Italy. She subsequently tested positive for the illness on returning home to Belfast.

February 29: The Health Protection Surveillance Centre confirms the first case of Covid-19 in the Republic of Ireland. The patient is a male in the east of the country.

It’s also reported that the first death of a Covid-19 patient had taken place in the US.

March 1: Scoil Chaitriona secondary school in Glasnevin, Dublin 9, closes for two weeks. Health officials do not publicly name the school but its identified on social media. It follows confirmation that a male student had Covid-19. He had been at an at-risk area in northern Italy.

March 2: Paul Cullen reports in The Irish Times that Covid-19 is especially worrying for elderly people with underlying health conditions.

He writes::

 “In the US, a serious outbreak near Seattle has occurred in a nursing home. Obviously, the risk of something similar happening in Ireland is a huge worry.”

He later added:

 “Nursing Homes Ireland, representing the owners of private nursing homes, has sought to reassure the public that its members have the experience to know what to do if the virus arrives, given their experience in dealing with seasonal flu and the vomiting bug. Some restrictions on visiting may be needed if the threat from the virus rises.”

March 6: It’s reported that visiting restrictions are being introduced in more than 400 private and voluntary nursing homes across Ireland. Nursing Homes Ireland says no non-essential visits by children or groups would be allowed.

March 9: The Government cancels all St Patrick’s Day parades.

March 10: The Department of Health’s Chief Medical Officer Dr Tony Holohan said blanket restrictions on visitors at nursing homes and some hospitals should be lifted as they were premature.

He said visitor restrictions at private nursing homes had a major impact on residents, for whom social interaction was a key part of wellbeing.

While restrictions might be necessary in a particular nursing home depending on circumstances, he said there was no case for across-the-board restrictions, saying: “We want to avoid introducing measures before they are really necessary.”

The National Public Health Emergency Team (NEPHT) announced in a statement that “socially restrictive actions” around hospitals and nursing homes were “not necessary at this moment in time”.

It’s reported that the annual St Patrick’s Day reception in Washington DC has been cancelled but that a meeting between the US President Donald Trump and Taoiseach Leo Varadkar will still take place.

On the same day, Nursing Homes Ireland writes to the Minister for Health Simon Harris and the letter is also sent to the chief executive of the HSE Paul Reid, and the Department of Business, Enterprise and Innovation.

In the letter, the NHI called on the Government to lift curbs on the recruitment of healthcare assistants from outside the EU and warned that older people’s health could be placed in danger if HSE poached nursing home staff following the lifting of public service recruitment restrictions.

March 11: A woman in the east of the country dies of Covid-19, the  first death to take place in Ireland.

The World Health Organisation says Covid-19 is a pandemic.

March 12: Speaking from Washington in the US, Taoiseach Leo Varadkar announces the closure of schools and significant public restrictions in Ireland until March 29 because of Covid-19.

Rose Hegarty, an 84-year-old resident of St Mary’s Hospital nursing home in the Phoenix Park, Dublin listens to Mr Varadkar’s speech from her bedroom.

March 16: Dr Tony Holohan says that restrictions will be imposed on visitors to nursing homes, hospitals and prisons.

March 17: During a St Patrick’s Day speech broadcast on RTÉ and Virgin Media One, under Section 122 of the Broadcast Act 2009, Taoiseach Leo Varadkar tells those listening and watching that the restrictions will likely go beyond March 29. He adds:

“We’re in the middle of a global and national emergency. A pandemic. The likes of which none of us have seen before. So far, the number of cases in Ireland has been relatively small. However we believe the number will rise to 15,000 cases or more by the end of the month and rise further in the weeks thereafter.”

He also says:

“At a certain point we will advise the elderly and people who have a long-term illness to stay at home for several weeks. We’re putting in place the systems to ensure that if you are one of them, you will have food, supplies and are checked on. We call it cocooning and it will save many lives, particularly the lives of the most vulnerable, the most precious in our society.”

It’s also reported that Nursing Homes Ireland is appealing for people within hospitality and retail to look for opportunities to care for older people. CEO of NHI Tadhg Daly is reported as saying:

“One considerable concern is to ensure a staffing complement is consistently available to meet the day-to-day social care needs of nursing home residents, especially at a time of emergency and with visitor restrictions.”

“Irish people have a tremendous ability to support one another during difficult times and this has never been more required.”

March 21: In a HSE memo from David Walsh, National Director of Community Operations, to the chief officers of community healthcare organisations, about revised guidance in relation to testing.

Mr Walsh tells his colleagues:

“Following confirmation of a Covid positive diagnosis within the unit/centre then it is assumed that all residents presenting with symptoms are Covid positive. Multiple re-referrals to NAS for potential Covid cases should be avoided.”

March 22: It’s reported that  40,000 people are waiting up to five days for Covid-19 tests. It’s also reported that “when asked about reports of a cluster of positive cases at a nursing home, the HSE said outbreaks of infectious diseases in nursing homes were not uncommon and staff were used to dealing with this issue. However, the scale and numbers would be extremely challenging.”

A cluster is defined as two laboratory-positive cases in an institution.

The report added: “The HSE has asked the media not to identify any nursing homes concerned.”

March 24: Taoiseach Leo Varadkar announces further restrictions until April 19.

March 25: The HSE’s Health Protection Surveillance Centre reports that there have been six outbreak clusters of Covid-19 in hospitals and four in nursing homes.

It’s also reported that 21 male residents of a nursing home in the Vosges in France, all aged in their 90s, are believed to have died of Covid-19. It’s feared as many as 100,000 nursing home residents could die of Covid-19.

March 26: Chief Medical Officer Dr Tony Holohan expresses concern about clusters of cases in healthcare settings such as hospitals and long-stay settings such as nursing homes.

March 27: In a report about the statistic that about 25 per cent of confirmed cases are health workers, at least four Covid-19 outbreaks have occurred in nursing homes and that nursing home operators, and others, are concerned about a lack of guidance and the availability of PPE.

Later, new figures show there have been nine Covid-19 clusters in nursing homes. Dr Holohan says the clusters are a significant concern for public health experts.

Taoiseach Leo Varadkar announces further restrictions for two weeks, until Easter Sunday on April 12, specifically that people must remain at home, with limited exceptions, and must remain within 2km of their homes when shopping for food or exercising. During his speech he mentions the increase of clusters in nursing home and residential care centres.

He also quotes from the movie The Terminator 2: Judgement Day when he says, “There is no fate but what we make for ourselves.”

March 28: CEO of Nursing Homes Ireland Tadhg Daly says the health system will “crumble” if the nursing home sector is not supported. Vicky McDwyer, managing director of Esker Lodge nursing home in Cavan tells The Irish Times:

“I would say we are in the trenches. The State needs to have our backs.”

March 29:  Statistics show there are Covid-19 outbreaks in 16 nursing homes in the east of the country, one in the north-east and a further three in residential-based institutions, two in the east and one in the west.

Minister for Health Simon Harris says the Government will introduce specific measures to stem the outbreak of Covid-19 in nursing homes. He also says he will meet representatives from Nursing Home Ireland on March 30 to hear their suggestions on how the Government can support the nursing homes, their residents and their staff.

He also says NPHET would consider measures for nursing homes when it meets on March 31.

CEO of the HSE Paul Reid announces that an isolation facility will be made available in City West Hotel providing 750 rooms and/or 1,100 beds. He announces there will also be 600 overflow beds for step-down care from hospitals.

March 30: New figures from the HSE’s Health Protection Surveillance Centre show there have been 22 Covid-19 outbreaks in nursing homes across Ireland – 20 in homes in the east of the country and two in the northeast.

The Government announces that it has brokered a deal with private hospitals to use their facilities to treat Covid-19 and non-Covid-19 patients. Minister for Health Simon Harris says the deal will lead to 17 per cent increase in capacity for the Irish health service.

March 31: In its nightly press release the Department of Health confirms that, as of midnight on Sunday, March 29, 22 per cent of Covid-19 clusters were located in ‘private houses’, 20 per cent in nursing homes and 18 per cent in hospitals.

The National Public Health Emergency Team also announces that it recommends, among other things, that “in response to infections in long-term residential care (nursing homes, disability and mental health) and homecare settings NPHET will work with the HSE to identify a number of measures which can be taken to strengthen support to staff and providers of nursing home care”.

Dr Holohan is also quoted as saying:

“The measures that we have recommended today should significantly enhance the preparedness and response to cases and outbreaks in nursing homes and other residential settings.”

Nursing Homes Ireland says the Minister for Health Simon Harris had committed to addressing PPE and staffing issues and to bring forward a package of financial supports for nursing homes before the end of the week.

April 1: Chief medical officer Dr Tony Holohan says NPHET wanted to interrupt the spread of the virus in institutional settings such as nursing homes and other residential accommodations, and hospitals, saying:

“The measures that we have recommended today should significantly enhance the preparedness and response to cases and outbreaks in nursing homes and other residential settings.”

Six policies aimed at keeping people in nursing homes and long-term residential care facilities include staff screening and prioritising for testing for Covid-19; transmission mitigation; the provision of personal protection equipment and oxygen; training; and preparedness plans for infection outbreaks.

Taoiseach Leo Varadkar, the Minister for Health Simon Harris and the CEO of the HSE Paul Reid hold a photocall in Citywest Hotel.

April 2: Following 24 Covid clusters detected in nursing homes, it’s announced that at least 750 home carers are to be redeployed to nursing homes.

It’s also announced that sick nursing home residents will no longer be sent to hospitals for treatment in order to prevent transmission of the disease.

Dr Colm Henry is quoted as saying that nursing homes would provide “as much care as possible” to those who were diagnosed with Covid-19.

He said:

“In the context of a pandemic and to break the chain of transmission our clear preference is to provide as much care as possible in that setting”.

In the Dáil, Fianna Fáil TD Stephen Donnelly says that almost 100 staff and residents in one nursing home have tested positive for Covid-19.

He says:

“Yesterday, I was told that in one nursing home 70 of its 200 staff have tested positive. At the time I received this information, I was also told that 19 of the 100 residents had tested positive and four had passed away. In addition, three of the home’s kitchen staff and several cleaning staff have gone.

“It does not know where it can get help, given that no agency staff are available. I imagine every Member in the House has been contacted with similar stories. The Minister will be aware of these cases. The situation is very serious.

“Nursing homes cannot get the staff they need, particularly in areas where additional skills, such as palliative care, are required. They cannot get their hands on personal protective equipment. They are receiving small amounts but that is not enough.

“I know the HSE is trying to deploy its staff to try to plug some of these gaps, but much more is needed. We support the decision to deploy vast sums of money to build capacity in our healthcare system.

“However, it does not seem right that we would spend all of that money getting our healthcare system right so that when people get sick they can be helped without making the same efforts and investments for vulnerable people, home care and nursing homes in order to stop people getting sick in the first place. There needs to be urgent movement on that.

“I would like to raise many more issues, but we are short of time. Perhaps the Minister and I could pick up the questions I have raised, which have come from nurses, doctors, scientists and families.

“Why are only 1,500 tests a day being done? Why are healthcare workers waiting so long for test results to allow them to get back to work? Why is Ireland running out of reagent when we have such a large chemical industry here?

“Why are clinicians still being told not to wear masks at work when many working in hospitals feel they should?

“Why is the modelling work on projected cases being withheld from the public? Why is it not being made public? Why are private consultants being brought into the HSE temporarily being paid more than some of the HSE consultants? Why is the HSE not able to say yet how many cases it feels it will be able to handle on a given day.”

Minister for Health Simon Harris leaves the Dáil chamber – to attend a briefing of all party and group leaders on Covid-19 – without answering any questions from deputies.

Fine Gael TD and Minister for Culture Josepha Madigan is left to conclude the debate but she also doesn’t answer any questions, saying that she had taken notes for Mr Harris, after berating opposition TDs for insisting that some members sit in the Dáil. She says:

“The members here today who have insisted on this Dáil sitting have shown a complete disregard for our national fight to contain Covid-19. Shame on you.

“They have forced us to stray from home rather than stay at home, which is completely contrary to public health guidelines and nothing to do with any public representative shirking his or her responsibilities.”

April 3: New figures from the HSE show the number of Covid-19 outbreaks in nursing homes has risen to 38 – 29 in the east, three in the midwest, three in the northeast, two in the west, and one in the Midlands.

The vast majority of clusters detected in nursing homes (29) are in the east; three each are in the midwest and northeast, two are in the west and one in the midlands, according to the epidemiological report from the executive.

Chief Medical Officer at the Department of Health Dr Tony Holohan says:

“We are concerned with the number of clusters identified in nursing homes. We have identified a range of measures, working with the HSE. We need to see continuous actions being taken to reduce the risk of transmission in nursing home and long-term residential facilities.”

April 4:  A staff member at St Mary’s Hospital nursing home in Dublin’s Phoenix Park raises serious concerns with senior management over access to PPE, saying they’re “gravely concerned”.

There are now 40 Covid-19 clusters in nursing homes.

Minister for Health Simon Harris announces €72million package of measures to help nursing homes respond to Covid-19. The minister also said that some of the restrictions on work, travel and education, could remain in place until a vaccine is found, which could take six to 12 months.

The Irish Times reports:

Mr Harris said agency staff, who move from nursing home to nursing home, presented a risk of spreading the virus.

As part of a temporary Covid-19 financial support scheme there will be a per head payment of up to €800 a patient a month for each person in a nursing home.

This will apply to the first 40 residents. The figure for the next 40 residents will be €400 per month and it will be €200 per resident per month thereafter.

In addition to this, any nursing home that has an outbreak of Covid-19 will be able to apply for financial assistance of up to €75,000 a month for the months of April, May and June.

This money will be provided when a nursing home has incurred significant costs arising directly from a Covid-19 outbreak as certified by the HSE.

The costs involved will have to be independently certified by an auditor.

Mr Harris said there was an “urgent need for a focused and targeted response” to the number of Covid-19 cases in nursing homes.

“The nursing home sector cares for one of the most precious and vulnerable groups in our society,” he said. “We must do everything we can to support them to help break the transmission of the virus.”

“We must also support staff working in nursing homes and ensure their safety and health as we continue to deal with this pandemic. “It is vital we leave nobody behind as we navigate our way out of this pandemic.”

Dr Holohan says:

“We need to see continuous actions being taken to reduce the risk of transmission in nursing home and long-term residential facilities.”

April 5: The number of Covid-19 outbreaks in nursing homes rises to 50.

It’s reported that, on March 25, the HSE advised nursing homes to manage Covid-19 positive residents in their own facilities.

The note said:

“In general, residents in residential care who are coronavirus, also known as Covid19-positive, should be managed in their facilities.

“Transfer to hospital is only appropriate where this will confer additional benefit.”

April 6: Number of Covid-19 outbreaks in nursing homes rises to 57 – 41 in the east.

April 8: CEO of Nursing Homes Ireland Tadhg Daly tells RTÉ’s Seán O’Rourke that the €72million nursing homes support package previously announced by the Minister for Health “hasn’t materialised to the level that we would expect”.

It’s also announced that, as of Sunday, April 5, there were 86 Covid-19 outbreaks at nursing homes.

Mr Daly also says:

“The numbers are rising but we’ve known from the outset that Covid was always going to attack the weakest. But I suppose what we’re confident of is with the right supports given the dedicated and professional staff in the nursing home sector, we’re well able to cope with this.

“I think we need to be conscious here that a cluster is two or more but also the nursing home sector has stepped up. The majority of people with Covid at this point in time are being cared for and being cared for very well I would suggest in the nursing home sector.”

April 9: Number of Covid-19 outbreaks in nursing homes rises to 100.

Figures show nursing homes represent a third of the clusters of infection across the country, followed by hospitals which account for 16 per cent, or 48 clusters.

The results of a Nursing Homes Ireland survey finds 74 homes – or 44 per cent of the 167 homes that took part in the survey – had waited 10 days or more for residents to get their Covid-19 test results.

It also found 61 homes had lost 114 senior nurses in total due to staff shortages as a result of having been infected with Covid or having to self-isolate because of exposure to Covid. A total of 113 homes had lost 278 nurses in total.

Fianna Fáil leader Micheál Martin claims more than 50,000 people are waiting to be tested for Covid-19.

HIQA chief inspector Mary Dunnion tells the Department of Health, in a risk assessment, that 124 public and private nursing homes, 23 per cent of the 580 homes in Ireland, were “at risk” and may need additional HSE support.

Ms Dunnion wrote:

“However, the lack of direct relationship of the HSE with the private sector has highlighted a challenge to effectively project the specific needs of nursing homes during the Covid-19 outbreak.”

This risk assessment warning becomes public knowledge on June 9, after Ms Dunnion’s document is provided to the Oireachtas Covid-19 committee.

April 11: New figures show that 54 per cent of Covid-19 deaths have taken place in nursing homes.

April 12: Dr Tom Ryan, an intensive care specialist at James’ Street Hospital in Dublin, was interviewed on RTÉ and was asked about reports that hospital ICU facilities were not keen to accept patients from nursing homes.

In response, he said most doctors were reluctant to refer nursing home patients to ICU. He said ICU teams were also reluctant to take “futile” cases and this had been the ethos of medical teams for 20 to 25 years.

April 13: Martin Cormican, professor of bacteriology at NUI Galway and HSE clinical lead on healthcare-associated infection and antimicrobial resistance, is reported as saying:

“What strikes me is control of an infection once it gets into a nursing home is very difficult. It’s a congregated setting in most incidents and by their nature they are places with people who need a lot of care and are very dependent.”

And…

“There does need to be accommodation for essential visiting for relatives approaching the end of life. There has to be some degree of exception.”

April 14: Number of Covid-19 outbreaks in nursing homes rises to 149. This figure represents one-third of Covid-19 clusters in Ireland.

Dr Tony Holohan says:

“We remain concerned about the prevalence of COVID-19 in nursing homes and residential care settings.”

Nursing Home Ireland CEO Tadgh Daly says only 75 per cent of nursing homes are struggling to get the PPE they need. Mr Daly also says a backlog in testing is “exceptionally challenging” for nursing homes.

In an opinion piece in The Irish Times, Fintan O’Toole, writes:

“When we think of the “front line” in this struggle, we think of hospitals and intensive care units, of doctors and nurses. And so we should: these are our saviours. But there’s another front line.

“It lies in a sector of our society that has historically been neglected: the places where we house elderly people and people with severe disabilities. The hospitals and ICUs have, in this crisis, a kind of dark glamour – they radiate a desperate heroism. But nursing homes don’t.”

April 15: Figures show 167 people in nursing homes have, to date, died after contracting Covid-19.

The HSE and trade unions agree a deal to allow existing HSE staff to be re-deployed on a voluntary basis to work in private nursing homes affected by Covid-19.

RTE reports that nine residents in the Maryborough Centre, St Fintan’s Hospital, Portlaoise, Co Laois, died over the Easter bank holiday weekend.

April 16: The number of outbreaks in nursing homes rises to 155.

Mary Dunnion, HIQA’s chief inspector of social services, tells RTÉ’s Morning Ireland that almost one-third of nursing homes in Ireland have Covid-19. Ms Dunnion says staffing is a real issue for nursing homes and faster testing would help.

Prof Jack Lambert, professor of infectious diseases at the Mater and Rotunda hospitals, tells RTÉ’s Today with Seán O’Rourke that Covid-19 in nursing homes is “a catastrophe in the making”.

It’s reported that Dublin Coroner Dr Myra Cullinane has said not all Covid-19 deaths are being reported as required by law and that she has written to medical staff who complete death certificates saying they must comply with the requirement to report “any death in the context proven or suspected” Covid-19.

The Irish Times appeals for nursing home residents and/or staff members to tell the newspaper of their concerns via an online form.

Fianna Fáil leader Micheál Martin tells the Dáil:

“We all know that nursing homes are now at the forefront of the spread of the virus and a large number of virus-linked deaths. Today, we will seek greater clarity on a number of essential points.

“Unfortunately, I must report to the House that I know of a case in which relatives of a person in a nursing home have been informed the nursing home has been told by the Department that it should not give out information about the number of cases in the home.

“This information will come out anyway and it would be much better to help the nursing homes through showing them how to communicate information and the reassurances families need that their loved ones are being protected as much as possible.”

Sinn Féin TD Pearse Doherty tells the Dáil:

“I welcome the deal that has been struck between the HSE and the trade unions so that health staff can be redeployed to deal with the spread of Covid-19 in nursing homes. That is important.

“Despite that, however, the fact is that there is a massive crisis in the nursing home and care home sector. We are told that 200 clusters have been identified in nursing homes and residential institutions and that 245 people have died in care homes. That is over half the deaths in the State as a result of Covid-19 so far.

Some nine people died in Maryborough Centre for psychiatry in Portlaoise at the weekend alone. We can all agree that it is absolutely shocking to see those figures in that centre. Our thoughts are with all of the bereaved families at this time.

“However, the most regrettable thing about all of this is that the crisis in the residential care setting could have been foreseen.

In fairness, Nursing Homes Ireland foresaw some of this. That body introduced visitor restrictions to nursing homes off its own bat on 4 March, but let us remember that in doing so it was criticised by the Department of Health for moving too fast.

It was not until ten days later that the Department of Health gave its approval for such measures. It is fair to say that this has proved to be a monumental error and a fatal one for many of our most vulnerable citizens.

“Nursing Homes Ireland has stated publicly that it made numerous requests for a meeting with the Minister for Health and his officials in the early days of this crisis, but such a meeting was not forthcoming. I would be glad to hear what the Minister has to say on this.”

Taoiseach Leo Varadkar tells the Dáil:

“The latest figures show that just under 70% of deaths are occurring in hospitals, and around 30% or 35% in the community. However, many people move from nursing homes to hospitals when they get sick and subsequently die there.

“…As the Deputy pointed out, our nursing homes are a mix of public, private, and voluntary. We have trouble in both the public ones and the private ones. I have seen no evidence as of yet that cases are more common in private homes over public ones or vice versa, or that the death rate is higher or lower in either.

“We need to be careful and responsible in our remarks on this issue because there are people in care homes and nursing homes who are really worried now. They are terrified about getting this virus, their relatives are terrified for them, and we need to be responsible in our commentary around this issue.

“People in nursing homes and long-term care homes are doing the best they can, but even with copious PPE, good staffing levels and doing all the right things, once a virus gets into such a setting it is very difficult to contain it.”

April 17: Minister for Health Simon Harris tells RTÉ’s Morning Ireland that 18 Covid-19 response teams, including doctors and nurses, will be deployed to nursing homes.

Latest figures show there 163 Covid-19 outbreaks and 253 deaths in nursing homes in Ireland.

It’s announced 30,000 nursing home staff and 28,000 residents will be tested over the next 7-10 days.

April 18: The Irish Times reports:

A number of families with relatives in nursing homes have told The Irish Times they have been advised their loved ones will not be transferred to hospital if they contract Covid-19.

The National Public Health Emergency Team (NPHET) has denied such a blanket policy is in place, though they say the default is to treat patients in their nursing homes unless a transfer to hospital is clinically indicated.

The HSE has advised nursing homes to manage the disease in their own facilities and only transfer residents to hospitals where this would “confer additional benefit”.

One family told The Irish Times their nursing home, citing HSE “guidelines”, told them residents should not be sent for resuscitation in relation to Covid-19. NPHET have said no such guidelines are in place.

April 19: In France, the total number of Covid-19-related deaths reaches 19,323 – more than a third of the total have taken place in nursing homes.

CEO of the HSE Paul Reid says it has tested 4,000 nursing home healthcare workers and residents over the previous weekend. There have been 248 separate suspected outbreaks in nursing homes.

HSE national clinical adviser Dr Colm Henry says the situation in Irish nursing homes is not unique to Ireland.

April 20: Prof Sean Kennelly, of Tallaght University Hospital, says everyone in residential nursing homes, including staff, should be tested for Covid-19.

Figures show 1,204 Covid-19 cases have occurred in nursing homes. They also show nursing homes account for 337 deaths, including 61 probably or suspected deaths.

It emerges that 15 patients have died from Covid-19 in St Mary’s Hospital in Phoenix Park since April 2. The hospital is run by the HSE and provides care to 198 older people.

April 21: It’s reported that one in five residents of nursing and other care homes believed to have died of Covid-19 were never tested for Covid-19. New figures from the National Public Health Emergency Team (NPHET) show nursing homes and other long-term facilities account for almost 60 per cent of Covid-19 deaths.

Seven of 13 residents at the Millbury private nursing home on Commons Road, Navan, who caught Covid-19, are reported to have died.

Minister for Health meets representatives from Nursing Home Ireland. It’s reported there are more than 250 nursing homes which have Covid-19 clusters while 60 per cent of nursing homes do not have Covid-19.

April 23: New figures show there have been 191 Covid-19 clusters in nursing homes, while there have been 2,231 confirmed cases in nursing homes.

Nursing Homes Ireland says 96 per cent of nursing homes (227 of 236 who responded to a survey) said they had not received staffing support from the HSE to deal with Covid-19.

April 24: New figures show there are now 198 clusters, and 2,500 cases, in nursing homes in Ireland.

It also emerges that 48.1 per cent of probable and confirmed Covid-19 deaths in Ireland – 488 out of 1,014 – were nursing home residents.

At a government press conference, in which he was accompanied by Minister for Children Katherine Zappone and Minister for Health Simon Harris, Taoiseach Leo Varadkar says that it has been difficult to implement supports pledged to the nursing home sector to deal with Covid-19.

April 25: It emerges that a further ten people have died of Covid-19 at St Mary’s Hospital in Phoenix Park.

David Aikman, from bray in Co Wicklow, writes in a letter to The Irish Times:

I live in a very well-run nursing home. The management has taken very firm steps to prevent any resident catching coronavirus.

Unfortunately, even after the lockdown, one resident contracted the virus.

All of a sudden, and without any warning, the HSE sent a small team to the home and said they wanted to test all the residents.

We are compliant and dutifully went back to our rooms and received the swabs. But the team implementing the tests completely failed to test any of the care staff in the nursing home.

When I and some of the care staff asked why the team doing the testing was not testing the care staff at the same time, the answer was, “It will be done in a few days.”

What that means is that if even one of the care staff tests positive, even though being asymptomatic, all the residents will have to be tested a second time.

This surely doesn’t make any sense at all.

Why would you not test the current staff, at least those are on duty that day, at the same time as you test the residents?

The testing process is not very pleasant, especially for us older people, when the swab is inserted high up the nose. Many residents were quite uncomfortable.

All 93 of us will surely be very uncomfortable again if they have to repeat the process in a few days.

What is the rationale, or the explanation, for the failure to test the care staff at the same time as the residents?

April 26: A member of the public, whose partner’s mother tested positive for Covid-19 in a nursing home, emails Taoiseach Leo Varadkar saying they were unable to get information from management at the nursing home; that the woman had had a fall; and her “hourly bed checks” were two hours apart because of staff shortages.

The woman wrote to the Taoiseach: “This, we were told, was because there was one nurse managing two floors of 38 patients on each. One nurse caring for 76 patients.”

This emerged on June 18 after The Irish Times obtained documents under the Freedom of Information Act.

April 27: New figures show there are now Covid-19 clusters in 211 nursing homes.

April 28: Jane Carrigan, from Dublin 11, writes in a letter to The Irish Times:

“From her private bedroom in St Mary’s Hospital, Phoenix Park, my aunt watched the news and read the papers.

At the beginning of March, she decided to stop going to dinner in the communal dining room and instead had food brought to her room. She kept a hand sanitiser by her bed.

She listened to Leo Varadkar’s announcement on March 12th.

On March 17th, she waved at family members through her ground-floor window for the last time. Restricted physical mobility was not new to her and the phone and the post became her communication with the outside world.

On March 29th, the nursing home rang us to tell us there was a case of Covid-19 in the facility.

The next day, she rang to let us know that fact too.

On April 19th, my aunt began displaying symptoms.

On April 25th, we learned her test result came back positive.

My wonderful aunt, Mrs Rose Hegarty, died on April 27th, 2020.

Each sentence tells a story. I hope we get to hear the full one.”

New figures from NPHET show just a sixth of nursing home residents who died with Covid-19, died in an acute hospital.

April 30: It’s reported that, according to figures released to Fianna Fáil, 400 hospital patients were released into nursing homes during the early stages of the Covid19 emergency but only those who had Covid-19 symptoms were tested.

Taoiseach Leo Varadkar tells the Dáil:

“On the issue of the capacity in hospitals, our private hospitals are 33% occupied, our public hospitals approximately 80% occupied, our intensive care units, ICUs, approximately half-occupied and Citywest largely unoccupied.

“That is not necessarily bad. The reason that is the case is because we wanted to be prepared to make sure that our hospitals and ICUs were not overwhelmed the way those in other countries were. It is good that we had such spare capacity. We may need it yet. This could yet go wrong.”

May 5: New figures show there have been 229 Covid-19 clusters and 4,108 Covid-19 cases in nursing homes.

The number of Covid-19-related deaths in nursing homes reaches 706 deaths, or almost 53 per cent of total deaths.

Figures also show that 83 per cent of nursing home Covid cases recover from the virus, while the death rate among elderly nursing home residents is more than three times the death rate among the general population.

Dr Colm Henry, chief clinical officer of the HSE, says the mass testing of nursing home residents and staff is 91 per cent complete.

Also in the Dáil, RISE TD Paul Murphy speaks of the private hospital deal that the Government brokered in March. He says:

“I want to ask the Minister about the cost of the private hospitals. The Taoiseach confirmed to me two weeks ago an estimated cost of €115 million per month for the leasing of the private hospitals. I then later asked the Minister for Finance why we are paying more than four times as much per bed as they are in the UK, which he was not able to answer.

“I then wrote to the Minister for Finance, copying to the Minister for Health, seeking the publication of the final agreements with the individual hospitals, a detailed breakdown of the €90.2 million which has been already given to the private hospitals and asking him again to explain the discrepancy between the €44,000 paid per bed in Ireland and the €10,000 paid per bed in Britain.

“I will give one example as to why we need to see these figures. The Beacon Medical Group was bought by Mr. Denis O’Brien for €35 million, according to The Irish Times. If they get €44,000 a month for 200 beds, the State will have paid more than €35 million in four months but will not own a bed at the end of that process.

“Can we get the full final agreements? Can we get a breakdown of the costs so that we can see if there is profiteering going on?”

In his response, Minister Harris tells Mr Murphy:

“I want to be clear that nobody is meant to be profiteering as a result of this. The whole purpose here is to ensure that nobody can make a profit and we pay solely according to the cost-only open-book model. We were in a very lucky position to be able to acquire the use of these facilities. Thank God we have not needed to use their ICU capacities yet.”

May 7: Catherine Fegan, in The Irish Independent, reports that a Dublin HSE nursing home whistleblower has sent a 35-page protected disclosure to Minister for Health Simon Harris and CEO of the HSE Paul Reid over the facility’s response to Covid-19.

In a statement to the Irish Independent, the man, who is suffering from Covid-19 himself, says he first raised his concerns with his managers in mid-March.

Sinn Féin TD Ruairi Ó Murchú tells the Dáil:

“I want to deal with the tragic situation at Dealgan House Nursing Home in County Louth, about which I have written to the Minister. Staff in Dealgan House have at times been working in nightmare conditions and continue to do their very best to care for the residents, some of whom they see as family, and I want to pay tribute to them.

“According to figures that have been shown to me in the last few days, 26 people have died in this nursing home and they are believed to have died from Covid-19. These are mothers, fathers, siblings and grandparents. Unlike other nursing homes that have featured in the media, I have not seen official figures for the number that have died in Dealgan House. This is a feature of the lack of communication that has surrounded this issue, which has added to the worry and trauma.

“It is almost three weeks since red flags were raised with me in regard to Dealgan House. Families, some of whom have lost loved ones, have come to me or contacted me about their worries. Nursing staff, care assistants and ancillary staff have also come to me. I want to thank every one of them for having the fortitude and the bravery to speak out and, today, I am looking to speak for them.

“Operational control of Dealgan House was taken over by the RCSI hospitals group on 17 April. In a statement to the media, the RCSI said it would review its involvement at the end of May. Since the start of last week, I have been told by staff at Dealgan House that there will be no more RCSI staff by this coming weekend. I have been told that senior management and disease control specialists from the RCSI are already gone.

“I have repeatedly asked the hospitals group for clarity on this point and while it says it remains in control at Dealgan House, it will not say for how long and, crucially, has not outlined when and under what conditions the RCSI will hand back operational control to the owners of the nursing home.

“I would like the Minister to address this directly. Staff, residents and families are desperate for answers about the RCSI plans at Dealgan House and I hope the Minister will be able to provide information about the future role of the RCSI at this home. I also seek answers as to how the situation in Dealgan House came about.

“I have been informed that, as early as 7 April, the owners of Dealgan House were in contact with the HSE and they discussed the developing and worsening situation at the home. Is the Minister aware of these contacts? Does he know why it was not until ten days later that the RCSI hospitals group took control? Why and by whom was the decision taken?”

In his response, Minister for Health Simon Harris said:

“I extend my sincere sympathy to the families, friends and staff in Dealgan nursing home, which he referenced. I will have to liaise with the HSE on the specific question on the RCSI’s involvement. I know it has been playing a proactive role.

“The Deputy wants an assurance that the role will continue. I will revert to him directly or through the HSE on this in the coming days. To anybody who has any concern about any long-term residential care facility, I point out that HIQA is there as a regulator.”

In the Dáil, while speaking about Citywest, Taoiseach Leo Varadkar says:

“On the issue of people who need to be isolated, Citywest is available and people have been isolated there. There is capacity at the site and also a possibility of isolating people in hotels if necessary. I do not have exact figures in front of me.”

May 8: Managing director of Dealgan House Nursing Home in Dundalk, Co Louth Eoin Farelly confirms that 23 residents of the home have died since April and that many of them were Covid-19 related.

New figures also show there are now 238 Covid-19 clusters in nursing homes, and 4,393 Covid-19 cases in nursing homes.

May 9: It emerges that Dealgan House limited residents to one visitor per day, after Nursing Homes Ireland advised nursing home operators to ban visitors on March 6. Dealgan House did not impose a full ban on March 13.

May 10: CEO of the HSE Paul Reid tells journalists that the HSE had finished the mass testing of 28,000 nursing home residents and 30,000 nursing home staff in the country’s 577 nursing homes.

HSE chief operations officer Anne O’Connor tells journalists that “confirmed or suspected outbreaks” of the virus had been found in 371 nursing homes, or 64 per cent of the country’s nursing homes – far higher than previously thought.

Health Information and Quality Authority speaks about the loneliness of some nursing home residents and urges the Government to discuss and consider a plan to reopen nursing homes. HIQA’s deputy chief inspector Susan Cliffe is quoted as saying: “It is time to start the conversation; we are not saying that it is happening today or tomorrow.”

The Irish Times also reports that there have been postmortem examinations carried out on the remains of just five people who died from Covid-19.

May 11: The number of Covid-19-related deaths in nursing homes reaches 798.

Nursing Homes Ireland says same-day testing and visitor restrictions could allow nursing homes to reopen to visitors.

Dr Tony Holohan says the recent mass testing of nursing homes has shown the transmission rate of Covid-19 in nursing homes has slowed.

May 12: HSE appoints independent investigator to examine claims made by a healthcare worker regarding St Mary’s Hospital in Phoenix Park, Dublin, where 24 people died with Covid-19.

The move follows a staff member making a protected disclosure to the HSE, Department of Health, and HIQA.

Dr Tony Holohan says 815 nursing home residents have died with Covid-19.

It also emerges that, while between 750 and 1,000 carers were to transferred to nursing homes, fewer than 150 carers have been redeployed since an agreement in early April between the HSE and Home and Community Care Ireland.

May 14: New figures show 818 nursing home residents have died of Covid-19. This is almost 55 per cent of the total number of fatalities, 1,497.

May 19: New figures show there have been 849 Covid-19-related deaths in nursing homes, accounting for 54 per cent of the total number of deaths, and 258 Covid-19 clusters in nursing homes.

Dr Tony Holohan tells journalists: “No country introduced [nursing home] visitor restrictions more quickly that we did, relative to when it had its first case of infection.”

May 20: HIQA says it will carry out an inspection of Dealgan House to determine the standards of care and support provided to residents. HIQA will also review the nursing records of residents and those who had died.

In a written response to a question from Sinn Féin TD Louise O’Reilly, about the breakdown of the use of private hospitals and the bed occupancy of the same to date, Minister Harris outlines the following:

Aut Even 21%
Beacon Clinic 36%
Blackrock Clinic 39%
Bons Cork 66%
Bons Dublin 34%
Bons Galway 39%
Bons Limerick 1%
Bons Tralee 83%
Galway Clinic 16%
Hermitage Clinic 60%
Kingsbridge 0%
Mater Private Cork 42%
Mater Private Dublin 48%
Santry Sports Clinic 7%
St Francis Hospital 0%
St Vincents Private 80%
UPMC Kildare 71%
UPMC Whitfield 40%
Grand Total 43%

May 21: Jane Carrigan, whose 84-year-old aunt Rose Hegarty died in St Mary’s Hospital nursing home in Dublin’s Phoenix Park on April 27, calls for a statutory inquiry into the State’s response to Covid-19 in long-term residential facilities.

Minister for Health Simon Harris announces that he will establish a four-person nursing home expert panel. He tells the Dáil:

“We must continue to plan appropriately to meet the ongoing challenges of Covid-19 into the foreseeable future. It is not just about getting on top of the nursing home situation today, although there has been good progress in that regard. It must be about ensuring we maintain that vigilance.

“Today, I announce the establishment of a Covid-19 nursing home expert panel to examine and advise on these matters. It is a crucial aspect of good planning and a recommendation of the National Public Health Emergency Team, NPHET.

“It will support Ireland’s navigation through the Covid-19 landscape and ensure the best possible safeguards are in place to protect the many people who call nursing homes their home.

“The panel will have four members, a public health expert who will chair the group, a geriatrician, a senior nurse and a public interest representative. I expect the group to do its work by the end of June such that we can share it with the House as we prepare for the weeks and months ahead.”

May 23: It’s reported that, in 2018, HIQA checked 215 nursing homes to see if infection prevention and control rules were being met and it found 39 of those 215 were not following rules under regulation 27 of the Health Act 2007.

It’s announced the expert panel will be chaired by Professor Cecily Kelleher, principal of the college of health and agricultural sciences at UCD. The other members are Professor Cillian Twomey, a retired geriatrician; Petrina Donnelly, group director of nursing at the RCSI Hospital Group; and Bridget Doherty, who will represent the public interest.

May 25: The Irish Times reports that more than 1,400 nursing home healthcare workers were infected with Covid-19 while working in facilities where clusters of Covid-19 were found.

May 26: Tadhg Daly, CEO of Nursing Homes Ireland, appears before the Special Committee on Covid-19 Response.

During the committee meeting, Fine Gael TD Fergus O’Dowd raised with CEO of Nursing Homes Ireland Tadhg Daly the millions of euro in profits made by nursing homes; and how, he said, just 123 of 581 nursing homes were fully compliant with HIQA.

Initially, Mr O’Dowd went through a timeline of correspondence and contact between the NHI and the Department of Health during the coronavirus crisis, including a conference call Mr O’Dowd claimed took place with the Minister for Health Simon Harris on March 19.

Mr Daly said he didn’t believe such a conference call with the minister took place. He said the first meeting with the minister took place on March 30. Mr O’Dowd said his information is that the conference call with the minister did take place on March 19.

Mr O’Dowd told the committee that the correspondence shows that “nobody from NPHET asked Nursing Home Ireland not to tell families where the cases or clusters were”, a claim previously reported on the front page of the Business Post.

The Fine Gael TD said:

“The key point I’m making to you is your statement that ‘key State organisations left the nursing home sector and its residents isolated’ is patently and obviously untrue.”

He added:

“You’ve 12 directors, all businessmen and businesswomen. I looked at their accounts and there’s some very wealthy companies represented among your directors who are very fine people in every respect. €23.3million was a profit in the last accounting year for eight of those directors and for the other directors, I can’t get the accounts because they’re a part of other companies.

“So would it be fair to say that the nursing home sector is a privately funded organisation and has a lot of money for buying things like PPE for doing test, for paying for staff accommodation, for paying for extra staff in this crisis?”

Mr Daly said: “Yes, absolutely…”

Asked later what funds NHI spend additionally to the normal nursing homes funds to get PPE, to pay for testing and extra staff, Mr Daly said:

“It runs into the millions and I can get those figures for you.”

Mr O’Dowd argued:

“You were recompensed… and I’m not saying that’s not a bad thing. You got the money back that you spent. That’s the point I’m making. To say that you were left isolated is not a fact.”

He added:

“In the last public report on your nursing homes, how many of them were compliant fully with HIQA regulations? Of the 581 homes, how many were fully compliant?”

Mr Daly said he didn’t know.

Mr O’Dowd said:

“Well I have…the fact is that 123 only, of the 581 nursing homes, public, private, not-for-profit, were fully compliant. And of those, governance and management, there was a failure under that governance and management regulation of 32%. Residents rights failure of 23% non-compliance. Risk management 22%. And infection control 18%.”

At the end of his contribution, Mr O’Dowd referenced an article in The Guardian about Hong Kong, saying:

“The point is you are making the point that the State, or the HSE or the minister or department didn’t assist you: I believe that you did and I believe you could have done a lot more for yourself and you didn’t do that.

“…. I am going to say this as loud as I can. And it is exceptionally clear and it is something that I say all my life. That the care of old people, older people in nursing homes is not acceptable. That the nursing home private sector is not compliant in the main, right across. That they are very wealthy companies who complain that the taxpayer isn’t doing enough for them.

“I want to say exceptionally clearly that we need a total change in the way the care of older people is looked at….We’ve to stop this game of blaming everybody and to accept the facts: the facts are that we’re not doing enough. We’ve never done enough and unless things change now, we’re going to go down the same road…

“…In Hong Kong, there is no death certificate in all of Hong Kong for one person from a nursing home who had Covid-19 because nobody died there. Nobody died there. And I just get so angry at this.

“And I think, sorry Mr Chairman, I’ve 14 seconds left. Let me say that I think that we need to move forward together but we must establish the facts and the truth is the truth and the truth will out. We have to change absolutely, radically, everything to do with older people.”

HIQA CEO Phelim Quinn tells the committee:

“Currently, 80% of nursing homes are operated by private providers. Although funded through the nursing homes support scheme, the HSE did not know this sector. As a consequence, the infrastructure required by the HSE to support the private sector was under-resourced and became increasingly challenged.

“In addition, the current model of private residential care for older persons has no formal clinical governance links with the HSE. Importantly, this means there is no national clinical oversight of the care being delivered to some of our most vulnerable citizens.

“Many nursing homes and disability centres were adequately prepared and managed to contain Covid-19 outbreaks. However, the private nursing home sector faced unique challenges. For example: timely testing and results; access to sustainable levels of PPE, oxygen and subcutaneous fluids; and baseline staff numbers, including senior nursing expertise in infection prevention and control.”

It also emerges that some nursing homes used painters’ overalls and supplies of PPE from local schools and vets in their response to Covid-19, as hundreds of pages of correspondence between the Department of Health and nursing home organisations are released.

HIQA’s chief inspector of social services Mary Dunnion tells Social Democrat TD Roisin Shortall that:

“At the onset of this particular pandemic, we identified premises that would be challenged in the context of managing Covid-19 outbreaks. Our findings would have been communicated to the Department of Health and the HSE. We are talking about February and March.”

“…We took a look at particular types of nursing homes that would have been at risk in the event of a Covid-19 outbreak. We would have determined these to be single, stand-alone providers and limited companies, as well as those with regulatory non-compliance not only with infection control but with governance and management, risk management and staff training.”

Asked about the response it received, Ms Dunnion told Ms Shortall that HIQA received an acknowledgement from the Department of Health.

Dr Tony Holohan, while speaking about nursing homes and the growing public discussion about the same, tells journalists that Ireland needs to move away from the “language of blame” around Covid-19 deaths.

Dr Holohan also says NPHET is looking at easing restrictions around visits to nursing homes.

May 30: The Catholic Church calls for an inquiry into the impact of Covid-19 on nursing homes in Ireland.

June 5: It’s announced that nursing home visits will be able to resume from June 15, under certain conditions – namely that visits will be limited to two named visitors per resident; visitors must undergo temperatures checks; visits will be limited to daytime visits of less than 30 minutes; each visitor will only be allowed a maximum of one visit per week; and children aged under 16 are not allowed to visit.

Figures show there have been 927 Covid-related deaths at nursing homes. This represents 55 per cent of the total number of deaths.

Taoiseach Leo Varadkar, while addressing the nation, ends his speech with a quote from the movie Lord of The Rings, when he says:

“In the end, it’s only a passing thing, this shadow. Even darkness must pass. A new day will come and when the sun shines, it’ll shine out all the clearer.”

June 8: Records released to The Irish Times under the Freedom of Information Act show 280 complaints about nursing homes were made to HIQA during the March and April.

One new Covid-19 cluster is identified in a nursing home.

June 10:  The Irish Times appeals for healthcare workers to get in contact about their experiences with supplies of PPE.

June 11: In a submission to the nursing home expert panel, Sage Advocacy asks the Minister for Health to investigate claims of neglect involving a nursing home resident with “seriously infected and possibly infested wounds” and “the adequacy of response by statutory agencies”.

In its submission, the group argued that it isn’t clear who is responsible for clinical care in nursing homes.

World Health Organization’s special envoy Dr David Nabarro, via video link from Geneva, addresses the Oireachtas Covid-19 committee.

Fianna Fáil TD Mary Butler tells Dr Nabarro that, as of June 10, 1,695 people had lost their lives in Ireland as a result of Covid-19 and that 62% of these deaths occurred in nursing home and residential care settings. Ms Butler asks if this is a high percentage compared with other countries.

He replies:

“Internationally, the figure for fatalities in residential care for older people is approximately 25%. To break it down country by country, in Switzerland that figure is 53%, in Sweden it is 49% and in Scotland it is 46%.

“Ireland is certainly at the upper end of the spectrum in that regard. I do not have the figure for Spain in front of me. The figure in Ireland is quite high but it is not unexpected.”

He later adds:

“Ireland has probably got the widest circle of inclusion of all the countries that I have studied, which may be one of the reasons there is a relatively high rate of deaths in nursing homes associated with Covid in Ireland compared with some other countries.

“As far as I can tell from the analysis that I have done, Ireland moved pretty quickly on a number of issues particularly trying to get personal protective equipment, PPE, in its various forms, to the staff in nursing homes and restricting visitation in nursing homes, recognising that visitors were a primary way of bringing in the virus.

“Ireland, possibly, might have been one of the faster countries to introduce this. At the moment I am not thinking that there is something that Ireland has not done. I just think that one, we have got a very honest counting of numbers and two, as with every country, this has been quite a struggle but it seems that Ireland did pretty well.”

June 12: Dr Tony Holohan tells RTÉ’s Morning Ireland that people may be able to visit their relatives in nursing homes from next week.

June 13: New HSE figures show just under 100 Covid-19 cases were detected in 25 nursing homes during the two weeks before June 9.

June 15: Relatives of nursing home residents resume visits under certain conditions. Residents will be limited to two named visitors and visitors must undergo temperature checks before visiting.

New figures show there are now 5,371 Covid-19 cases in nursing homes while the number of people who have died at nursing homes reaches 943.

June 16: The Irish Times reports that up to 2,300 patients were approved for transfer from acute hospitals to nursing homes in February and March.

June 17: RTÉ reports new HSE figures show more than 1,680 patients were approved for transfer from acute hospitals to private nursing homes in March (1,363) and April (324).

It’s not known how many people took up the offer and an audit is under way to find out this figure.

The patients were approved by the HSE under transitional care funding, for the Fair Deal Scheme, or for convalescence.

The figures were provided in a written answer to the Special Committee on Covid-19 Response.

RTE also reports that, between January and May, 4,073 patients were approved for transfer from acute hospitals to private nursing homes – 1,118 in January; 980 in February; 1,363 in March; 324 in April; and 288 in May.

In the Dáil, Social Democrat TD Roisin Shorthall tells Minister for Health Simon Harris:

“We are coming to the end of a very expensive deal with private hospitals. In recent weeks, I urged the Minister to ensure that all of that additional capacity was used to make progress with the public hospital waiting lists because we are paying very dearly for that extra capacity.

“The other area of extra capacity is in Citywest, where we are paying €25 million for a 1,000-bed facility which is being completely underused.”

June 18: Representatives of the Department of Health and HSE appear before the Special Committee on Covid-19 Response, including secretary general of the department Jim Breslin; CEO of the HSE Paul Reid; chief clinical officer Dr Colm Henry and national director of community operations David Walsh.

Sinn Féin TD Louise O’Reilly asks the representatives about the transfer of patients to nursing homes at the early stages of the pandemic and tries to find out how it was decided these patients would be moved out, when the decision was made and who made it.

Ms O’Reilly also asked how many of these patients were tested before they were moved.

She had the following exchange:

Louise O’Reilly: “My questions are mainly around the transfer of patients initially from the acute hospital sector into the private and the public nursing home sector. When Tadhg Daly was before the committee a couple of weeks ago, he said that there was no plan for the nursing home sector for the entire month of March. He also said that the sector was exasperated and that they were crying out for a specific plan but that there was none forthcoming.”

“He further said that key State organisations left the nursing home sector and its residents isolated in those early days. Would [Secretary General at the Department of Health Jim] Breslin agree with Mr Daly that the nursing home sector was abandoned and left without a plan for almost the entire month of March?

Jim Breslin: “No. I do not agree with that. I do note that Mr. Daly also commented very favourably at least half a dozen times on the extent of the engagement he had with the Department and the HSE over the period. The documents we have released to the committee – 160 separate communications – show just how much engagement and problem-solving was going on at the time.

“The fact that we were dealing in a national situation with the scaling up of PPE supply and testing did have implications for the nursing home sector but that was not the nursing home sector being discriminated against. It was quite the reverse. There was a clear focus on vulnerable older people, both in the community and in nursing homes, and a clear process in place to try to get as much support to nursing homes as possibly could be provided. That was continued throughout March and into April.

“We can see that in that as the situation worsened in nursing homes we were able to put further support in place, including further infection control advice and the community teams that were put in place on a multidisciplinary basis to respond and to get the situation back under control.”

O’Reilly: “On 10 March, when Mr. Daly wrote asking that all transfers would be risk-assessed, medically assessed and tested for Covid-19 at the same time as the acute hospital sector was being emptied in preparation for the expected surge – very necessary work which we do not dispute – that was not done at that stage. In terms of the patients who were moved out, can Mr Breslin timeline that for me?

“According to figures I have, 819 patients on the nursing homes support scheme were transferred from the acute hospital sector, which would be more than double the norm, so there was an escalated transfer of patients. In the month of March specifically, how many of those patients were tested for Covid-19 before they were transferred out?”

“How many were risk assessed and how many medically assessed? My next question might be one for [CEO of the HSE Paul] Reid. On whose instruction were the patients transferred? It is my understanding that they were transferred without being tested. There was a big increase in the numbers and a concerted effort was made to clear the hospitals, so somebody was telling the discharge co-ordinators to discharge these patients to the care of nursing homes. Where did that instruction come from? The discharges could not have started spontaneously.”

Breslin: “I will take the first part of the Deputy’s question. Regarding engagement with Nursing Homes Ireland, Deputy O’Reilly mentioned 10 March. On the same day, guidance was issued by the HSE concerning the transfer of patients between acute hospitals and nursing home settings. I am sure representatives from the HSE can address that further.”

O’Reilly: “No, I asked a very specific question about the numbers of people tested.”

Breslin: “That guidance set out in detail the protocols to be adopted regarding testing and isolation of patients, depending on which categories they fell into.”

O’Reilly: “Guidance is not a plan. I asked a specific question. How many patients were tested?”

Breslin: “I am happy for the HSE to address that issue, but guidance is a plan. It tells a clinician and an institution how to put the procedures in place that are going to manage the transfer of patients. It is more detailed than a plan because it works at an individual patient level.”

O’Reilly: “How many of those individual patients were tested?”

Breslin: “I think the HSE has communicated with the committee on that matter. I am happy to have that answered.”

O’Reilly: “How many patients were tested in March?”

Paul Reid: “Perhaps Dr Henry might take that question.”

Dr Colm Henry: “It is important, looking at testing at the time, to recognise it was based on our understanding of the case definition. The case definition at the time presumed the presence of symptoms for Covid-19. We know since then, because of evolving evidence that did not come through until the beginning of April when it was published in medical literature, the significance of asymptomatic transmission and atypical transmission.”

O’Reilly: “I am sorry, but we are under extreme time pressure. This is not like a normal committee, so I am just looking for a number. Of the 819 patients transferred out in March, how many were tested? It is fine if the number is zero. I would just appreciate the number for March.”

Reid: “I will come in on that question. First, the 800 figure refers to applications for the nursing home support scheme and, as such, they are applications from a range of sources. We cannot give a definitive number of people who were tested, but it can be assumed, as Mr Breslin said, that guidance to our hospitals was very strong guidance. It was not a request but a direction. That was the protocol and process to test people on 10 March. That was the guidance at that stage.”

O’Reilly: “In the period up to 10 March, therefore, no testing was taking place, but Mr Reid is stating that from 10 March the testing would have taken place. Is that the testing that was recommended, as I understand it, in April so that there would be two negative tests before a person would be transferred out, as well as the medical and risk assessment? It is my understanding they were not being carried out in March.”

Dr Colm Henry: “It was. People were tested in hospitals settings and elsewhere based on the symptoms and case definition at the time. Regarding people who were Covid-19 positive within hospital settings and who were due for transfer, the direction on 10 March stated that there would be two negative tests prior to transfer out. Testing was, therefore, taking place. The point I was trying to make, however, and I will not labour it, is that testing was based on a case definition as the transmission of the virus was understood at the time.”

O’Reilly: “People were not tested unless they were symptomatic or unless they fulfilled the case definition. If that is the case, I will go back to my original question. Somebody made a strategic decision to transfer the patients from the acute hospital sector into the nursing home sector. Who was that? Was it done by memorandum or how was it done? The numbers are significant. I appreciate they were only applications, but they were still way out of line with the normal level of applications.”

Dr Colm Henry: “At that time, based on what we were seeing internationally, hospital systems in other countries were overwhelmed with Covid-19. There was no reason for us, other than the plan, not to have a similar eventuality. It was not just a case of getting people out of hospitals; it was a case of recognising that hospital settings were potentially hazardous scenarios, particularly for vulnerable older people. The reason for getting people out of hospitals was not just to create space in hospital settings for an anticipated surge in Covid-19 presentations, but also in recognition that a hospital setting could be potentially hazardous.”

O’Reilly:  “That is understood. Who made the decision to transfer out the patients? It did not just happen. Somebody sent a memo or direction. Who was that and can we have a copy of the direction that was issued?

Henry: “It is my understanding that these decisions are made by clinicians on the ground and they are made, as happened well before Covid-19…”—–

O’Reilly:They were made without any national guidance, individual clinicians made that decision. I must tell Dr Henry that I find that hard to believe.”

Henry: “As part of our overall approach we were of course trying to create as much capacity in our hospital system as we could. We were also trying to discharge people out of what was a potentially hazardous health caresetting, namely the acute hospitals, as we were watching the experience of other countries.”

O’Reilly: “I have only a few seconds left. No memo was issued to instruct the transfer out of patients to clear space in the hospitals, that was just done on a case-by-case basis by individual clinicians. I do not find that to be a very credible statement.

It strikes me that the Department and the HSE had a plan to use the capacity in the nursing home sector but no plan to protect the nursing home residents. I do not hold any candle for the private nursing home sector. Anyone who knows me knows my views on that but the Department and the HSE had a duty of care to the patients – not to the private nursing home sector – but to the residents of those nursing homes, all of whom should be entitled to the full protection of PPE and the full protection of the State.

“I do not think that it is enough for people, by the way, who may or may not be complicit in the privatisation to say that somehow there could have been a hands-off approach. I have asked a series of very simple questions. It is clear that there was no plan to protect nursing home residents, there was only a plan to utilise that capacity.”

Michael McNamara (chair):  “I thank Deputy O’Reilly. Deputy Butler is next, she is taking ten minutes.”

Breslin: “If the Chairman will excuse me, Mr Walsh wanted to complete the answer to Deputy O’Reilly and you cannot hear us on the microphone when everybody is talking.”

McNamara: “Apologies. Mr Walsh may come back in on that point.”

Walsh: “I thank the Chairman. Perhaps I can clarify to Deputy O’Reilly that the HSE uses two mechanisms to assist with the discharge of people from acute hospitals. One is the nursing home support scheme that the committee is familiar with. The second support to that is the use of transitional care where people are going through the process of that scheme or, if they just need some convalescent time in a nursing home prior to discharge home, then they can access transitional care funding.

“Additional transitional care funding was made available to assist with the discharge of people who had completed the acute phase of their care to take people who were inappropriately in hospital so that they could be cared for in an appropriate setting, which is a nursing home.”

Earlier, Mr Breslin told the committee:

“Whereas Ireland recorded its first case of Covid-19 on 29 February, it was not until 16 March that the first case in a nursing home was notified by the Health Protection Surveillance Centre, HPSC. Cases peaked in the general population on 28 March but, around this time, cases in nursing homes commenced their increase in numbers. The peak in nursing homes occurred almost four weeks later on 22 April.

“Since then, the number of new cases has steadily declined and, today, 50% of all nursing home clusters are closed, meaning they have been Covid free for 28 days or longer. This has been a very challenging time for the residents, staff and families. Some 18% of the 30,000 residents of nursing homes have had a confirmed diagnosis of Covid-19.”

June 19: Taoiseach Leo Varadkar quotes from the movie Mean Girls when he addresses the nation.  While speaking about the economy recovering he says:

“Some have asked whether there is a limit to what we can achieve. My answer is that the limit does not exist.”

It follows a bet publicly made by Lord of the Rings actor Sean Astin on 2FM Breakfast.

June 22: The entire board of the Regulation and Quality Improvement Authority, which oversees Northern Ireland’s care homes, resigns following on from complaints by former board members that they were not being consulted about Department of Health decisions concerning Covid-19.

June 23: Phil Ní Sheaghdha, general secretary of the Irish Nurses and Midwives Organisation, tells the Special Committee on Covid-19 Response:

“At present, Ireland is top of the league and has the highest infection rate of healthcare workers globally. That is an absolute scandal. We have sought figures and the Minister for Health, Deputy Harris, instructed that figures be issued on a weekly basis when he met us two weeks ago.

“We have now got the second set of figures, following on from that meeting with the Minister for Health. These again confirm that 88% of those infected who work in the health service got the virus at work.

“In other words, this is an occupationally acquired illness or injury and they, therefore, have to absent themselves for 14 days to self-isolate. We know from the figures that we received last Friday that 4,823 healthcare workers remain out sick, and “still ill” is the category that is stated.

“We know that 1,600 of those are categorised in the category of nurse or midwife. We have asked the HSE for the workplace settings but it has not been able to supply them to us as yet.”

In what may be his final days as Taoiseach, Leo Varadkar is interviewed by David McCullagh on RTÉ’s Prime Time. During the interview, Mr McCullagh asks Mr Varadkar about his decision to quote movies during the Covid-19 pandemic and the most recent Mean Girls quote. They had this exchange:

David McCullagh: “At a time when people are looking to you as Taoiseach, for leadership, do you really think it’s appropriate to be using a speech to quote teen movies as an in-joke with an actor?”

Leo Varadkar: “I think any quote is appropriate if it’s appropriate in its context whether it was written in a movie or by a poet.”

McCullagh: “Ok, so the quote ‘the limit does not exist’ which I believe is from the movie Mean Girls, that was appropriate for use?”

Varadkar: “Yeah, in the context, the context of our ambitions, as a country. And I know that some people may be snobbish about those things, that a quote from a movie is different to a quote from a poet or great author, like yourself, but I don’t see it that way.”

McCullagh: “But, in fairness now, it is a trivial issue, but at a time when people have died, at a time when people have seen their livelihood destroyed, is it really appropriate to be quoting from teen movies as an in-joke?”

Varadkar: “I think any quote, in any speech, is appropriate if it’s in context. And, you know, I’ve used quotes from poets and from other writers precisely to deal with the issue that you’ve raised. The fact that there are nearly over 2,000 people on this island as a consequence of Covid, that they have families who are grieving and there are 100,000 people out of work. I’ve used quotes that I identified with, that I think explain some of the feelings that they’re having and the darkness around that.”

McCullagh: “Ok, well is this not a distraction from the serious message that you’re trying to get across, to have this little joke with Sean Astin?”

Varadkar: “I think it’s a distraction for some people, but not for me.”

McCullagh: “Ok.”

Later Mr McCullagh asks the Taoiseach about Ms Ní Sheaghdha’s comments in the committee and he responds:

“I checked that [the healthcare worker infection Covid-19 rate] actually with the HSPC today so, at least according to them, the figures that she gave were not accurate. I think she suggested that 60% of healthcare workers were still sick with Covid. That is not the case. The HSPC says 90% have recovered and they say that we’ve had 8,000 positive cases out of a healthcare workforce of 250,000 so that’s between 3% and 4% positivity rate. So they’re saying that that was wrong.

“But leaving statistics aside, and let’s leave statistics aside for a second, what is indisputable is that there are 8,000 healthcare workers who did contract Covid and the vast majority of whom who did so at work.

“So we need to make sure that they’re properly protected, that we have a testing regime in place, that we make sure that we test them and test patients, that they have adequate PPE, that they’re properly trained to use that PPE and we need to make sure all of that is in place and I believe it is in place now, should we have a second wave or should we have a particular situation with an influenza outbreak at the end of the year.”

Mr McCullagh also asked him about the death rates in care homes and asked him “how did we get it so wrong?”. Mr Varadkar replied:

“We need to be very careful about any of those international comparisons. This pandemic is still happening. In fact it’s getting worse around most of the world and also different countries, as you know, count things in different ways and we’ve been recognised by the World Health Organisation as one of the countries that has been the most honest. We count all deaths no matter where they happen.”

Sources: The Irish Times, RTÉ, Kildarestreet, Oireachtas.ie, Irish Independent, BBC, France 24,  Washington Post, The Guardian,, Broadsheet (!) and others.

Previously: ‘I Expect It To Be Ignored, As The Elderly Have Been Ignored’

Elderly Lives

‘Livestock’

Rollingnews

32 thoughts on “Left To Die: Nursing Home Timeline

  1. ReproBertie

    So throughout the lockdown the number of new cases and new clusters in nursing homes continued to grow. Was this via infection from nursing home staff?

    Can you explain the relevance of highlighting the movie quotes to the piece?

    1. GiggidyGoo

      Repro. It may well be to highlight his, and his writers, capabilities. He’s making speeches with quotes from all over the shop. The latest is https://www.thejournal.ie/leo-varadkar-mean-girls-quote-5131005-Jun2020/ which suggests (to me anyway) that he’s quite an immature person to be – in theory – leading this country.

      While other leaders get the contents of their speeches quoted, Varadkar quotes lines from movies. I shudder to think what his epitaph will read.

      1. ReproBertie

        And how is any of that relevant to the continued outbreaks in nursing homes during the lockdown? I mean, that’s the point of the article, right? So were those outbreaks worsened because Leo quoted Terminator? Why not include the quotes from Seamus Heaney so we can see what impact they had?

        1. GiggidyGoo

          Maybe to show that he and his government weren’t capable of devising a plan, and resorted to quotes from films to try give the impression they had a handle on it.
          (I suppose if that were to continue, then future governments could have their tenure scripted by movie-makers)
          I mean you have Kenny, and Varadkar, plagiarizing works and sayings of others. There won’t be much of note left by them as regards originality, speech-wise in the history books.

          1. ReproBertie

            Maybe it was an ingenious ploy to give their critics something meaningless to distract them from the actual issue. It certainly seem to have worked given the pointless references to them in the post and how much you’ve been banging on about the movie quotes like they mean something.

          2. GiggidyGoo

            Not banging on about the movie quotes. Banging on about the quality of the person using them.

          3. ReproBertie

            But not banging on about the cause of the increase in clusters in nursing homes during the lockdown.

          4. GiggidyGoo

            We know the cause. The point I’m making is that Varadkar is trying his hand at plagiarism in order to divert from his, Harris’ and Holohan’s failings.

  2. Charger Salmons

    Impressive research.
    If I may add a couple of dates to it.
    Much has been made of Boris Johnson ignoring the dangers of Covid-19 and the fact that he didn’t attend his first COBRA emergency planning meeting until March 2nd.
    His actions were roundly criticised in a deluge of negative pieces in the Irish media.
    What’s not often reported is that was the also first COBRA meeting Scottish First Minister Nicola Sturgeon attended preferring,like Boris,to leave it to her health ministers to prepare for the pandemic during January and February.
    It wasn’t until the following day, March 3rd, that after an Irish Cabinet meeting Leo Varadkar announced he was setting up a special Cabinet sub-committee to look at the possible effects of the virus.
    Also on that day the Chief Medical Officer Dr Tony Holohan said he was confident only a “small numbers of sporadic cases” would occur.
    The UK also instituted its lockdown orders four days before those in Ireland.
    Facts,eh ?
    Incovenient little blighters …

    1. Vanessanelle

      This is set specially to Irish Nursing Homes
      Not the Brexit or Foreign Affairs tick-tock

      Secondly, Cummings was repping Boris in those COBRA gatherings

      And finally- do your own effing one

  3. Ragamuffin

    Well done Bodger, this is a great summary. Two extra questions worth investigating in the future could be:

    1) how long was it taking for test results to come back for NH residents & staff throughout the crisis? Delays had a huge effect on how CNMs could manage a ward, both in terms of grouping infected residents and staff rostering. I heard at the time (when the government were boasting about testing thousands of this population) it was still taking several weeks, and so NH management had to ‘fly blind’.

    2) When did NPHET learn that Covid 19 symptoms were often atypical in NH populations? And when was this information shared with NH managers? Apparently very elderly people (who may have complex comorbidities including dementia) are more likely to present without respiratory symptoms, and instead may display GI symptoms etc. Anecdotally I heard that when NH managers eventually learned this for themselves they were able to slow the spread by quarantining these cases too. But surely this unusual feature would have been noted in China/Spain/ Italian populations and shared with NPHET?

  4. Kate

    I was quite anxious my goddaughter ,3 years into a nursing degree, obviously still in college, was in ICU ,tending to condif patients. It brought home to me the level of sIckness among staff despite what was reported in the media at the time. Ms Jane Carrigan poignant letter on her deceased aunt Rose Hegeraty is a powerful lesson….remove from immediate danger….weeks of inconvenience will come to pass but so what? Relatives should be given the choice of caring in a pandemic.

  5. Charger Salmons

    I don’t know.
    Who is this father of 55,000 dead of which you speak ?
    Take your time now.

  6. Charger Salmons

    Only 19 responses.
    To a thoroughly-researched thread about the real scandal of Ireland’s handling of Covid-19.
    You’d get more reaction posting a picture of a puddle that looks like Ireland
    Accept it Bodger.They really don’t give a toss.

      1. Johnny

        Its a really important a great piece,I’m sure many people like me are simply rereading it, sadly there’s not a lot to say, except Rest In Peace.

        One hopes lessons will be learned as this is not the last virus, but a full independent inquiry will most likely get binned, so there is probably some apathy about even calling for it, one word sums up irish investigations,Siteserv.

        I want separate the deaths from the process and have a decent exchange, but its so raw and so emotional,probaly needs a bit of time,this piece will referenced by many Bodger.

        You did great its really amazing,I’m literally rereading it, comparing it to NY/NJ-its tough reading about this stuff for me and im sure others, not exactly great way spend an evening:)

  7. Your Home Correspondent

    Fair dues Bodge. Seems like so long ago we were up in arms about that school trip… wondering if the Temple Bar Hands, Holding, Hands job was the first COVIDIOT case in Ireland?

  8. Truth in the News

    Good analysis by Bodger, which the Irish Media has not done so far. what we have been
    fed from the Dept of Health, HSE,Harris and Varadkar is spin, they have not explained
    how there are almost a Thousand dead in Nursing Homes and over 30 % of medical
    care staff infected, we had a PR blitz since the middle of March trying to create the
    impression that the crisis was under control……when it was not, there was no interest
    taken until the middle of March when Varadkar went to America and discovered that
    things were out of control there also……then the PR started, in fact more of it was
    designed to counter the negative election result that FG and indeed FF had early
    February……We have now discovered that the Little Emperor has no clothes:

  9. Leo

    That guy veruka has to be kicked out. He CLEARLY has no conscience.

    Of all the scammers we have had through the decades….he’s by far the worst and an incredible creep as Well.

  10. Unhappy niece

    I’m a niece of a deceased resident of a Nursing home in Co. Meath that happens to have a Dublin City bus route.

    My uncle contracted COVID 19 while at the home and unfortunately also suffered serious neglect of his health condition in the nursing home during the crisis. This is now being investigated and hopefully some good will come of this for private nursing home residents.

    I cannot fathom how the Minister of Health is not taking responsibility for this. The private nursing home that my uncle was a resident of continued to charge for his care even after he was moved to the public hospital in Dublin which cared for him (in a much better manner) until his death. In fact, a payment was taken days before his death at that public hospital.

    It is very sad to think of my Uncle who unfortunately due to his condition, was not able to express how he felt or voice concerns about his treatment.

    I am very angry that the nursing home management ignored our family’s concerns as far back as last year.

    I have learned an important lesson.. that private nursing homes are businesses. They are owned by businessmen with interests in property, fruit farming, etc. who don’t care about the residents but are happy to take their money every week.

    My uncle could not get a place in a HSE nursing home, and so he was forced to endure the substandard care offered by a private nursing home 40km from his family home and owned by a business conglomerate.

    I am not going to rest until that the nursing home admits a neglect of care for my uncle, and the Minister of Health makes sure there is oversight in the private nursing home industry in Ireland.

    1. Steph Pinker

      Unhappy niece, I wish you the very best in your fight for your uncle, believe me, you won’t be alone; this caretaker government will reap a whirlwind soon enough when the reality of the decisions taken by the Taoiseach, Minister for Health, HSE, NPHET, faceless Civil Servants, private business cronies et al., become known.

      I’m sorry to read about your uncle, may he Rest In Peace.

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