A horrific crisis: COVID-19 and nursing homes scandal

By Mary Cahilliane

The Government and the HSE’s abject failure to protect the elderly and most vulnerable in nursing homes right across Ireland is an absolute scandal. Coronavirus is known to affect the over 70s and over 80s disproportionately and this is increasing the death toll in these homes where the virus can easily spread amongst vulnerable patients.

At the time of writing, Wednesday 15 April, 45% of all COVID-19 deaths in the Republic of Ireland have occurred in nursing homes. The figures are harder to determine in Northern Ireland as any COVID-19 deaths that occur in nursing homes are not counted in the official figures. However, the BBC reports that 32 care homes in Northern Ireland have been affected and on 17 April the number of COVID-19 deaths in settings outside of hospitals are due to be released.

Numerous warnings

Across Europe also, the elderly in care homes have borne the brunt of COVID-19 deaths. In the Spanish State the army reported finding dead and abandoned people in their beds after it was drafted in to help disinfect care centres. In France almost a third of all coronavirus deaths were in care homes, and in Germany hundreds of care homes reported deaths right across the country.

The Irish Government and the HSE were well aware of what had happened in other European countries in relation to care homes and had plenty of warning to put proper procedures in place to protect the elderly and staff in nursing homes, but they failed to do so. In fact when nursing homes themselves put restrictions on visitors in early March, Tony Holohan and the public health team told them that these restrictions were premature and they should be lifted.  The nursing homes themselves refused to lift the restrictions and may well have prevented an even more catastrophic outcome than what we have seen so far.

History of nursing homes

Currently over 85% of nursing homes in Ireland are in private ownership, with just 15% under HSE control. This wasn’t always so. Twenty years ago the mix was 85% public and 15% private. The shift to privatisation of care for elderly was swift and directly as a result of two decades of Fianna Fáil and Fine Gael-led Governments that incentivized private over public by way of tax breaks given to the builders of private nursing homes. Between 2004-2014 these tax breaks amounted to over €10 million and care for the elderly became a massive profit-making opportunity. The majority of care homes in Northern Ireland are privatised and they have been the subject of scandal after scandal in terms of the quality of care. In the case of Muckamore Abbey this resulted in the horrifying degradation and abuse of the elderly and vulnerable.

The privatisation of nursing homes has resulted in lowering standards, with more emphasis on cutting costs to increase profits and more costs being borne by the families of the elderly, while the workforce in nursing homes are on very low pay with long working hours and huge pressure. But it has also meant lower standards when it comes to health and safety and we are seeing the tragic human cost of this now amidst the COVID-19 crisis. 

As well as the criminal lack of testing and shortage of PPE for nursing home staff, many workers in private nursing homes do not have access to any sick pay scheme whereas the workers in public nursing home settings have access to the HSE’s occupational sick pay scheme. This means that any worker with mild symptoms or who contracts COVID-19 in a private setting is under economic pressure to take a chance otherwise they may end up having their income cut, even halved in some cases.

Lack of PPE and medical staff

Given the disproportionate impact of COVID-19 on the elderly, it was legitimate to expect a greater focus from the Government and the HSE as the virus took hold. Instead nursing homes continued to lack basic essentials in terms of PPE, no prioritisation of testing of staff or patients and it took the Government almost a month to respond to the growing crisis. 

Workers in nursing homes have spoken about how slow the response to their demands have been, while family members of the elderly have reported that they are being denied admission to intensive care units in hospitals, the lack of ventilators and oxygen in many nursing homes and the total lack of information from nursing homes in terms of whether family members have the virus, or if the virus is present in the homes or not. In the North, the situation is even more dire as little or no testing has taken place.

End private ownership

As the scale of what was taking place began to emerge the Government and the HSE did a dramatic u-turn and Simon Harris announced a €78 million package to bail out private nursing homes to give them access to PPE, prioritisation of testing and the redeployment of staff from the public health service through a voluntary scheme. New clarity was also given in terms of guidelines for nursing homes which on paper at least gives each person regardless of age access to hospital and intensive care units and the right of families to have full information in relation to what is happening in any care home they have family members in.

What the COVID-19 pandemic has demonstrated quite clearly is the complete failure of Ireland’s two-tier health system not only in terms of bed and ICU capacity, but also on the reliance of private nursing homes for elderly care. It has demonstratively left them more exposed and more at risk.

When this crisis is over, we should never again return to a two-tier health system. We should demand that the private hospitals remain in public hands and that we end the for-profit system of private nursing homes, because by their own admission they are incapable of dealing with a crisis without massive state intervention. Like the private hospitals they should be brought into full democratic public ownership, with no compensation for their wealthy proprietors. The workers in all the private nursing homes should be employed by the HSE and become recognised as the vital workers that they are with proper pay, resources and terms and conditions instead of just generating profits for private entrepreneurs. Health and safety should never again be compromised for profit.