protecting the elderly - hasn't really worked all that well

peasant

One nursing home has seen almost 100 of its staff and residents tested positive for the Covid-19 virus, the Dáil has heard.

The shocking situation, believed to be a Leinster-based facility, was outlined by Fianna Fáil TD Stephen Donnelly as TDs debated the pandemic and gaps in responses.

Mr Donnelly outlined how 70 of the 200 staff had tested positive as had 19 of the 100 residents.

https://www.irishexaminer.com/breakingnews/ireland/dail-hears-of-shocking-coronavirus-cluster-in-nursing-home-in-leinster-991766.html

There are now 29 clusters of Covid-19 infections in the country's nursing homes.

New figures published by the Health Protection Surveillance Center show there are now 134 outbreaks or clusters of the virus, linked to 563 confirmed cases.

Nursing homes now account for 21% of these clusters. A cluster means at least three people.

https://www.rte.ie/news/coronavirus/2020/0402/1128012-figures-show-29-clusters-of-covid-19-in-nursing-homes/

That's not good and I don't really know what could be done to improve or at least mitigate this situation, very much a case of the bolted horse.

But it is very important to learn from these failures so they don't get repeated.

And before people start going on about Irish inadequacies etc ...posterboy Germany has plenty of cases (and sadly also plenty of deaths) in care homes for the elderly.
(Don't trust me? Go to google news. de and type "Seniorenheim" into the search function and google translate away)

hmmm

Do we know why there are so many cases in nursing homes? Looking at the stats there are very few recorded outbreaks in employers, but lots in nursing homes. I'd have thought both would be likely.

Is it because the people in the homes tend towards worse outcomes, and are more likely to need hospitalisation? That would point towards significant undetected spread in the general community.

Harry Palmr

plus

There are also 24 clusters of infection in hospitals, nine in residential institutions and four in community hospitals or long-stay units.

These places are the proverbial tinder box. they all share similarities - Elderly/frail people mixed with nursing staff of various types and competencies. Once it's in then it's a losing race against the clock due to Covid 19's hidden in plain sight characteristics.

lozenges

hmmm wrote: »

Do we know why there are so many cases in nursing homes? Looking at the stats there are very few recorded outbreaks in employers, but lots in nursing homes. I'd have thought both would be likely.

Is it because the people in the homes tend towards worse outcomes, and are more likely to need hospitalisation? That would point towards significant undetected spread in the general community.

I reckon at least part of it is that people in nursing homes are generally dependent on others for their care in at least one way, and therefore it's simply not possible to have strict quarantine within the home

E.g. they need assistance from another person for say, eating meals, getting in and out of bed, going to the toilet. Also some patients with cognitive impairment/dementia are not going to be able to carry out the guidelines re handwashing, coughing into a tissue, not touching your face etc.

An independent working adult however can effectively self quarantine without any of those issues.

jmayo

The big issue is once it gets into a nursing home it will spread like wildfire.

Same would apply to places like special needs homes.

Anyone that has ever been a frequent visitor to a nursing home would easily see this.

People wander around, some are compos mentis, some believe they are waiting for Daddy to take them to town.
People are in dining rooms together, put sit in day rooms together and some people just can't be told to separate.

I know this sounds heartless, but having parents and relatives go through it and I can safely say some don't have a freaking clue what day it is, never mind to continously wash their hands and not sit beside their friends.

Also sometimes some of the staff may not be the best and if they can't be assed then the place is doomed to infection.

Desperately sad reading. It’s always a difficult decision to place someone you love into someone else’s care.

SuperRabbit

hmmm wrote: »

Do we know why there are so many cases in nursing homes? Looking at the stats there are very few recorded outbreaks in employers, but lots in nursing homes. I'd have thought both would be likely.

Is it because the people in the homes tend towards worse outcomes, and are more likely to need hospitalisation? That would point towards significant undetected spread in the general community.

There are cases everywhere, absolutely everywhere. It just gets noticed in nursing homes because everyone there is symptomatic.

https://www.craftpassion.com/face-mask-sewing-pattern/ < is anyone with skills able to get on making these for nursing homes until the government can get them proper PPE equipment?

millb

Harry Palmr wrote: »

plus

These places are the proverbial tinder box. they all share similarities - Elderly/frail people mixed with nursing staff of various types and competencies. Once it's in then it's a losing race against the clock due to Covid 19's hidden in plain sight characteristics.

So once it's in for sure.... but how is it getting in?? What has the tracing found out.. where are the original sources? It is some common contractor... Is it NH workers living together and working different Nursing Homes ... eg contract help doing relief here and there from an agency ... Or food and medicial deliverys? or multiple owners / visiting doctors & "professionals?"

Is it random from the air ? If so no need to trace .......... can anybody share an insight .. we need to learn .. quickly ..

millb

peasant wrote: »

https://www.irishexaminer.com/breakingnews/ireland/dail-hears-of-shocking-coronavirus-cluster-in-nursing-home-in-leinster-991766.html


https://www.rte.ie/news/coronavirus/2020/0402/1128012-figures-show-29-clusters-of-covid-19-in-nursing-homes/

That's not good and I don't really know what could be done to improve or at least mitigate this situation, very much a case of the bolted horse.

But it is very important to learn from these failures so they don't get repeated.

And before people start going on about Irish inadequacies etc ...posterboy Germany has plenty of cases (and sadly also plenty of deaths) in care homes for the elderly.
(Don't trust me? Go to google news. de and type "Seniorenheim" into the search function and google translate away)

https://www.kreiszeitung.de/deutschland/wildeshausen-seniorenheim-atrium-corona-umzug-wegen-corona-zr-13633523.html .. story here is not holding back information .. people are named and one was fired for not wearing PPE /.. 300 masks donated..

millb

millb wrote: »

https://www.kreiszeitung.de/deutschland/wildeshausen-seniorenheim-atrium-corona-umzug-wegen-corona-zr-13633523.html .. story here is not holding back information .. people are named and one was fired for not wearing PPE /.. 300 masks donated..

How about this from that reference "The health department gave us clear instructions on how to proceed now so that the care of our residents is ensured," continued Münch. “Residents with a positive Covid 19 result stay in their rooms and are completely cared for there. The care is provided by employees who are also Covid 19-positive , but whose state of health enables them to work. For employees who have tested positive, there is an exemption from home quarantine for working hours in our company. ”

The negatively tested residents are in turn cared for by negatively tested employees in the Atrium Wildeshausen . Because of the corona virus, these residents are also housed individually for two weeks. According to information from our newspaper, the residents' doors are marked with green or red notes to quickly identify whether or not there is a sick person behind them. Apparently there are currently only weak courses of the viral disease in the atrium

Del Griffith

SuperRabbit wrote: »

There are cases everywhere, absolutely everywhere. It just gets noticed in nursing homes because everyone there is symptomatic.

It's this. It's inconceivable that workers in 29 separate facilities just happen to have a positive Corona staff member.

My bet is we all have it, or a huge amount of people anyway, and have no symptoms or very mild symptoms.

This would mean the % death rate and rates needing hospitalisation are far lower than the current figures too.

beggars_bush

no proper PPE gear for staff in nursing homes

plus most of the staff aren't medically trained. they are just helpers or porters

Jurgen Klopp

Posted this in another thread

Nursing homes of the private variety were notorious amongst healthcare workers before this pandemic. They never had enough supplies of gloves and masks and the few they had they barely ever gave out cause it affected profit margins. An MRSA breakout was about teh best time they'd let staff mask and glove up and I'd say that's because its such a bloody obvious infection to get they wouldn't get away with it

I've seen people shocked on here posting how shocked they were to visit relatives in homes by standing outside and seeing the carers inside with the resident with no gloves or mask's, that's nothing new, it's just normal practise being exposed and I can tell you a lot of these owners wont be too concerned with staff and residents catching this as it's a nice little one to say ah sure we did all we could but as we've seen worldwide its impossible to contain 100%

That's why you've seen nursing homes completely abandoned by staff in the likes of Spain too, I'd bet staff there were expected to spend their day coming in contact with residents without any PPE nevermind appropriate standards

Gonna see similar here unless the HSE starts the supplying here, the greedy fcukers of owners wont mind then as it won't be them shelling out

You also have to add in nearly every private run home never pays more than €10.50 an hour despite raking it in. There are some good workers in homes but most of the time the good, dedicated caring carers get disillusioned with working conditions, lack of patient care and low pay so nearly always move on to another field leaving the staff who have no interest usually being the majority of staff. The type who see it as just a job and a home resident is the same in their eyes as a bag of spuds is to a shop worker.

I'd also second the above that a lot aren't even that we'll trained. Most nursing homes and care agencies will take on anyone that that has the 2 basic Care of the Elderly and Care Skills modules which are 6 weeks each. These rarely cover more than proper hand washing, bed baths procedure etc

What's worse is most homes and agencies will take on workers who only have their name down for training too and haven't even sat in a classroom

boege

millb wrote: »

So once it's in for sure.... but how is it getting in?? What has the tracing found out.. where are the original sources? It is some common contractor... Is it NH workers living together and working different Nursing Homes ... eg contract help doing relief here and there from an agency ... Or food and medicial deliverys? or multiple owners / visiting doctors & "professionals?"

Is it random from the air ? If so no need to trace .......... can anybody share an insight .. we need to learn .. quickly ..

My wife is a nurse and she says there is an issue with agency workers. There is a disincentive for them to be tested. She had a direct experience with one agency worker who refused to report that she had potential contact with a colleague who was found positive.

I would wonder if many of these homes are using agency workers or employ them on hourly type contracts, where there is only payment for hours worked.

The sad news is that the virus has already got into many nursing homes and is wreaking havoc.

beggars_bush

Jurgen Klopp wrote: »

Posted this in another thread



You also have to add in nearly every private run home never pays more than €10.50 an hour despite raking it in. There are some good workers in homes but most of the time the good, dedicated caring carers get disillusioned with working conditions, lack of patient care and low pay so nearly always move on to another field leaving the staff who have no interest usually being the majority of staff. The type who see it as just a job and a home resident is the same in their eyes as a bag of spuds is to a shop worker.

I'd also second the above that a lot aren't even that we'll trained. Most nursing homes and care agencies will take on anyone that that has the 2 basic Care of the Elderly and Care Skills modules which are 6 weeks each. These rarely cover more than proper hand washing, bed baths procedure etc

What's worse is most homes and agencies will take on workers who only have their name down for training too and haven't even sat in a classroom

many staff out sick from a nursing home will get a higher payment from the government than their employer

Logan Roy

Del Griffith wrote: »

It's this. It's inconceivable that workers in 29 separate facilities just happen to have a positive Corona staff member.

My bet is we all have it, or a huge amount of people anyway, and have no symptoms or very mild symptoms.

This would mean the % death rate and rates needing hospitalisation are far lower than the current figures too.

Quick inform the authorities so we can release everyone back into the wild again....

Beasty

They had to strike a balance with limited "intelligence". It could equally be considered that they have saved a lot of lives of the elderly with some of the restrictions applied. It's not as if you could relocate all those in Nursing homes to somewhere where they could be fully "cocooned"

I am sure in due course there will be a review and lessons learned from a lot of actions taken (or not taken) in the course of this crisis, but the whole world has had to adjust to something it had never seen before (in terms of global impact)

lalababa

The cheapest private nursing home near me is 950 euro a week. The public one is 1500 a week. They are both run well and have caring staff.
How it costs a grand a week to care for somebody when a home carer might do it for 200 carers allowance beats me. But there you go.

Jurgen Klopp

boege wrote: »

My wife is a nurse and she says there is an issue with agency workers. There is a disincentive for them to be tested. She had a direct experience with one agency worker who refused to report that she had potential contact with a colleague who was found positive.

I would wonder if many of these homes are using agency workers or employ them on hourly type contracts, where there is only payment for hours worked.

The sad news is that the virus has already got into many nursing homes and is wreaking havoc.

There's 2 types of agencies. One is the ones that do home help the other is which your wife speaks of is the ones that provide cover staff to homes and hospitals

Yes you are right, they are zero hour contacts, you don't work you don't get paid. You could be given 5 X 12 hour shifts in various places this week and have zero work next week depending on demand

Nursing home staff are paid by the number of hours worked so there's gonna be an incentive to keep turning up too

The home help ones aren't much better. Its a rare female carer that makes 40 hours to be offered a salary position unless she's very lucky with, most average 30 hours a week and if a client is in hospital or dies you are down those hours.

As for male carers, forget it. Can only go into male clients so straight away only 50% potential work. It's the normal for a male carer to only make 15-20 hours a week even if they work 6/7 days a week and that would include hundereds of miles of driving. Any man and most women would be better of financially working as cleaners for min wage at least the hours would be guaranteed.

In fact a funny tidbit is a nursing home is €10.50 an hour where as a cleaner is €10.80 go figure

Jurgen Klopp

lalababa wrote: »

The cheapest private nursing home near me is 950 euro a week. The public one is 1500 a week. They are both run well and have caring staff.
How it costs a grand a week to care for somebody when a home carer might do it for 200 carers allowance beats me. But there you go.

It's actually the government preying on families who are too upset at the thought of putting their loved ones into homes for the €200. Imagine having a family member who can't move and needs to turned and washed, cleaned and dressed every day, hoisted from a bed to chair and then fed 3x daily. Then repeat the same to put them to bed

Even better if you care for 2 people the scumbags won't even give €400, it's something like €300 it's disgusting if every family carer refused in the morning the government would be up **** creek and they know it

wadacrack

Del Griffith wrote: »

It's this. It's inconceivable that workers in 29 separate facilities just happen to have a positive Corona staff member.

My bet is we all have it, or a huge amount of people anyway, and have no symptoms or very mild symptoms.

This would mean the % death rate and rates needing hospitalisation are far lower than the current figures too.

This is basically it to some extent. Its incredibly infectious. Probably about 100,000 true cases here. That's probably a conservative estimate too. The problem is ith out ICU capacity. Its a very difficult situation to manage,

Will be a case of restrictions...outbreak--lockdown---outbreak until some sort of immunity is present. Lockdown's will shorten and the outbreak will begin to have a longer peak each time as time goes on

RocketRaccoon

A family member of mine has tested positive for the virus in a nursing home in the west, it's absolutely awful knowing we most likely will never see her again.

wheresthebeef

I'll tell you the reason why this is happening. It's called asymptomatic transmission. A person who is not sick, but is able to infect others.

I can only speak from my own experience so others may not have done this.
When this virus came about, we got guidance from the HSE that basically said buy a bit of PPE, increase hand hygiene, provide tissues for residents and if anyone in the nursing home tests positive they'll be cared for in hospital to avoid them transmitting to anyone else. The effect that this had was to lead providers into a belief that they would only need to isolate people for short periods of time. Visiting restrictions were said to be unnecessary and all social activities could continue as normal.
Many nursing homes took a much tougher view on this and implemented extra cleaning, visiting restrictions, reduction in social contacts and purchased additional PPE. We were advised that sick staff should not attend work, so we educated our staff and agreed to pay their full wages to make sure no-one had an incentive to attend whilst feeling unwell. Before social distancing was in for everyone, we asked all our staff to socially distance to reduce their risk of becoming a carrier.
The problem with these strategies is that a sick staff member needs to be able to use a crystal ball to excuse themselves from work 5 days before they become Ill.
The HSE then changed their policy to say that residents with Covid19 would be left in the nursing home unless it was unequivocally clear that intensive care would benefit them (which largely it doesnt for an older person). In an instant, the PPE we had put aside to isolate any cases whilst we awaited for them to be admitted to hospital went from being a 2 week supply to being a 24 hour supply. So began the scramble for PPE at a time when all the suppliers prices had gone up by 800% and were practically out of stock. We were told not to worry that the HSE had warehouses full of stuff and would supply us. The following day we got an email from HSE telling us a surgical mask could be re-used by baking it for 30 minutes at 70 degrees. This didnt work as the limited supply they did give us had plastic straps which melted in the heat of the oven and also who wants to wear a mask that someone else had been using.
We were told that we didnt need to use PPE if residents were well, despite emerging evidence worldwide that masks on staff would prevent asymptomatic transmission from staff to residents by blocking respiratory droplets. We bit the bullet and masked up the staff with the masks we had acquired at 8 times their usual price.
We all rowed in to try to lift residents spirits. Staff went above and beyond to fill the gap left by visiting families, musicians, therapists and activities providers. We washed our hands until they were raw and realised that we needed hand cream as much as we needed hand sanitiser. We sat to the side as we positioned residents in front of video chat screens to talk to their loved ones and hid our own sadness that this was what things had come to. We smiled and gently redirected when residents living with dementia came up to us and hugged us because they couldn't understand or remember to socially distance. We felt our hearts bursting in our chests every time we cared for residents and had the niggling worry of "what if I'm sick and I dont know it and I give it to a resident".
We isolated residents with symptoms of illness as a precaution, despite the fact that the symptoms are so vague that they are also in common with about 50 other conditions that older people suffer from a lot of the time. We checked our own temperatures multiple times a day as well as the residents.
We come home every night trying to avoid our own family members, just in case.
We try to support each other, manage the fear, and prop each other up because even though we are the risk, our absence and the consequences of our absence are unthinkable as we have seen in Spain.
Many of us are now considering moving out of our family homes so we can self isolate to make sure we are "clean" coming to work. That is a deep sacrifice, but one we are willing to make.
At the moment even with priority testing, it is taking 8 days to get swab results. So far they have all been negative, but the not knowing is killer.

What needs to be done -
Testing turnaround needs to dramatically improve for this population
HSE should row back on admission policy and isolate positive cases away from other vulnerable people and do so rapidly
All staff caring for vulnerable people should be masked at all times to reduce asymptomatic transmission in conjunction with hand washing
More comprehensive PPE to protect staff from falling Ill needs to be provided so that staffing levels can be maintained to care for people and reduce the risk of onward transmission
Financial support for staff working
Accomodation so staff can self isolate outside of work and remain Covid-free
Support for nursing homes with additional staff to meet increased demands due to isolation and distancing (it's much harder to care for people when they are all separated)

I dont know what else we can do. We can do all of this and it still might not be enough. We promised to keep these people safe and we will break ourselves trying to do that and it still might not be enough.

RocketRaccoon

wheresthebeef wrote: »

I'll tell you the reason why this is happening. It's called asymptomatic transmission. A person who is not sick, but is able to infect others.

I can only speak from my own experience so others may not have done this.
When this virus came about, we got guidance from the HSE that basically said buy a bit of PPE, increase hand hygiene, provide tissues for residents and if anyone in the nursing home tests positive they'll be cared for in hospital to avoid them transmitting to anyone else. The effect that this had was to lead providers into a belief that they would only need to isolate people for short periods of time. Visiting restrictions were said to be unnecessary and all social activities could continue as normal.
Many nursing homes took a much tougher view on this and implemented extra cleaning, visiting restrictions, reduction in social contacts and purchased additional PPE. We were advised that sick staff should not attend work, so we educated our staff and agreed to pay their full wages to make sure no-one had an incentive to attend whilst feeling unwell. Before social distancing was in for everyone, we asked all our staff to socially distance to reduce their risk of becoming a carrier.
The problem with these strategies is that a sick staff member needs to be able to use a crystal ball to excuse themselves from work 5 days before they become Ill.
The HSE then changed their policy to say that residents with Covid19 would be left in the nursing home unless it was unequivocally clear that intensive care would benefit them (which largely it doesnt for an older person). In an instant, the PPE we had put aside to isolate any cases whilst we awaited for them to be admitted to hospital went from being a 2 week supply to being a 24 hour supply. So began the scramble for PPE at a time when all the suppliers prices had gone up by 800% and were practically out of stock. We were told not to worry that the HSE had warehouses full of stuff and would supply us. The following day we got an email from HSE telling us a surgical mask could be re-used by baking it for 30 minutes at 70 degrees. This didnt work as the limited supply they did give us had plastic straps which melted in the heat of the oven and also who wants to wear a mask that someone else had been using.
We were told that we didnt need to use PPE if residents were well, despite emerging evidence worldwide that masks on staff would prevent asymptomatic transmission from staff to residents by blocking respiratory droplets. We bit the bullet and masked up the staff with the masks we had acquired at 8 times their usual price.
We all rowed in to try to lift residents spirits. Staff went above and beyond to fill the gap left by visiting families, musicians, therapists and activities providers. We washed our hands until they were raw and realised that we needed hand cream as much as we needed hand sanitiser. We sat to the side as we positioned residents in front of video chat screens to talk to their loved ones and hid our own sadness that this was what things had come to. We smiled and gently redirected when residents living with dementia came up to us and hugged us because they couldn't understand or remember to socially distance. We felt our hearts bursting in our chests every time we cared for residents and had the niggling worry of "what if I'm sick and I dont know it and I give it to a resident".
We isolated residents with symptoms of illness as a precaution, despite the fact that the symptoms are so vague that they are also in common with about 50 other conditions that older people suffer from a lot of the time. We checked our own temperatures multiple times a day as well as the residents.
We come home every night trying to avoid our own family members, just in case.
We try to support each other, manage the fear, and prop each other up because even though we are the risk, our absence and the consequences of our absence are unthinkable as we have seen in Spain.
Many of us are now considering moving out of our family homes so we can self isolate to make sure we are "clean" coming to work. That is a deep sacrifice, but one we are willing to make.
At the moment even with priority testing, it is taking 8 days to get swab results. So far they have all been negative, but the not knowing is killer.

What needs to be done -
Testing turnaround needs to dramatically improve for this population
HSE should row back on admission policy and isolate positive cases away from other vulnerable people and do so rapidly
All staff caring for vulnerable people should be masked at all times to reduce asymptomatic transmission in conjunction with hand washing
More comprehensive PPE to protect staff from falling Ill needs to be provided so that staffing levels can be maintained to care for people and reduce the risk of onward transmission
Financial support for staff working
Accomodation so staff can self isolate outside of work and remain Covid-free
Support for nursing homes with additional staff to meet increased demands due to isolation and distancing (it's much harder to care for people when they are all separated)

I dont know what else we can do. We can do all of this and it still might not be enough. We promised to keep these people safe and we will break ourselves trying to do that and it still might not be enough.

You and people like you are absolute heroes for the work you are doing throughout all of this. I hope and wish my aunt had carers like you over the last few weeks who will be there for her for the next few days when we feel the inevitable will happen.

I'm quoting this post in the hope everyone in this thread sees and reads it.

peasant

wheresthebeef wrote: »

I'll tell you the reason why this is happening...

Thank you very much for your explanation and analysis...and thank you even more for all the hard work and energy you are putting into this !

CIARAN_BOYLE

wheresthebeef wrote: »

I dont know what else we can do. We can do all of this and it still might not be enough. We promised to keep these people safe and we will break ourselves trying to do that and it still might not be enough.

Thank you for sharing your opinions.

wheresthebeef

RocketRaccoon wrote: »

You and people like you are absolute heroes for the work you are doing throughout all of this. I hope and wish my aunt had carers like you over the last few weeks who will be there for her for the next few days when we feel the inevitable will happen.

I'm quoting this post in the hope everyone in this thread sees and reads it.

I'm the manager, the staff are the heroes. I'm just trying to make sure they feel safe and supported at work and trying to live up to the trust that families placed in us to care for their most precious people. I've never been more stressed in my life. I wished my mam happy birthday on Monday through steel railings, a situation which I purposefully planned to stop her trying to hug me. I hope to survive this and then never ever see anything like it again for the rest of my life.

Pretzill

By rights nursing homes should be the last place to suffer this, (that and possibly prisons) - but it's only spread because those working there haven't been informed early enough, aren't trained enough in the first place and don't or can't social distance their patients.

Private nursing homes in this country have for a long time suffered high cost that doesn't match that level when it comes to care. I hope if anything comes out of this crisis it's that many of these nursing homes are scrutinised more.

Let's face it you would expect the word "cocooning" to be first applied to nursing homes - those residents didn't bring covid 19 in, they couldn't have.

I say that as a family carer who will do all I can not to let my loved one enter a private nursing home in Ireland.

Mrs OBumble

People who require nursing home care are already sick, usually with no prospect of recovery. Most will die within a few years anyway, no matter whether from Covid-19 or something else.

It's dreadfully sad for their families not be be able to say goodbye.

But not surprising that there are high rates of this, of the flu, of winter vomiting bug, etc.

As for why it costs a grand or more to care for someone, when a home carer will do it for 200: it's because the level of care required for someone who actually needs nursing home care is often far more than a home-carer can provide. In my own relatives case, it was being turned once every four hours, which took two people to do. One home carer could not do it. Even two home carers could not do it except on a very short term basis, because adults need to sleep for more than 4 hours at a stretch at least sometimes. So the actual cost of delivering this sort of care 24x7 in a domestic setting is a lot more than 1000.

wheresthebeef

Pretzill wrote: »

By rights nursing homes should be the last place to suffer this, (that and possibly prisons) - but it's only spread because those working there haven't been informed early enough, aren't trained enough in the first place and don't or can't social distance their patients.

Private nursing homes in this country have for a long time suffered high cost that doesn't match that level when it comes to care. I hope if anything comes out of this crisis it's that many of these nursing homes are scrutinised more.

Let's face it you would expect the word "cocooning" to be first applied to nursing homes - those residents didn't bring covid 19 in, they couldn't have.

I say that as a family carer who will do all I can not to let my loved one enter a private nursing home in Ireland.

That's not correct. We knew what everyone else knew and we communicated it immediately to staff, residents and families. Our staff are very well trained.
Private nursing homes are strangled by government and are funded to an average of 50% less than public homes. Private homes also systematically perform better on HIQA inspections compared to HSE run homes. You can verify that by looking at HIQAs annual list of fully compliant nursing homes.

You are correct in saying that we cant do social distancing because how can we care for someone at a distance of 2 metres. We put as much distance and contact precautions as we possibly could.

We are under no illusions about where people would prefer to be and I think everyone agrees that the preferred place for every older person is always in their own home. If that isn't possible, we try to be the best alternative possible.

wheresthebeef

Mrs OBumble wrote: »

People who require nursing home care are already sick, usually with no prospect of recovery. Most will die within a few years anyway, no matter whether from Covid-19 or something else.

It's dreadfully sad for their families not be be able to say goodbye.

But not surprising that there are high rates of this, of the flu, of winter vomiting bug, etc.

As for why it costs a grand or more to care for someone, when a home carer will do it for 200: it's because the level of care required for someone who actually needs nursing home care is often far more than a home-carer can provide. In my own relatives case, it was being turned once every four hours, which took two people to do. One home carer could not do it. Even two home carers could not do it except on a very short term basis, because adults need to sleep for more than 4 hours at a stretch at least sometimes. So the actual cost of delivering this sort of care 24x7 in a domestic setting is a lot more than 1000.

Any place where people live together increases the risk of infection. Same as cruise ship issue.

Home care appears cheaper because it's only for 2 or 3 hours a day and is only the cost of the staff time and they are care assistants only. A nursing home has to employ a Nurse Manager, Registered Nurses, Carers, Cleaners, Chefs, Activities staff, Maintenance and there are the costs of the building, light and heat, food, medical supplies, therapists, often a mortgage to pay, insurance, commercial rates etc...

The family issue is truly heartbreaking. You cant win either way, by keeping families out you are impairing their ability to grieve and by letting them in you are increasing risk to others. The whole situation is cruel on every front.

tabby aspreme

wheresthebeef wrote: »

Private nursing homes are strangled by government and are funded to an average of 50% less than public homes. Private homes also systematically perform better on HIQA inspections compared to HSE run homes. You can verify that by looking at HIQAs annual list of fully compliant nursing homes.

HSE nursing home my mother is , charges in excess of €1700 /week

wheresthebeef

tabby aspreme wrote: »

HSE nursing home my mother is , charges in excess of €1700 /week

Private average is €980. Either way, hope your Mum is happy there and well cared for and stays safe during this awful time.

The One Doctor

Del Griffith wrote: »

It's this. It's inconceivable that workers in 29 separate facilities just happen to have a positive Corona staff member.

My bet is we all have it, or a huge amount of people anyway, and have no symptoms or very mild symptoms.

This would mean the % death rate and rates needing hospitalisation are far lower than the current figures too.

The estimates are that between 10% and 50% of people are asymptomatic.

beolight

wheresthebeef wrote: »

Any place where people live together increases the risk of infection. Same as cruise ship issue.

Home care appears cheaper because it's only for 2 or 3 hours a day and is only the cost of the staff time and they are care assistants only. A nursing home has to employ a Nurse Manager, Registered Nurses, Carers, Cleaners, Chefs, Activities staff, Maintenance and there are the costs of the building, light and heat, food, medical supplies, therapists, often a mortgage to pay, insurance, commercial rates etc...

The family issue is truly heartbreaking. You cant win either way, by keeping families out you are impairing their ability to grieve and by letting them in you are increasing risk to others. The whole situation is cruel on every front.

Thank you for your post and answers

Can I ask a question ? Anytime I have been in Nursing Homes I couldn’t help but notice that all the Nurses we’re very task oriented, you would see one Nurse doing the meds and then another Nurse doing dressings and so on so basically multiple interactions with Nurses and resident not to mention care staff meals drinks etc.and multiply this by change of shifts. With this type of work practice it is quite easy to see how quickly and easily a virus can spread from resident to nursing home staff and vice versa. Is this how your Nursing Home operates?

wheresthebeef

beolight wrote: »

Thank you for your post and answers

Can I ask a question ? Anytime I have been in Nursing Homes I couldn’t help but notice that all the Nurses we’re very task oriented, you would see one Nurse doing the meds and then another Nurse doing dressings and so on so basically multiple interactions with Nurses and resident not to mention care staff meals drinks etc.and multiply this by change of shifts. With this type of work practice it is quite easy to see how quickly and easily a virus can spread from resident to nursing home staff and vice versa. Is this how your Nursing Home operates?

Task oriented is a sort of negative term so for starters I think anyone would be reluctant to say they were task oriented. Each resident has an assigned nurse and assigned carer for each shift. Those staff however obviously have assignments with other residents too. In a long term care setting the staffing is heavily weighted towards Care Assistants so 1 carer might have 6 or 8 people on their 'group' and 1 nurse might have 20 residents on their group. So we wouldn't have staff roaming between huge cohorts of patients, obviously we couldn't provide 1 to 1 care. Carers have the most contact with residents and they operate in the smallest groups, which is a benefit. Since the start of Covid season we have minimised the rotation of staff between groups so that same staff are looking after same small groups of residents repeatedly. Shift changes obviously cant be avoided either as staff have to rest.
If staff were to be looking after Covid patients, they would not be allowed to then look after non-Covid patients regardless of the groups. That will obviously put additional pressures on the rest of the team, and then added to again if staffing is depleted due to sick leave. Meals are all taking place 1 to 1 in residents own rooms. The movement/rotation is at the minimum it can possibly be and the hygiene measures between residents has been maximised. As I said previously a number of us are now suffering with contact dermatitis from the frequency of hand washing and we are all wearing masks when we are within 2 metres of each other or residents to stop us asymptomatically depositing our respiratory droplets on anyone. Cleaning staff are using bleach on hand rails, switches, buttons, door handles throughout the day. Where the building layout is conducive to compartmentalisation, we've tried to use those features to section off areas. However we have to balance all these measures against residents rights and quality of life too.
It's a very fine balancing act. Some of these measures are more onerous than the HSE advice in some respects and in implementing them, we have to be careful not to do more harm. For example, if we ask residents to limit their movement, we might increase their risk of bowel issues or increase their risk of getting a normal bacterial chest infection as they arent moving as much as they would normally. There is also the obvious risks to peoples mental health too. The ideal scenario is one where we implement the most protective measures possible, and have sufficient compensating measures to reduce the risks of those protections. All of this adds hugely to the stress and workload of staff which can then have a knock on effect on their wellbeing.
For example, the decision to wear a mask at all times is seen as not required by the HSE guidance. So we had to purchase those masks privately at inflated cost. In deciding to advise wearing them, we had to consider if the staff would take this as a sign of increased perceived threat to their safety and if it would cause a rise in absences. We also had to consider that breathing through a mask all day can make you feel very stuffy and short of breath. Carers work can be physically strenuous at the best of times. It's really not easy to decide what the best course of action is. Over the last 3 weeks, we've found ourselves ahead of the advice on a number of occasions which has given us a head start. I would be hopeful that the measures we've taken this week might be incorporated into official guidance soon which would indicate we're on the right track.

In saying that, I am familiar with one of the nursing homes that currently has a large cluster and they would be one of the best resourced and best managed nursing homes out there and it still happened to them. To me, that speaks to the extreme difficulty in controlling this virus unless you can implement 100% cocooning, which we can not. That's why I am filled with dread. You can do everything right and it still comes for you.

beolight

Thanks

What was your reaction to the CMO admonishing Nursing Homes for acting unilaterally and the Taoiseach chiming in the same day!

“Chief Medical Officer Dr Tony Holohan has insisted the risk of contracting Covid-19 in Ireland remains low.

He appealed again to organisations... not to act unilaterally...following the decision of the Nursing Homes Ireland to implement visitor restrictions nationwide."

I remember Leo Varadker using the same words later that day in his briefing.

NHI made their decision on March 6 and even if it was too late,thankfully a lot ignored the CMO and Taoiseach but unfortunately HSE run Nursing Homes would of been obliged to follow it.




https://www.rte.ie/new...1120765-coronavirus/

Rodney Bathgate

lalababa wrote: »

The cheapest private nursing home near me is 950 euro a week. The public one is 1500 a week. They are both run well and have caring staff.
How it costs a grand a week to care for somebody when a home carer might do it for 200 carers allowance beats me. But there you go.

The home carer is not providing accommodation for a start.

Danzy

hmmm wrote: »

Do we know why there are so many cases in nursing homes? Looking at the stats there are very few recorded outbreaks in employers, but lots in nursing homes. I'd have thought both would be likely.

Is it because the people in the homes tend towards worse outcomes, and are more likely to need hospitalisation? That would point towards significant undetected spread in the general community.

I'm Guessing that fresh air, open windows might not be common in nursing homes, maybe how they all go in to the day room, all day.touching hand rails.

100 people confined to a small building with closed windows is my guess.

wheresthebeef

beolight wrote: »

Thanks

What was your reaction to the CMO admonishing Nursing Homes for acting unilaterally and the Taoiseach chiming in the same day!

“Chief Medical Officer Dr Tony Holohan has insisted the risk of contracting Covid-19 in Ireland remains low.

He appealed again to organisations... not to act unilaterally...following the decision of the Nursing Homes Ireland to implement visitor restrictions nationwide."

I remember Leo Varadker using the same words later that day in his briefing.

NHI made their decision on March 6 and even if it was too late,thankfully a lot ignored the CMO and Taoiseach but unfortunately HSE run Nursing Homes would of been obliged to follow it.




https://www.rte.ie/new...1120765-coronavirus/

I was disappointed reading it, but looking back there were a number of HSE hospitals doing it too. We thought very hard on it and decided to boil it down to simple maths - resident has contact with 30% less people = 30% less risk. Our families were also supportive of the move even though it was tough on them. As you know, days later, the government gave in on that recommendation so we were vindicated in a way.

wheresthebeef

Danzy wrote: »

I'm Guessing that fresh air, open windows might not be common in nursing homes, maybe how they all go in to the day room, all day.touching hand rails.

100 people confined to a small building with closed windows is my guess.

A lot of older people feel the cold. It can be hard to get them to agree to an open window in blistering weather we had last summer, nevermind in April. We opened all the windows on corridors and communal areas though. Theres almost nobody in day rooms anymore.

DeVore

In truth, with an R0 of 2.2 , most people are going to contract Covid at some stage. The intent is not so much "to protect the elderly" as it is to protect the hospitals so that when the elderly get sick, we can treat them effectively.

Danzy

wheresthebeef wrote: »

A lot of older people feel the cold. It can be hard to get them to agree to an open window in blistering weather we had last summer, nevermind in April. We opened all the windows on corridors and communal areas though. Theres almost nobody in day rooms anymore.

I agree, my point was referring to the explosive potential a nursing home represents.

There is a massive effort being made to keep people safe there, just to clarify I'm not doubting that at all.

Danzy

DeVore wrote: »

In truth, with an R0 of 2.2 , most people are going to contract Covid at some stage. The intent is not so much "to protect the elderly" as it is to protect the hospitals so that when the elderly get sick, we can treat them effectively.

The R0 number changes with weather and circumstances.

In all probability the Corona virus will be here for good, but more time will mean a milder version and drug/treatment to manage it.

beolight

DeVore wrote: »

In truth, with an R0 of 2.2 , most people are going to contract Covid at some stage. The intent is not so much "to protect the elderly" as it is to protect the hospitals so that when the elderly get sick, we can treat them effectively.

Exactly we need to realise the Nursing Home environment is just a microcosm if every neighbourhood/ community/ workplace.

200 residents and staff interacting makes it inevitable once containment ( South Korea:Taiwan style )doesn’t stop it spreading in the community ... then at least 10% of the 200 will have it and unless twice daily monitoring ( at least) of everyone plus everyone wearing PPE with suspected cases immediately isolated it will spread and spread and unfortunately Nursing Home residents will score poor on the Fraility Index so ICU not a viable option especially when ventilators are in such short supply

Boris’s original herd immunity plan was based on not only isolating the old and vulnerable ( group A)but on also isolating the health care staff( group . Group C was everyone else whom it was argued should be strong enough to get over it. The theoretical flaw in that plan was the healthcare workers had families and all the problems that entailed

MadYaker

The sad reality of this situation is that no matter what we do it isn't possible to protect everyone.

DeVore

It isnt possible to protect everyone. However that doesnt mean you dont attempt to protect as many as possible.

The minute someone stuck their dick in a bat in China, some people were going to die. However by careful management of resources we can minimise that number.

SuperRabbit

DeVore wrote: »

It isnt possible to protect everyone. However that doesnt mean you dont attempt to protect as many as possible.

The minute someone stuck their dick in a bat in China, some people were going to die. However by careful management of resources we can minimise that number.

**** off. What happened to your positivity? Go stick your dick in yourself, racist.

ILoveYourVibes

peasant wrote: »

https://www.irishexaminer.com/breakingnews
And before people start going on about Irish inadequacies etc ...posterboy Germany has plenty of cases (and sadly also plenty of deaths) in care homes for the elderly.
(Don't trust me? Go to google news. de and type "Seniorenheim" into the search function and google translate away)

Do you realize what the german death rate is compared to ours?
https://www.businessinsider.com/why-germany-has-a-low-covid-19-mortality-rate-2020-4?r=US&IR=T


https://www.irishtimes.com/news/health/coronavirus-irish-death-rate-from-covid-19-rises-to-2-4-of-cases-1.4217851?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fhealth%2Fcoronavirus-irish-death-rate-from-covid-19-rises-to-2-4-of-cases-1.4217851

Still waters

SuperRabbit wrote: »

**** off. What happened to your positivity? Go stick your dick in yourself, racist.

Lol

ILoveYourVibes

[QUOTE=DeVore;113044570

The minute someone stuck their dick in a bat in China, some people were going to die..[/QUOTE]
I think you have some odd ideas of what a wet market is DeVore.