The National Lead for Integrated Care with the Health Service Executive has said she could not say with certainty if all deaths for Covid-19 in nursing homes and care centres were reported as such.

The National Lead for Integrated Care with the Health Service Executive has said she could not say with certainty if all deaths for Covid-19 in nursing homes and care centres were reported as such.
Dr Siobhán Ní Bhriain said they are looking at the possibility that at the early stage of the virus outbreak there may have been a few deaths that occurred that “were not typically Covid in terms of symptoms”.
Speaking on RTÉ’s Morning Ireland, she said there is a system in place “to look back at all those deaths and we will be reviewing that.”
She said the HSE is trying to protect those in nursing homes and residential centres where there have been outbreaks of Covid-19 by cohorting patients.
She admitted that in smaller nursing homes that is not always possible and can be “difficult.”
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Dr Ní Bhriain said if a resident is infected they are isolated immediately and if others get it they are cared for together away from others in the home or care centre.
Referring to the residential centre in Co Laois where nine patients died, eight of them had Covid-19, over a three-day period, she said the staff there had followed Health Service Executive policy, which is to separate and cohort. 
She said they mobilised a lot of support from Midland Regional Hospital, Portlaoise, and they were able to manage staff rosters to ensure they got the care they needed.
None of the residents were transferred to hospital after they were infected. 
“Decisions were made about the level of care by the two consultants from Portlaoise hospital and the overall feeling was there would have been no benefit by transferring them to hospital.”
She said for those who remain in the residential centre they are being “closely monitored” and if they require testing they will get it. 
Dr Ní Bhriain said the situation may arise that some residents may need to be moved out of a nursing home setting depending on a Covid-19 outbreak.
“If we find it unmanageable in one nursing home we will look at moving them into another facility.”
She said there are daily outbreak meetings and for now the Health Information and Quality Authority feels quite strongly that people should not be moved out of their current setting.
HIQA has said that early testing and early results could help to address staff shortages in nursing homes across the country.
HIQA’s Chief Inspector of Social Services Mary Dunnion said elderly people have the highest vulnerability to Covid-19 and nursing homes are integrated into the community, which makes them vulnerable to community transmission.
Speaking on the same programme, she said that over 30% of nursing homes have confirmed or suspected cases of the virus and enhanced supports are needed for the other 70% of homes to reduce transmission of the virus if it reaches them.
Ms Dunnion said there were suspected cases of Covid-19 in 72 nursing homes yesterday, and there are 118 centres with confirmed cases. 
In some of these homes, she said, there are a lot of staff in self-isolation awaiting test results, which may turn out to be negative, and cannot return to work for at least 14 days without the results.
This is impacting on care and resources in nursing homes where it is best practice to have nurses who know the residents. 
Infection controls with proper personal protection equipment and adequate palliative care supports also need to be improved in the sector.
She said many nursing homes are standalone facilities, with no historic relationship with the HSE.
HIQA is working with providers each morning to identify centres needing additional supports and escalating concerns to the HSE as required.
Ms Dunnion said that it is possible to move patients out of infected nursing homes and into hospitals.
She said it has happened and the situation is that if a person’s symptoms change there is a decision made about whether they need to be transferred.  
She said the health crisis has challenged all areas of health and social services and lessons will need to be learned at the end of this.