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'This thing is coming for care homes and we're not prepared'

Facilities 'not equipped to be Covid wards', says nursing chief

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Care home manager Aoife Kiernan

Care home manager Aoife Kiernan

Care home manager Aoife Kiernan

Every time care home manager Aoife Kiernan starts a shift, the war on Covid-19 begins.

First, she puts on a set of gloves, then puts another set on top of those.

Then over her mouth and nose, she carefully attaches a FFP2 mask, a special grade respirator that filters airborne particles.

A full-length protective gown is next to go on over her clothes, followed by an apron, a hair net and, finally, a face visor.

Ready and armed, the 26-year-old takes a deep breath, opens the door, and steps on to the frontline.

Killer

"When you're going into a room where someone has Covid it's a very daunting moment," Ms Kiernan told the Herald.

"You're meeting this ferocious virus face on. It's in the room with you and yes, it's scary."

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Professor Martin Cormican, HSE, with some
of the PPE equipment sourced from China a couple of weeks ago

Professor Martin Cormican, HSE, with some of the PPE equipment sourced from China a couple of weeks ago

Professor Martin Cormican, HSE, with some of the PPE equipment sourced from China a couple of weeks ago

Aoife's enemy, an invisible killer, found its way in to the nursing home she works in a number of weeks ago.

Since then, Covid-19 has been stalking the corridors of the family-run facility, turning sunlit living spaces and laughter-filled day rooms into a viral stalking ground for some of the most frail and elderly.

Four residents have died. Of the 17 who remain, six are Covid positive and eight others have symptoms and are awaiting test results.

"This is so serious," said Ms Kiernan.

"We have controlled the virus in the home we are in at this stage, but this is coming for nursing homes across the country and when it hits, it truly hits. It's like being hit by a bus."

The devastating toll Covid-19 has taken on nursing homes has been impossible to miss. At least 348 people living in long-term care have died in the Covid-19 outbreak.

The actual count is very likely far higher, many believe, in part because the early testing protocols meant that many who died went untested.

The escalating crisis forced Ms Kiernan to go public. Almost two weeks ago, she took on the role of interim director of nursing in her current place of work after the permanent holder of the position fell ill with Covid-19.

Since then she has been battling the virus, scouring the country for PPE and begging the HSE for help, she said.

"I think it's time I spoke up," she said. "We are being sent to war with no armour.

"This virus is inside nursing homes across the country and the PPE the HSE is offering won't protect us during battle.

"We won't survive the war if we aren't given the best available tools to protect and I'm not willing to put my staff at risk with what the HSE is offering in terms of protection."

According to Ms Kiernan, the HSE has been forthcoming with their PPE supplies. Her issue is with the standard, in line with national guidelines, of what is being offered.

"They have told me that surgical masks are to be used in this environment," she said.

"These masks are single ply and the HSE argue that because we are not doing ventilation in nursing homes, specialised masks aren't required.

"I have patients who are mobile and Covid-19 positive as well as dementia patients for example and some of those don't have the awareness that they are symptomatic for Covid 19.

"They are eating and drinking, they're walking in the halls, they are passing staff.

"They are unaware of the need to cover their mouths when they cough. They are unaware of the need to cover when they sneeze.

"They touch multiple surfaces, and this is their home.

"The only way I can protect my staff is by ensuring they have the best quality PPE there is to protect them. I cannot control where the Covid-19 is in the home. It's absolutely impossible to control, given the circumstances, when you have mobile patients who are unaware that they are Covid positive."

Last week, following a visit from the Community Liaison Services via the Department of Medicine for Older Persons at St Vincent's University Hospital, Aoife was told to treat her nursing home like a "Covid ward".

But she says the setting is not designed or equipped for such a change of use. "There are patients in here who are not symptomatic," she said.

Assistance

In a statement, the HSE said it was providing assistance to the staff and residents of the home where Ms Kiernan works.

On the issue of masks, the HSE said: "On April 22 the HSE updated its guidance on the use of surgical masks in healthcare settings in the context of the Covid-19 pandemic."

This follows a decision by NPHET based on advice from the Expert Advice Group.

The HSE said new guidance on masks requires staff to wear surgical masks when providing care within two metres of a patient.