July  2021 – A snapshot survey, conducted by the Nursing Home Quality Initiative (NHQI) and completed by people identifying as relatives, advocates and in one case a nurse with over 30 years of experience, reveals that many of the serious concerns about nursing homes predate the pandemic.

The survey was completed by 49 people and included representation from counties Carlow, Cavan, Clare, Cork, Dublin, Kerry, Kildare, Laois, Leitrim, Louth, Meath, Tipperary, Wexford and Wicklow. While 84% based their responses on experience of nursing homes over the last two years, 44% cited prior experience with some respondents basing their answers on accumulative experience over the last decade. The majority of the responses centered around private nursing homes (75%) with the remainder coming from community and public nursing homes.

On a positive note, 57.5% rated the general level of care in nursing homes as “good” or higher while 72% described hygiene as “good” or higher. However, the majority of the results suggest failures in clinical governance compounded by poor communications. While a more comprehensive nationwide survey is required, there is reason to believe that these failings are widespread throughout the sector.

Staff Levels

  • 36% rated staff levels as “poor” with a further 34% describing it as “fair”.
  • 33% rated staff levels at night and weekends as “poor” with only 27% rating it “good” or higher.
  • A number of key areas attracted a 29% plus “poor” rating, including availability of medical equipment and staff responsiveness to personal needs.

Care Plans

  • 40% of those who responded were not involved in developing a care plan. One respondent said, “Individualised care seems to go out the window, mainly due to staffing levels and no consistency of care.” Another said, “I have had to fight constantly to have my voice included.”
  • 63% said they had not received a copy of their relative’s care plan.
  • 56% said they were dissatisfied with the frequency of updates while 65% said they were not consulted when changes were made.
  • 60% said there were no regular meetings to discuss the care plan. One respondent said, “It is my opinion that the care plan is only ever updated if I challenge them.”
  • The quality of care plans attracted the higher proportion of negative responses, ranging from 65% to 56%. Some described it as merely a “cut and paste exercise” and another as a “tick-box piece of paper.” Another said, “I don’t think the nurses or carers ever read it.”
  • When asked, why they are not consulted about the care plan, narrative responses paint a picture of arrogance, lip-service and tokenism. “They don’t seem interested in consulting with relatives.” “Professional knows best.” “Institutional arrogance.” “They don’t feel obliged to inform me.” Others cited lack of resources.

Complaints Process

  • 48% of respondents do not know whether there is a complaints procedure and 63% do not know whether there is an independent advocate available.
  • Experience of nursing home responses to complaints was disappointing with 28% ranking it as “poor” and 10% as “fair”, compared to 8% ranking it as “excellent”, 13% “very good” and 8% “good.”
  • When asked if HIQA canvassed their views as relatives during inspections, 83% of respondents said that they had never been asked to participate while only 17% were included. While this result may be impacted by restrictions during COVID, NHQI believes that this is indicative of a general lack of user consultation by HIQA.
  • Moreover,HIQA’s approval rating in respect of complaint handling is particularly poor, notwithstanding the structural weaknesses in this area with 86% of those that proffered an opinion ranking it as “fair” or “poor.”

Vaccine Programme

  • 76% of relatives had not been informed of the level of vaccine take up by staff at the home.
  • 90% said they had not been informed if their relative is in direct contact with unvaccinated staff members.
  • These negative responses indicate a serious breach of trust and arguable disregard for the safety of residents. We believe that this calls for immediate action and investigation, especially in light of Delta variant concerns.
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