A specialist in infectious disease at the Mater Hospital has said the situation facing nursing homes and residential care facilities is a national emergency.

Dr Jack Lambert said the redeployment of healthcare staff from all underworked healthcare facilities needs to happen today to each of the public and private nursing homes and care facilities.

He said these staff need to be given strict directions about what to do in relation to PPE access, looking at testing pathways and training.

Speaking on RTÉ's Today with Sean O'Rourke, Dr Lambert said the focus on acute hospitals meant Ireland "never put together a battle plan for community care facilities".

He said it was a huge disaster that the virus had spread over the last four weeks in nursing homes, with the number of clusters growing from the mid-20s in March to more than 200 clusters now in nursing homes and care facilities.

Dr Lambert said he had sight of a document that showed that nursing homes were expected to make their own plans to deal with the pandemic.

He criticised the expectation "to put it back on nursing homes" to find their own PPE, to organise testing, training and isolating residents and clients, as well as coping with staff getting sick in an already under-resourced environment.

He said nursing homes were relying on calling GPs and requesting swabs and this was not going to happen fast enough.

Speaking in the Dáil the Taoiseach said safeguarding residents in nursing and care homes was the burning and pressing issue and it was the focus of the cabinet subcommittee today.

Leo Varadkar said it was a reflection of the scale of the crisis that dealing with the problem wasn't happening as quick as they would like.

He said the virus was in the community and was targetting those who were old and infirm.

Mr Varadkar said Covid-19 was going to exact a significant toll on the nursing home population and their job was to minimise that.

He said the issue of congregated settings had always been on the agenda and was identified early on.

He also said there was no evidence of Covid-19 being more common in either private or public nursing homes. 

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All deaths in nursing homes will be reviewed in light of Covid-19

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

Dr Siobhán Ní Bhriain said they were 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 was a system in place "to look back at all those deaths and we will be reviewing that".

Dr Ní Bhriain said the HSE was trying to protect those in nursing homes and residential centres where there have been outbreaks of Covid-19 by "cohorting patients" or keeping the patient with an existing room-mate.

She admitted that in smaller nursing homes that is not always possible and can be "difficult".

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.

Dr Ní Bhriain 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.

She said for those who remain in the residential centre they are being "closely monitored" and if they require testing they will get it.

Elderly have highest vulnerability to Covid-19

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 were 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 affecting 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.