Half of nursing homes inspected by the Health Information and Quality Authority after Covid-19 outbreaks were not following proper infection prevention and control measures.
A report on the impact of the virus on nursing homes published by HIQA shows that almost 60% of nursing homes inspected by the authority after having outbreaks of Covid-19 may have had more severe outbreaks than they should have had because of weak governance and management.
In one nursing home, the bedroom door of a resident who had tested positive was left open and another facility was deemed so unfit for residents it was taken over by the HSE and ultimately shut down.
In another example, care staff were carrying out multiple tasks such as laundry and kitchen duties, which posed a risk of cross infection in the centre.
HIQA found that multi-occupancy rooms and outdated facilities made it difficult to stop the spread of the virus.
Inspectors found poor contingency planning in the event of managers falling ill, a lack of effective communication and supervision between staff and management and staff shortages.
In one home, 29 members of staff tested positive for Covid-19, which had a knock-on effect on nursing care and proper cleaning of the centre in line with guidance.
HIQA said it is vital nursing homes be modernised as a matter of urgency "to facilitate physical distancing requirements, allow for infection prevention and control and to give residents the dignity and privacy they deserve".
Chief Inspector Mary Dunnion said: "Covid-19 has brought into sharp focus the need for reform of current models of care for older people."
She said there must be alternative models of care for older people, such as homecare and assisted living.
Ms Dunnion said: "Regulations governing nursing homes are outdated and must be revised to make them fit for purpose, particularly as regards governance, staff numbers and infection prevention and control".
Speaking on RTÉ's Drivetime, she also said that it is "regrettable" that mass testing in nursing homes was not introduced until June.
She said mass testing was "highly effective" when it began, and warned that this level of testing and contact tracing is "critically important" as Ireland proceeds through the pandemic.
HIQA said: "Further analysis is needed to determine whether the focus on hospitals during the early stage of the pandemic distracted attention from residential care facilities."
The authority has recommended that nursing home providers have access to data on the prevalence of the virus in their area so they can manage visits and access to their centres appropriately.
The report also outlines the human impact of dealing with the pandemic on staff, residents and their families who contacted HIQA to tell their story.
Residents spoke of the fear of never hugging their family again and of what would happen if a resident of staff member tested positive.
One said he would "not leave the room again until a vaccine was found".
Others were frustrated and angry that prevention measures meant they were largely confined to their bedrooms and cut out from the friends in the centre.
The only human contact was from staff, many of whom were wearing PPE. There was also a serious impact on the well-being of staff.
One home said: "We have some staff that are still out and it is likely they will never return, such is their upset."
Most inspectors recounted stories of management and staff becoming overwhelmed with emotion when speaking about how they managed during the pandemic, exhibiting signs of extreme stress, fatigue, exhaustion and anxiety in trying to come to terms with what happened to them.
One member of staff at a nursing home said: "I am constantly worried, I am thinking and worrying in case I missed something."
Staff spoke to inspectors of feeling guilty for not having time to give reassurance and important human contact for residents but on top of an increased workload they were extremely worried about the residents and their own families.
One family member said: "My dad is a broken man, he misses his family more than anything."
Non-compliance rate 'just not acceptable'
The 58% rate of non-compliance in governance and management in nursing homes inspected by HIQA was "just not acceptable", according to a Fine Gael TD.
Speaking on RTÉ's Drivetime, Fergus O'Dowd said while "the interaction now between the State, the Department of Health, the HSE and the nursing homes, private and public, is much more focused now on better health outcomes", there is a need to go back to home care so that people can be kept and supported at home.
He said HIQA's report is "a shocking indictment of these homes which HIQA judged them to be non-compliant in 2018".
The Louth TD said the findings were unacceptable two to three years ago.
Meanwhile Sinn Féin's spokesperson on health has described the HIQA report as "damning" and said it is time to look at the role of HIQA in the clinical governance of nursing homes, which he said was very very weak.
Speaking on the same programme, David Cullinane said there is a need to "establish all of the facts", that HIQA is the regulator and on their watch there were very low levels of compliance.
He said there is a need for a full, comprehensive and compassionate special Oireachtas committee to examine all the issues to establish the facts of what happened.
The Waterford TD said it was a "very distressing report" for those who lost loved ones in nursing homes.