Documentation released under FOI from the HSE shows how Dealgan House Nursing Home in Co Louth begged the HSE for help as it battled a Covid-19 outbreak that led to a critical staffing shortage and brought the entire home to crisis point.
Since March 23rd Dealgan House had been in regular contact with the HSE seeking testing, PPE and later staffing, but by April 13th and April 14th,Fintan Farrelly on behalf of management at Dealgan House, wrote emails significantly raising the alarm and seeking urgent help from the HSE. "It is not an exaggeration to say that a tragedy is unfolding in Dealgan House," he said.
At the time he wrote, six people at the home had died having contracted Covid-19.Within a month, a further 16 people would succumb to the virus, with a total of 22 Covid-19 related deaths.
Fintan Farrelly highlighted how the lack of staff was impacting on all residents. "Chronic staff shortages ..has a very detrimental effect on all of our residents. They are isolated and fearful."
Two days earlier on Easter Sunday he had also written to the then Minister for Health, Simon Harris, in an email which was which was passed on as a matter of urgency to the HSE. Only 6 out of 20 nurses were available for work and the correspondence shows that overall staff fell to 34 out of 104, at the lowest point of the crisis.
Mr. Farrelly explained to the HSE:"The time that the staff usually devote to ensuring residents are clean, well fed and hydrated is not available." As a result "the general condition of all residents is in decline leaving them more exposed to infection and less able to fight the virus if infected."
"I believe it is not too late to avert this tragedy if underutilised resources in the HSE .. are reallocated", he said.
Although the HSE had the week before provided some staffing – a clinical nurse manager and two health care assistants - Mr Farrelly said that the home urgently needed a vast amount more: "A doctor's services, four to five staff nurses per day.. to work 12 hour shifts day or night" along with health care assistants, catering staff, cleaners. He also urgently requested equipment, including "oxygen, oxygen saturation monitors, fluid drip stands, an adequate supply of PPE" stating that "the home virtually needs to be turned into a hospital."
In the first email on April 13th, he also set out the alternative: "All our residents deserve a chance to fight this virus and if they cannot get it in Dealgan House, the only alternative is to transfer them to OLOL [Our Lady of Lourdes Hospital, Drogheda]. This is not our wish, nor that of the families, nor I am sure, that of the HSE."
Mr Farrelly also expresses concern that transferring them to hospital might not even been possible as there appeared to be "an apparent change of policy in OLOL" in accepting residents from the home to the hospital.This is because two residents had not been transferred even in circumstances where the Dealgan House nurse "was of the opinion that the residents would benefit from hospital treatment."
An Urgent response
At 5.30 on the evening of April 13th, a Bank Holiday Monday, on receipt of the first email from Fintan Farrelly, an urgent telecall was convened including staff from the Midlands, Louth and Meath Community Health Organisation (CHO), Royal College of Surgeons Hospital Group staff and one of the Dealgan House GPs.
The notes from the Telecall state that "the situation in Dealgan House remained critical. It describes how most of the residents had not been seen by a GP lately and that the residents' GP "will 'gown up' tomorrow and go in."
It was also noted that that "the bins were overflowing; cleaning team left the premises", and that "Care is urgently needed for the residents."
On the same day, an internal HSE email states that its public health division had concluded among other things that it was "requesting army support as they can provide cleaning services and health care members could provide fluids."
The following evening another telecall was convened with most of same HSE and hospital group staff present but also present were management from Dealgan House. It was noted "that staffing situation in Dealgan N. H remains critical". It was also noted that the home’s Deputy Director of Nursing, Dolores Conroy (DC), stated that in "Dealgan it can be so hot in the rooms and the residents can become dehydrated, however DC stated that she is happy with the residents’ hydration status currently." It was also noted that she had received one drip stand and the HSE was to follow up and provide more.
Lack of equipment and PPE
Emails between the nursing home’s manager, Eoin Farrelly and Ann Marron, the HSE lead for nursing homes in County Louth, illustrate the need for the nursing home to get more supplies and support from the HSE.
Ms Marron points up the concerns of the Dealgan House Nurse Manager about the lack of thermometers who reported "no ability to check temperatures with only one dodgy thermometer on site." Elsewhere it is noted that due to a lack of ear covers for thermometers "temperatures can only be taken once per day and not the recommended twice per day".
She also brings to the attention of the manager, Eoin Farrelly, that there was insufficient hand sanitiser outside each room and that supplies were running low.
In relation to responding to Dealgan House’s need for oxygen, Ann Coyle, the HSE Interim lead for Quality and Patient Safety for the Midlands, Louth Meath Community Health Organisation, writes about the difficulty in sourcing it. " We did have in place a good system in relation to linking Nursing Homes but this was changed suddenly and has left us without emergency supplies." Later, an email indicates that the Louth County Hospital agreed to send over a cylinder.
Difficulties with staff recruitment
In the hours and days that followed the urgent emails from Fintan Farrelly in mid April, the HSE scrambled to provide more staffing and other supports to the nursing home.
It also provided Dealgan House with a contacts for health staff recruitment agencies and cleaning contractors. HSE staff were in short supply due to being diverted to their own facilities. Emails show attempts to recruit agency nurses was also unsuccessful.
As a result, the attempts to provide and retain sufficient numbers failed.
The difficulties are highlighted in a number of emails. In one, it was noted that a carer who came in to cover a few night shifts, left after it citing "that she just could not return to work in such conditions." In another email the Deputy Director of Nursing Dolores Conroy says, along with five Health Care Assistants "I have only one junior nurse on duty tonight and she is not happy taking responsibility for 69 people and 15 people who are suspected of Covid along with other frail and vulnerable residents."
The documents released under Freedom of Information which detail communications between Dealgan House, the HSE, the Royal College of Surgeons of Ireland (RCSI) and Health Information and Quality Authority (HIQA) in the run up to the hospital group’s take over, show that there was involvement by both the HSE and Our Lady of Lourdes medical staff at Dealgan House prior to the Covid-19 outbreak and after it.
Despite intensive efforts by the nursing home and all involved to improve staffing and conditions at the home, on Friday April 17th, General Manager, Fiona Brady, from Our Lady of Lourdes and Louth Co hospital writes "Due to ongoing concerns in relation to Dealgan Nursing Home a decision was made today that Our Lady of Lourdes Hospital in conjunction with Louth County hospital will temporarily take over the care and governance at the home." The Covid-19 outbreak was subsequently brought under control in the following weeks.
In a statement, Dealgan House Nursing home told RTÉ that it "is currently Covid free and has been since 20th April 2020. The nursing Home has also been operating without assistance from the HSE since Mid-May 2020. Life for residents is as near as possible to normal within current Covid 19 restrictions."
It also previously told RTÉ that "From the date that the first case was confirmed on the 4th April, until the RCSI Hospital Group support arrived on April 17th, we suffered from a shortage of Nurses and Carers due to staff illness and not being able to work. We asked repeatedly for help but as you can imagine the resources at CHO [HSE Community Health Organisation] disposal proved totally inadequate."
In 2019, Dealgan House was commended by Health information and Quality Authority (HIQA) in its 2019 inspection report for the way it had handled the winter vomiting bug.
In a statement to RTÉ the HSE said that since the beginning of the pandemic in March 2020, it has provided "supports and assistance to various nursing homes, including Dealgan House, to assist them and their residents. This has been both nationally, through their representative body, Nursing Homes Ireland, and locally through individual providers and the Community Healthcare Organisation (CHO) network.
"Specific supports have been put in place due the current pandemic. Each CHO Area Crisis Management Team (ACMT) has and continues to prioritise the needs of long term care residents within their areas across public, voluntary and private facilities and offers very significant support to the nursing homes in their areas.This has included management support, PPE, other supplies, testing of residents and staff, Public Health inputs, other clinical inputs…in some cases, the reassignment of HSE staff to support nursing homes."