LTCcovid Country Profile – Printable Version
1.00. Brief overview of the Long-Term Care system
Most LTC in Ireland is provided by unpaid carers supplemented by home care services. There are more public resources available for residential care than for home care services. By December 2018, 581 nursing homes in Ireland registered with the Health Information and Quality Authority offered 31,250 places for people with care needs. More than 460 of the homes are operated by private or voluntary (not-for-profit) providers), supporting 25,000 people. Ireland also has some ‘psychiatry of later life units’. Most of the residents are 65 years and older. Publicly funded support for home care can be obtained following a needs assessment conducted by a healthcare professional. So far financial means are not taken into consideration. Most home care services are provided by private providers, but these providers are contracted by the State. The role of the public sector in the delivery of home care is relatively small (Pierce et al., 2020).
References:
Pierce, M., Keogh, F., O’Shea, E. (2020). ‘The impact of COVID-19 on people who use and provide long-term care in Ireland and mitigating measures.’ Country report available at LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 13 May 2020
Update for: Ireland Last updated: February 16th, 2022
1.05. Quality and regulation in Long-term care
Since 2008, there have been independent, unannounced inspections of all public, private and voluntary nursing homes. These inspections are carried out by the Health Information and Quality Authority (HIQA). Since 2012, a system of approved service providers has been put in place under home support services, which must meet a uniform level of national standards. There are 35 standards including a person-centred approach, autonomy, safeguarding, the promotion of rights and dignity as well as standards in relation to provision and use of resources. It is planned that home care services will be independently inspected, however as of 2021 there was no statutory basis to do so (source: European Commission: 2021 Long-term care in the EU).
Update for: Ireland Last updated: February 10th, 2022
1.11. Role of unpaid carers and policies to support them
Most long-term care in Ireland is provided by unpaid carers supplemented by home care services (Pierce, et al. 2020). Income support is often targeted at carers (rather than people with LTC needs), in the form of carer’s allowance/benefit. In order to qualify for carers’ allowance one needs to be in a position to provide full-time care to a person with needs. Ireland also has a home carer’s tax credit for married couples or civil partners where one partner carers for a dependent person (rather than being in paid employment). The Carer’s Leave Act 2001 entitles employees to leave work temporarily to provide full-time care for someone who requires full-time care (as signed off by a GP). To be eligible, the carer must have been in the continuous employment for at least 12 months. The leave can be taken for a period ranging from 13 weeks up to a maximum of 104 weeks. The leave can be taken either as a continuous period or for a number of separate periods not exceeding the maximum number of 104 weeks. The leave is unpaid, however it offers job protection and the person may be eligible for carer’s benefits (EC, 2021).
References:
European Commission, EC (2021) 2021 Long-term care report. Trends, challenges and opportunities in an ageing society. Country profiles Vol. 2. Joint Report prepared by the Social Protection Committee (SPC) and the European Commission (DG EMPL)
Pierce M, Keogh F and O’Shea E (2020). ‘The impact of COVID-19 on people who use and provide long-term care in Ireland and mitigating measures’. Country report available at LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 13 May 2020.
Update for: Ireland Last updated: February 16th, 2022
2.02. Deaths attributed to COVID-19 among people using long-term care
Ireland has a centralised system to collect epidemiological information in relation to cases of COVID-19 infections (Source: https://ltccovid.org/wp-content/uploads/2020/04/Ireland-COVID-LTC-report-updated-28-April-2020.pdf). All deaths, in all care settings and dwellings, related to COVID-19 that are notified to the Health Prevention Surveillance Centre are included in the official count of deaths. A weekly report detailing mortality by place of death and as linked to outbreaks is published by the HSPC.
A report by the Department of Health and the Health Prevention Surveillance Centre published in December 2020, estimated that up to December 13, 2020, there had been 1,112 deaths linked to COVID-19 in nursing homes. On that date, there had been 2,110 deaths attributed to COVID-19 in Ireland. Therefore, deaths of nursing home residents represented 51% of all deaths linked to COVID-19, but this figure has changed during the pandemic, suggesting lessons from the first wave may have improved the capacity of nursing homes to fight the pandemic. Based on the data in the same report, during what was the first wave in Ireland (up to early August 2020), the proportion of COVID-19 deaths attributed to nursing home residents was 54%, but in the second wave (August to October 2020) it was 38%, and between November and mid-December the share was 34%.
As of April 16th 2022, there have been a total of 6,964 deaths due to COVID-19 in Ireland, of which, 2,543 are linked to outbreaks in nursing homes and 2,240 occurred within residential institutions (including community hospital/long stay unit, homeless facility, mental health facility and nursing homes) themselves. Thus deaths linked to nursing home outbreaks represent 36.5% of all deaths from COVID-19. There are an estimated 30,000 people living in nursing homes. Therefore, 8.47% of all nursing home care residents would have died because of COVID-19 as of April 2022.
Update for: Ireland Last updated: May 3rd, 2022 Contributors: Disha Patel | William Byrd |
2.07. Impacts of the pandemic on unpaid carers
Quantitative evidence
An online survey of 225 relatives of people living in care homes carried out in June 2020 examined the perceived impacts of visiting restrictions on perceived loneliness, well-being and carer quality of life. The study found that many visitors experienced low psychosocial and emotional well-being during, the impacts were greater among relatives of people with cognitive impairment. Almost a fight of respondents reported that support for their role as carers from staff in the care homes had been poor and this had impacted their quality of life. Most respondents also reported that they perceived that the residents were not coping well (O’Caoimh R., et al., 2020).
References:
O’Caoimh R, O’Donovan MR, Monahan MP, Dalton O’Connor C, Buckley C, Kilty C, Fitzgerald S, Hartigan I and Cornally N (2020) Psychosocial Impact of COVID-19 Nursing Home Restrictions on Visitors of Residents With Cognitive Impairment: A Cross-Sectional Study as Part of the Engaging Remotely in Care (ERiC) Project. Front. Psychiatry 11:585373. doi: 10.3389/fpsyt.2020.585373
Update for: Ireland Last updated: January 9th, 2022
2.08. Impacts of the pandemic on people working in the Long-Term Care sector
Quantitative evidence of negative impacts on the mental health of nursing home staff:
An online survey of 390 nursing home staff across the Republic of Ireland during the third wave of the pandemic ( 20th November 2020 to 4th January 2021) gathered data on COVID-19 exposure and mental health. They study found that nursing home care staff reported high levels of post-traumatic stress, mood disturbance and moral injury (distress experienced when an individual witnesses or engages in acts that contradict their moral beliefs) during the pandemic. There was also high prevalence of suicidal ideation (13.8%) and planning (9.2%), a higher prevalence than that observed in hospital workers during the pandemic. 24.6% of staff also reported that they were not able to cope with work demands (work ability).
The study found significant differences between different staff groups, with health care assistants reporting a significantly higher degree of moral injury than non-clinical staff (Brady et al., 2021).
Evidence on the impact of COVID on working conditions in public and private sectors
A study by Mercille et al., (2022) illustrated that nearly 39% of care workers worked more hours during the pandemic compared to pre-pandemic times, while 16.5 % worked fewer hours. Those employed by private providers were more likely to experience increased working hours relative to those employed by public providers. Moreover, care workers reported that they had to work when they were affected by the pandemic because of the derogations. Nearly 70% of care workers in reported receiving little or no COVID-19 training. Moreover, those employed by public sector providers received somewhat better conditions relative to those employed by private providers, e.g. the former were more likely to receive sick pay when they were either sick themselves or had close contacts of positive cases. Public providers were also more likely to inform their staff of contact with positive cases. However, the study showed no significant difference between private and public providers in terms of availability of PPE, testing or the use of derogations.
References:
Brady C., Fenton C. , Loughran O. , et al. (2021) Nursing home staff mental health during the Covid?19 pandemic in the Republic of Ireland. Int J Geriatr Psychiatry.1?10. https://doi.org/10.1002/gps.5648
Mercille, J., Edwards, J. and O’Neill, N. (2022) Home care professionals’ views on working conditions during the COVID-19 pandemic: the case of Ireland, 6(1-2): 85–102, International Journal of Care and Caring, DOI: 10.1332/239788221X16345464319417
Update for: Ireland Last updated: March 4th, 2022
2.09. Impact of the pandemic on workforce shortages in the Long-Term Care sector
According to a recent report (February 2022) by The Federation of European Social Employers, Ireland has experienced an increase of between 1 – 10% in staff shortages since 2021. The sub-sector most critically affected by staff shortages across the countries surveyed for this report were services for older persons. The job position most affected was nursing, but care assistants and homecare / social care workers also face real shortages. The most common reasons given for staff leaving the social care sector for another include low wages, and mental and physical exhaustion relating to the pandemic.
Update for: Ireland Last updated: February 5th, 2022 Contributors: Daisy Pharoah |
3.01. Brief summary of the overall pandemic response (not specific to Long-Term Care)
A National Action Plan in response to COVID-19 was issued in March 2020. One of the aims is to ‘maintain […] critical and ongoing services for essential patient care’. This also captures long-term care services for different groups of people with needs for care and support. There is also a specific point on ‘Caring for our people who are ‘At Risk’ or vulnerable’.
By March 2020, additional public health restrictions emphasising the importance of people staying at home were published.
Update for: Ireland Last updated: September 7th, 2021
3.02. Governance of the Long-Term Care sector's pandemic response
By the end of March 2020, concerns were expressed regarding the lack of attention that was paid to nursing homes. A meeting between Nursing Homes Ireland, ‘representatives working within nursing homes’, the Minister for Health, and the Secretary General of the Department of Health took place. At the same time, the Health Service Executive provided an updated guidance document for residential care facilities.
This was followed by a request by the Minister of Health for the National Public Health Emergency Team to examine the situation of nursing homes. This led to a number of measures for nursing homes, such as supporting homes with supplies, staff and, the establishment of a national and regional outbreak team (Source: https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).
Update for: Ireland Last updated: September 8th, 2021
3.02.01. National or equivalent Covid-19 Long-Term Care taskforce
The Chief Medical Officer in the Department of Health chairs the National Public Health Emergency Team that was established in January 2020 in response to COVID-19. The role of the team is to ‘oversee and provide national direction, guidance, support and expert advice on the development and implementation of strategy to contain COVID-19 in Ireland.’ The Health Information and Quality authority that carries responsibility for inspecting nursing homes is part of the team (Source: https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).
Update for: Ireland Last updated: November 2nd, 2021
3.03. Monitoring Covid-19 impacts in the Long-Term Care sector: data and information systems
Nursing homes in Ireland have to report any ‘outbreak of COVID-19’ to the Chief Inspector of Social Services in the Health Information and Quality Authority (Source: https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).
Update for: Ireland Last updated: September 9th, 2021
3.04. Financial measures to support users and providers of Long-Term Care
In Ireland, financial support was given directly to care homes which were able to receive immediate temporary assistance payments to respond to a COVID-19 outbreak (Sources: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf; https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).
Update for: Ireland Last updated: September 10th, 2021
3.06. Support for care sector staff and measures to ensure workforce availability
The Health Information and Quality Authority provided a ‘Regulatory Assessment Framework of the preparedness of designated centres for older people for a COVID-19 outbreak’ in mid-April 2020. This framework was supposed to help care settings to prepare for a potential COVID-19 outbreak and to develop contingency plans. In Ireland, an agreement was put in place that enabled the Health Services Executive (HSE) to redeploy HSE staff to private nursing homes on a voluntary basis. (source: https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).
Ireland launched recruitment campaigns to attract newcomers and former staff to the sector. Efforts were made to reduce staff working across different care settings. The HSE could support staff with alternative accommodation and transport to facilitate this (source: https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).
Update for: Ireland Last updated: January 6th, 2022
3.06.01. Surge staffing and other measures to support care homes with outbreaks or critical staff shortages
In Ireland, national and regional outbreak teams were set up to oversee, prevent and tackle COVID-19 clusters in residential LTC settings. Care home providers started to report COVID-19 outbreaks to the Health Information and Quality Authority (https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).
Update for: Ireland Last updated: February 18th, 2022
3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, support and implementation
In Ireland, a new Infection Prevention and Control Hub offered residential LTC settings guidance for outbreak preparation and management, information on infection prevention and control, and support with applying national advice. Some of this support is provided via telementoring interventions and webinars for nursing homes. In addition, the national membership organisation of home care providers developed a COVID-19-specific National Action Plan (https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).
Update for: Ireland Last updated: November 2nd, 2021
3.07.03. Visiting and unpaid carer policies in care homes
In early March, Nursing Homes Ireland announced visiting restrictions for care homes across Ireland. At that time, the Department of Health found that a blanket ban was not required. To mitigate the impact of social isolation, Nursing Homes Ireland conducted a survey of activities that could be put in place in nursing homes to ensure that contact with families could be maintained. This was followed by the national initiative ‘Comfort Words’ that encouraged children to write to people living in nursing homes. It was anticipated that care home visiting should be reenabled as phase three of the Roadmap for Reopening Society and Businesses and to ‘return to normal’ in phase five. (https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).
Update for: Ireland Last updated: November 2nd, 2021
3.08. Access to testing and contact tracing for people who use and provide Long-Term Care
From late March 2020, staff and residents of nursing homes were among the groups prioritised for testing. ‘Assessment and testing pathways’ for residents showing symptoms of COVID-19 in residential care settings were issues by the Health Service Executive. By early April, it was recommended that care home staff should be screened twice a day, and that staff should be prioritised for testing (https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).
Update for: Ireland Last updated: November 2nd, 2021
3.11. Vaccination policies for people using and providing Long-Term Care
Family carers are not currently included on the Vaccine Prioritisation Programme in Ireland, this led Care Alliance Ireland to publish a position paper calling for vaccine prioritisation for Ireland’s family carers (https://www.carealliance.ie/userfiles/files/CAI-C19Vaccine_Position_Paper.pdf).
In Ireland, an international review of policies relating to mandatory vaccination for health care professionals was undertaken by the Health Information and Quality Authority (HIQA) in April 2021 (https://www.hiqa.ie/sites/default/files/2021-04/International_review-HCPs_who_do_not_avail_of_vaccination.pdf).
A report outlining advice to the National Public Health Emergency Team (NPHET) by HIQA relating to this issue was also produced in April 2021. In this report, the evidence from the literature and input from the COVID-19 Expert Advisory Group was considered (https://www.hiqa.ie/sites/default/files/2021-04/Advice-to-NPHET_HCPs-who-do-not-avail-of-vaccination.pdf). The report states that, among the Covid-19 Expert Advisory Group, ‘there was a general consensus that mandating Covid-19 vaccination may not be appropriate at this time as this may act as a deterrent. Additionally, such a measure may be perceived as being overly harsh on a workforce that have had a particularly traumatic year. If all lesser restrictive measures have been exhausted and there is still low uptake, consideration may be given to mandatory vaccination in the future. However, caution was expressed with regards to how far one should go to ensure high levels of vaccination, and the potential creation of a negative work environment’. The advice given to NPHET by HIQA is to maintain a ‘support and encourage’ model, whereby staff are facilitated to make the decision to become vaccinated in a supportive environment’. According to the report, anecdotally, uptake and demand for COVID-19 vaccine among healthcare workers are currently high.
Update for: Ireland Last updated: September 7th, 2021
3.12. Measures to support unpaid carers
A number of organisations in Ireland developed material, helplines and remote interventions to support family carers during the pandemic. Those qualifying for Carers Allowance will receive payments. Those who have lost their jobs can receive the Pandemic Unemployment Payment in addition to their Carers Allowance (https://ltccovid.org/wp-content/uploads/2020/06/International-measures-to-support-unpaid-carers-in-manage-the-COVID19-situation-17-June.pdf).
Update for: Ireland Last updated: September 7th, 2021
4.06. Reforms to improve support for unpaid carers
In 2017 Ireland implemented a programme of training and support for family carers which is funded from unused funds in dormant accounts in credit institutions and unclaimed life assurance policies (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).
Update for: Ireland Last updated: November 23rd, 2021