Important Update on Public Health Emergency / Covid-19 from Finian McGrath, Minister for Disabilities
I would like to update you on work being carried out in identifying and addressing specific challenges for people with disabilities and their families during COVID-19.
Firstly however, I would like to acknowledge that this is an extremely difficult time for people with disabilities and their families. I wish to offer my sympathies to the families of members of our disability community who have passed away as a result of Covid-19. I also want to commend and express gratitude for the work of every single person in the disability community including our HSE staff as well as our broader community for doing all they can to protect our families.
1 Data Collection and Reporting
On 12th March NPHET recommended the issuance of infection control guidance to all Long Term Residential Care Settings (LTRC, nursing homes, disability and mental health). This was followed on 30 March and 3rd April with recommendations for a set of enhanced public health measures aimed at residents and home support services. These measures reflect that our long term care residents are a particularly vulnerable population to COVID-19 as recognised by the World Health Organisation. This is most likely due to their age, the high prevalence of underlying medical conditions and circumstances where high care support with the activities of daily living is required in collection high physical contact environments.
A number of COVID support teams have been stood up to provide advice regarding infection control/PPE/ Public Health support and general advice to facilities. The number of disability facilities availing of this support changes based on need. As of Friday 24th April 82 facilities were availing of this support.
On foot of NPHET recommendations a series of actions/measures/decisions/milestones have been taken to support long term residential settings for people with a disability:
- there are just under 1200 designated centres regulated by HIQA nationally where 8300 people live
- Since 18th April, testing is being rolled out across all disability residential centres. Under this programme all residents and workers will be tested.
- The data shows that the majority of disability centres have not had an outbreak of COVID 19.
- In terms of Disability Residential centres, regrettably since the outbreak began I am informed that there have been ten fatalities.
- In line with a NPHET recommendation on Friday 17th April a mortality census was conducted over the weekend of 17 April. The census covered all LTRC settings registered by the Heath Information and Quality Authority (HIQA) and the Mental Health Commission (MHC). There has been a strong response rate and it is intended to bring a report to NPHET this week.
Data is constantly being updated. Everyday official data from Health Protection Surveillance centre is provided under outbreak and mortality for all residential settings – including Nursing Homes, disability Centres, Mental Health facilities, prisons, immigrant reception centres. See here: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/
2 Communication Protocol
HSE advises that all disability providers maintain strong communication links with families. In this regard where an outbreak of COVID 19 is confirmed families are contacted and kept informed of their loved ones medical status.
- Weekly communications with umbrella groups ensure two-way communication
- Targeted disability specific communications work highlighting the supports that are in place and will be forthcoming – a YouTube video is available now from the Head of Disability Operations Cathal Morgan, see below and also here: https://www.youtube.com/watch?v=3ptqVFp0Lu8
- An FAQ for people with disabilities and family carers which also provides information and contacts for 8 help lines
- Guidance has also been developed on
- Alternative Models of Care (Non-Residential)
- Streamlined Health Passport for people with disabilities who are admitted to hospital
- Use of PPE in Disability Services
- Supporting adults in a community residence/at home
- supporting children in a community residence/at home
For the full list, see https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/partner-resources/
- Personal Protective Equipment (PPE)
Supplies of PPE are made available to all residential providers in line with NPHET recommendations and guidance has been developed by HSE (see above)
4 Ethical Decision-Making in Clinical Settings
In the interest of contingency planning, the Department published “Ethical Considerations Relating to Critical Care in the Context of COVID-19”. This document, which was approved by the NPHET, aims to support healthcare professionals in their challenging roles and to ensure that clinical decisions regarding the allocation of finite critical care resources are made in a consistent and fair way, and in a manner that avoids unfair or systematic discrimination of any individual or group.
- Clinical decisions regarding who should be prioritised for access to ICU are and will continue to be, driven by an assessment of whether the person is likely to benefit from a given intervention. The guidance makes clear that such decisions must be informed by a number of considerations, including the will and preferences of the patients and their families.
- The guidance explicitly states that no single factor should be taken, in isolation, when determining whether a person should be provided with critical care. It highlights age as a specific example; however, the guidance equally extends to other factors including disability.
- People with a disability have the same rights as others to the highest attainable standard of health. The guidance seeks to ensure that there will be no systematic de-prioritisation of any group including those with a disability.
5 Assisted Decision-Making for People with Disabilities
The Government supports the principals of the 2015 Act and notes that health and social care workers always endeavour to ensure those with disabilities are supported to make informed decisions regarding their healthcare.
For further consideration
There are currently 2100 people remaining in congregated settings. The government is committed to moving people to live in community group homes (4 people sharing a house) where they will have a person centred service.