After New HSE Guidance, Some Home Carers Say They Are Scrambling to Find Enough Masks

A home carer working for a private company in Dublin says she has struggled to get PPE from her employer since the Covid-19 pandemic began.

On several occasions supervisors gave her a few masks, but she visits seven or eight separate clients each working day.

“A lot of the girls went out and bought their own, which they shouldn’t have to do,” she says. Also, a friend started making cloth masks and handing them out to other care workers, she says.

New guidance from the HSE on 22 April says healthcare workers should wear masks when they are going to be within two metres of someone for whom they are providing care. But the home carer working for the Dublin company says little has changed.

“Even since the new regulations came in, not one person [in management] has said anything to me about masks,” says the home carer, who doesn’t want to be named here, as she fears her employer could cut her hours in response.

She fears that with so little emphasis on protective equipment, Covid-19 could be spread to vulnerable older people by home carers. “It is just a nightmare,” she says. “Home carers are travelling all over the place.”

However, Joseph Musgrave, CEO of Home and Community Care Ireland (HCCI), which represents private companies providing home care in Ireland – many of which are in Dublin – says its members “have sufficient supply of enhanced PPE at the moment and most providers have sourced enough masks for the next couple weeks”.

Why Wait?

Social distancing was introduced in March, with the aim of slowing the spread of Covid-19.

Part of the reason the disease is so infectious is because people can spread it before they show symptoms.

When the two-metre distance cannot be maintained, a surgical mask can help prevent the wearer from passing on the virus, says Professor Sam McConkey, deputy dean of International Health and Tropical Medicine at the Royal College of Surgeons in Ireland.

Still, for more than a month (from 17 March to 22 April), the HSE’s advice to home carers was not to wear masks unless the patient was confirmed as having Covid-19.

“This guidance DOES NOT RECOMMEND use of surgical facemasks in situations other than for contact with patients with droplet transmitted infection including COVID-19,” says a HSE guidance document on PPE, issued on 17 March.

On 22 April, the HSE updated its advice on masks. “The new guidance requires staff to wear surgical masks when providing care to patients, if they are within 2 m of a patient,” she says.

The scientific understanding of the disease is constantly changing so the advice will change too, McConkey says. “This pathogen was not known about until 12 Jan. 2020, and there is yet a lot to learn about it.”

In hospitals, some workers had started wearing masks earlier in April anyway, before the HSE guidance changed, he says.

All staff in the hospital where he works have been wearing masks for about four weeks, in all instances when they couldn’t keep the social distance from patients McConkey said. “Every single encounter, such as if someone broke their leg.”

Ideally, the same rules should apply in all health and social-care interactions, McConkey says. But that is reliant on every company and organisation being able to source enough PPE – and there are international shortages, McConkey says.

Maria Jikijela, who used to be a home carer but works in a hospital now, says staff there have the full kit of personal protective equipment (PPE). We “make sure we don’t make any mistakes, wear the PPE and remove it”.

But for her friends still working as carers, it’s different, says Jikijela. They have gloves and aprons but often don’t have enough surgical masks – and don’t have any access to face shields, she says.

Care workers worry that if they contract the virus they will spread it to their vulnerable clients, says Jikijela, who is also a board member of the Migrant Rights Centre Ireland (MRCI).

“The situation is so tense, they are going through hardship and anxiety,” she says.

PPE Issues

Now that the HSE has updated its guidance though, for healthcare workers to wear masks in more situations – it’s unclear where all the masks are supposed to come from.

Fianna Fáil’s spokesperson on older people, Mary Butler TD, says the lack of appropriate PPE is causing fear among home care workers.

“Fear of the unknown, fear of unwitting contact with asymptomatic people, fear of infecting their families, and fear of working without proper PPE,” she said in a press release on 30 April.

Butler says supplies of PPE for care workers outside of hospital settings are patchy and that more needs to be done to support those workers.

In a 25 April survey of healthcare workers, 17 percent said they had no PPE, and a further 21 percent said they were running out of PPE.

The survey, conducted by HCA & Carers Ireland, which represents healthcare workers, gathered responses from 456 qualified carers and healthcare assistants, across public, private and voluntary settings.

Musgrave, of the HCCI, said the new HSE guidelines issued on 22 April “caused a bit of a challenge”. They came in suddenly and at one stage HCCI members only had around three days’ worth of masks in stock, he says.

However, this initial shortage has been resolved and the organisation is working with the HSE and Department of Health to resolve the ongoing supply needs, he says.

There’s also the issue of training: in the HCA & Carers survey, 31 percent of respondents said they had not had any Covid-19 training.

Musgrave, however, says HCCI members have rolled out specific training for all their workers since the pandemic started.

“Our members have been training staff on the PPE needed, and we are working to sort the final issues on managing PPE stock levels,” he says.

Who Is Responsible?

McConkey of the RCSI says home carers should be wearing masks, but “the challenge is – do the companies have access to the masks”?

Home-care companies should have been stockpiling PPE since the Covid-19 emergency first started in China back in January, he says.

“By the end of January, beginning of February, lots of businesses and organisations were working through the nitty-gritty of contingency planning for this,” says McConkey.

Likewise, if staff have not been sufficiently trained or do not understand the guidelines coming from the HSE, then the companies being paid to provide the care must roll out training in a language that the workers can understand, he says.

“It is the duty of the employer to give sufficient training,” McConkey says.

So has the HSE been working to ensure that private companies providing care in the community are compliant with the new advice for healthcare workers?

“The spread of Covid-19 is posing significant challenges for many areas of our Older People Services, including Home Support Services,” an HSE spokesperson said.

In light of those challenges, and the social-distancing and cocooning guidelines, “the HSE has had to reassess its operation of Home Support Services nationally, to ensure that the assessed needs of those clients with the highest priority are met”, they said.

On 24 March, Sinn Féin TD Louise O’Reilly raised the issue of PPE for home carers and called for companies in Ireland to temporarily switch to producing essential PPE.

The HSE and Department of Health didn’t respond to queries about whether any progress has been made on getting more PPE produced in Ireland.

Thinking Ahead

Twenty-nine percent of all confirmed cases of Covid-19 in Ireland are healthcare workers, according to official figures. It is unknown how many home carers have contracted the virus.

Musgrave, of the HCCI, says that of their 20,000 home-care clients, just 58 have tested positive for the virus.

There are no clusters of cases among home carers or their clients, according to McConkey of the RCSI. “So far, I believe – and I get to see some of the data – that it hasn’t happened yet.”

However, “this Covid-19 is going to be with us for a few years, so next month it could be in the home care setting,” he says.

It is sensible to look at where the future challenges could lie, he says.