It was one of the happier moments of lockdown for Christine Thompson and her family. A smiling Christine waved in at her mum, Kathleen, in Ballynoe Nursing Home, happy to enjoy a precious window visit and still full of hope for the future, with a vaccination for her mum just a day away.
A photo capturing the scene of the visit by Christine and her daughter Sarah is one of the last pictures she has of her mum.
"She was singing, smiling, waving," Christine told RTÉ Investigates. "It was brilliant, and I said, 'Tomorrow, she is going to get vaccinated and everything is going to be fine.'"
Within days of being vaccinated, her mum was diagnosed with Covid-19. She died two weeks later. Kathleen Thompson was among 21 residents confirmed to have died from the virus in the Cork nursing home, which has 51 beds, during the third wave of the pandemic.
Christine Thompson and her daughter, Sarah, enjoy a precious window visit with her mother, Kathleen
So how did the situation become so bad, so quickly? It's a question that could be asked of many nursing homes.
And it's a question that takes on even greater significance in light of the lessons that nursing homes were meant to have learned from the first wave of the pandemic.
Over the course of several months, RTÉ Investigates spoke with families, whistleblowers and experts to examine why the pandemic claimed so many lives in nursing homes.
By May 2020, nearly 1,000 nursing home residents had passed away from Covid-19, accounting for more than half of all virus-related deaths at the time.
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That month, just prior to becoming Taoiseach, Micheál Martin declared that the nursing home situation needed to be thoroughly evaluated, so that these mistakes would not happen again.
But when the third wave of Covid-19 peaked in Ireland in January, many nursing homes still suffered devastating consequences.
Outbreaks of Covid-19 claimed the lives of over 2,000 people in nursing homes. That's more than two-thirds of all deaths linked to outbreaks of Covid.
The Coroners Society has called for a wide-ranging inquiry into all Covid-related deaths in nursing homes
In April 2020, the health watchdog HIQA warned that, in the context of a Covid-19 outbreak, nursing homes with a "regulatory history of persistent noncompliance" would faces challenges when it came to infection control and governance.
This was a general warning, but it could have applied to Cahercalla Nursing home in Co Clare, which quickly became overwhelmed when the third wave of the virus struck.
Frontline staff in the community-run facility paid a heavy price. At one point, some 38 were out sick, and outside agency staff were called in to provide cover, including a healthcare-assistant-turned-whistleblower, who spoke to RTÉ Investigates regarding the crisis in the nursing home.
This carer made a protected disclosure to HIQA, and an inspection by the regulator has identified poor supervision and significant failings in governance in Cahercalla during the month of January.
Cahercalla Nursing home in Co Clare quickly became overwhelmed by the third wave of Covid-19
Even on her first night, the whistleblower told RTÉ Investigates that she noticed problems during the changing of incontinence pads.
"I observed a care worker taking off pads. We would go to each room…The pad was just taken off, and another pad was put on there was no personal care, no washing or anything done."
The carer also told RTÉ Investigates that residents' calls bells went unanswered, that Covid-positive and Covid-negative residents were placed in the same wards, and that breakfasts were served at 6.30am when some residents were still half asleep.
A second agency carer who witnessed similarly poor care in Cahercalla around this time also spoke to RTÉ Investigates.
Both healthcare assistants said they saw residents in over-sized incontinence pads that were leaking. They also said some residents were fitted with two pads in order to reduce the time required between changes.
Experts who spoke to RTÉ Investigates were alarmed to hear about these practices.
"The residents are lacking dignity in terms of their ability to have their personal needs met," said Dr Sarah Donnelly, of the UCD School of Social Policy.
The grieving process has been extremely hard: to lose her in the way we did, to think she died alone
"It is completely unacceptable that any resident should be in a situation where their personal care needs are not being met," she said.
These practices cannot be excused by the extraordinary circumstances of the pandemic, according to nursing home consultant Deborah Oktar-Campbell.
"We still deserve to have basic nursing care. Yes, people are under pressure, but no, there's no excuse for poor care."
According to the carers, on one occasion, a resident of Cahercalla was restricted in an unlit room, at night, effectively penned into his bed by a large mat that was propped up by a reclining chair.
The man rang his call bell for help. One of the whistleblowers told RTÉ Investigates that she was told by a colleague to take no notice of his pleas.
"She just said to me, 'Don't go down if he rings the bell. Just ignore the bell," the whistleblower said.
HIQA raised serious concerns about Cahercalla nursing home on five occasions since November 2020
There was also evidence of poor dental care being provided to some residents, according to the whistleblowers.
"Most of the residents did not have oral hygiene provided," one carer told RTÉ Investigates.
"One particular patient … she wasn't able to drink, as she developed an infection in her mouth. That lady was in pain."
Referencing pictures that demonstrated poor dental care, Ms Oktar-Campbell called it "disgraceful".
"There is no other word for it – that should not be happening, and that has clearly impacted on that person's ability to eat and ability to drink, so it is beyond poor care. It is not acceptable."
On a later shift, both carers noticed that a number of residents had skin sores, including a woman who had clearly visible sores on her back and hand.
I am absolutely horrified to think that my mother was just left in her own, not changed
One of the carers recalled meeting the resident on her rounds.
"She asked me to scratch her back and when I lifted up her vest, there were two huge scabs on her back, and they were so sore."
A number of days later, it emerged that an outbreak of scabies was reported in the nursing home.
Three days after the carers raised their concerns, HIQA inspected Cahercalla and found that there was "no person in charge" or any general manager to look after the 89 residents.
In a number of units, HIQA found, there was "no nurse on duty for up to 12 hours". And residents with Covid-19 were residing in the same units as residents who did not have virus.
Dr Donnelly said it was "extremely shocking and concerning to not have a registered nurse on duty in a nursing home with a high number of older highly frail physically dependent people."
Cahercalla nursing home has since implemented a new management structure
But HIQA had already had concerns about Cahercalla prior to the inspection in January.
In emails obtained by RTÉ Investigates under the Freedom of Information Act, HIQA said it raised serious concerns with the nursing home on five occasions since November 2020.
It also raised concerns about the isolation felt by residents on three separate occasions in January.
In a statement, the board of Cahercalla said it fully accepted the findings of the HIQA report.
"The inspection was carried out at a time when Cahercalla was at its lowest ebb … which .. resulted in 25% of staff being absent on Covid related leave," it said.
The statement went on: "A new management structure is now in place since February 22 which has substantially addressed the non compliance issues and is delivering new supports and training for staff to provide excellent care to residents at Cahercalla."
Covid-free until January 2021, the third wave took a huge toll on CareChoice Ballynoe in Co Cork
The issues in Ballynoe Nursing Home in Cork were different to those in Cahercalla. Ballynoe recorded one of the highest death rates of any nursing home during the third wave of the pandemic.
The families of residents told RTÉ Investigates that they were happy with this nursing home up until early January.
While the home had previously managed to keep the virus out, the third wave took a huge toll on Ballynoe.
Most residents became infected and almost all the regular staff members were required to leave for Covid-related reasons during the outbreak.
A healthcare assistant who worked in Ballynoe during the pandemic made a protected disclosure to HIQA.
This whistleblower told RTÉ Investigates that problems started in Ballynoe as soon as the first resident presented with symptoms in January 2021.
Teresa Kelleher's mother, Margaret, died in Ballynoe during the third wave
"From when she was swabbed until she tested positive she wasn't contained in her room," she said.
"And she was brought to the day room and she socialised with other residents and staff within the day room after being tested for Covid."
A second female resident who was awaiting tests results and later confirmed to be Covid positive was also taken to the day room on the same date, 7 January.
"It is just quite unbelievable that that would happen," said Ms Oktar-Campbell.
"We have all known from quite early on that, if a resident is suspected, then they should be isolated. There is no rationale for taking someone into a community area with Covid."
In a statement, CareChoice Ballynoe confirmed that "residents who were awaiting Covid test results had attended the day room on January 7."
It said social-distancing guidelines were followed and that "the two residents were put in self isolation" after they were confirmed as Covid positive the following day.
My sister Christine started clawing at the glass, calling her name, mam crying
The carer who spoke to RTÉ Investigates said that she and others were required, on some occasions during the early stages of the outbreak, to look after the two Covid-positive residents on the same day as they cared for residents who did not have Covid.
In a response, CareChoice Ballynoe said that under its procedures the "duration of time assisting staff in the care of these two women would be kept to a minimum."
A majority of staff caught the virus, and some were deeply traumatised. Agency workers were called in to provide cover.
Meanwhile, families found it increasingly difficult to get information as more and more residents contracted Covid-19.
Teresa Kelleher, whose mum Margaret died in Ballynoe, said she phoned the home as many as eight times a day.
"If I made contact once a day I was lucky," she told RTÉ Investigates.
Days after being vaccinated, Christine Thompson's mother, Kathleen, was diagnosed with Covid-19
Christine Thompson, who lost her mum Kathleen, added: "They just weren't giving any information."
Dr Donnelly told RTÉ Investigates that it was "inexcusable that family members were not communicated to in a timely way."
In a statement, Carechoice Ballynoe said: "Every possible effort was made to communicate with families, updating them on their loved ones' conditions."
The whistleblower told RTÉ Investigates that, on one occasion when she was assigned to work on one of the Covid wards, that at the time she was the only staff member working there.
"I went to that ward and I changed everybody's incontinence wear," she said. "I turned anybody that needed to be turned, I pushed fluids – I gave everybody 200ml of fluid."
In response, CareChoice Ballynoe told RTÉ Investigates that it was fully staffed on the day in question, with nurses and healthcare assistants.
Teresa and Sean Kelleher were deeply upset when they learned how their mother was treated
The nursing home said: "This was achieved despite the fact that at times almost all the regular staff from the home were unavailable for work."
The whistleblower said one of the residents she treated that morning was Margaret Kelleher.
"She was so delighted to actually see somebody," she said.
"I was actually so upset when I did the bed change that morning: when I removed the pad, I could see that she hadn't been cleaned."
Margaret Kelleher's son, Sean, and daughter, Teresa, were deeply upset when they learned of this incident.
"I am absolutely horrified to think that my mother was just left in her own, not changed," Sean told RTÉ Investigates.
While the crisis was unfolding, the whistleblower emailed the HSE to express her concerns. In that email, she asked for it to intervene to try and save lives.
"I literally begged them," she said.
Kathleen Thompson's son John said he will never get over that his mother died on her own
The HSE responded to her concerns the next day, saying that it had "been provided with reassurance by CareChoice management that they will do everything possible to address the nature of the concerns raised."
Because of visitor restrictions, many family members were unable to be with their loved one as they passed away.
"At around one o'clock on the Saturday morning I got a phone call to say Mum had died. I was told management would call me, but they never did," Margaret Kelleher's daughter, Teresa, recalled.
"The grieving process has been extremely hard: to lose her in the way we did, to think she died alone."
Kathleen Thompson's family had to watch her dying from an outside window. Her daughter, Christine Thompson, said: "There was nine of us outside the window watching her.
Kathleen's son John is still deeply upset over what happened: "My sister Christine started clawing at the glass, calling her name, mam crying."
"She was in the room on her own dying, not knowing that we were there. For a woman who loved company, to die on her own… it is something that we are never going to get over."
John Thompson had to inform the nursing home that their mum had died. "That was soul destroying," he said.
The relatives of 13 people who died in CareChoice Ballynoe are among those looking for answers
In a statement, CareChoice Ballynoe, said: "[the fact] that members of her family were not able to be in the room with Mrs Thompson when she died, is truly a source of deep sadness to all of us."
The nursing home said Kathleen Thompson "received care from a doctor and a nurse and they made sure she was comfortable" in the last two hours of her life.
Two-thirds of all deaths linked to outbreaks of Covid-19 happened in nursing homes. And the families of some residents say it is now time for a public inquiry into what happened in nursing homes during the pandemic.
"There needs to be a public inquiry," said Majella Beattie, of Care Champions.
"Families cannot move on until there are answers to what occurred in the nursing homes. Not just into the numbers of deaths but an inquiry into the standards of care and standards of care in nursing homes."
"It's very disappointing," said Ms Oktar-Campbell.
"It's not always been easy, but providing care has always been paramount – delivering the basic care. Everybody deserves that."
There were nine people watching Kathleen Thompson outside her window when she passed away
The Coroners' Society has also called for a wide-ranging inquiry into all Covid-related deaths in nursing homes.
The relatives of 13 people who died in Ballynoe are among those looking for answers. An enquiry, they feel, might help them move on.
Speaking at his mother Kathleen Thompson's graveside, John Thompson said: "If there is an enquiry and something comes out of it, it will ease the pressure. The fact that it's ongoing at the moment – it doesn't give us closure."
Margaret Kelleher's children, Teresa and Sean, feel they still haven't grieved properly.
"Hopefully, we will get some kind of justice and some kind of answers," said Sean.
"There is very little appreciation of the amount of suffering that went on behind closed doors during the pandemic," Teresa said.
Watch RTÉ Investigates: Care in Covid tonight at 9.35pm on Prime Time on RTÉ One and RTÉ Player.
