They have also spoken out about the lack of personal protective equipment (PPE), and delays with testing at the early stages of the fight against the virus.

The number of clusters in nursing homes has steadily increased, with 149 clusters recorded as of last Saturday.

There are 56 clusters in residential institutions, and 23 clusters in community hospitals or long-stay units.

A staff member at a Dublin residential facility for older people, who wished to remain anonymous, spoke with the Irish Examiner about the issues facing them. The staff member claims that mildly symptomatic patients were not isolated quickly enough, and that this led to the spread of the virus in their facility: “Patients who had just a cough were not suspected of Covid-19, and were not isolated.

“We were told not to wear masks around these patients. The issue was, if the doctor didn’t suspect them, they were not isolated, and therefore we weren’t allowed extra PPE for them.

“Those who weren’t suspected [in these cases] have now exposed everyone. It seems like because the equipment for testing is sparse, no testing was recommended.”

The lack of PPE was another serious issue. The facility has since received more protective equipment but, before it arrived, the staff member says that masks and gowns were “rationed”.

“We have been begging for PPE for the last three weeks. Every single mask and gown was counted. We were left short constantly. Masks were rationed to three per day. We needed respiratory masks, not surgical masks.”

Staff in the facility are now unwell. “Staff are calling in sick every day, which is leading to staff shortages. We are on half staff, and are pulling staff from other departments.”

Staff members reported their concerns to their superiors, but changes were slow to emerge: “It is now assumed everyone has already been exposed. I think there were insufficient defensive measures in place.”

The staff member wanted to speak up as they feel it is not too late for other residential settings to stop the spread. “Dublin has been very affected, but it is not too late for other areas.

“We should have been given more PPE three to four weeks ago. It’s costing lives now.”

A staff member in a different Dublin residential facility for older people, who also wished to remain anonymous, said the lack of testing is a serious concern.

“The lack of testing is crazy. You can still have this virus and not show any symptoms, yet no one is being tested for it [in care homes].

“I don’t know if I have this virus, but I am going into work with older people, some of whom have underlying conditions and dementia ... Honestly, I haven’t slept properly in a month, I am so worried. We haven’t had any confirmed cases yet, and no one is displaying symptoms to my knowledge, so I haven’t seen anyone in the long gowns and [full PPE]. We got a delivery of PPE at the start of [last] week.

“Management closed the facility to visitors very early on, around the start of March, so they were proactive in that. We are getting called heroes, but we have been the lowest-paid workers for years. The same [politicians] applauding us are the ones who cut our wages and funding.”

Another staff member from the same facility says there is a “huge disparity” between what is being announced and what can be delivered.

The staff member said some workers left to join the HSE once they announced their recruitment drive, due to higher pay. “We were already under severe pressure with short staffing before this outbreak, we couldn’t get healthcare staff.

“Measures are not being implemented quickly enough. Two weeks ago, we were told about testing, now one of the guidelines is monitoring temperatures. How does this pick up someone who has the virus but doesn’t have a temperature?

“I feel like the guidelines on PPE and testing are being dictated by supply.”

They also worry about end of life care plans being followed in a way residents could not have predicted.

“A resident makes an end of life plan, which may include a DNR [do-not-resuscitate order] and a wish not to be transferred to a hospital — but the resident could have made this decision thinking it would be in the distant future, when they were bedridden or in palliative care. Are residents who are able to enjoy activities now, who get Covid-19, not being transferred to hospital, as their end of life plans have to be followed?

“These plans were made with very different circumstances in mind.”

In a statement, the HSE said it has been “working closely” with a wide range of residential care services since early March.

“From the start of this process the proprietors of every unit have been directed to the latest guidance and advice on the HSE website.

“The HSE has nine area crisis management teams across the country ... [who have] been asked to prioritise the needs of long-term care residents within their areas across public, voluntary, and private facilities.

“Private nursing homes make up over 85% of long-term care provision in the country, and residents in long term care are at particular risk.

“At a national level, there has been ongoing contact with Nursing Homes Ireland and all advice and guidance produced by the HSE is shared.

“Further enhanced measures are currently being implemented in relation to PPE management and supply, occupational health, infection prevention and control, and the cohorting of staff to reduce transmission of illness between units.

“Health care workers and nursing home residents are also a key testing priority. Residents of long-stay residential settings are prioritised for testing through a pathway involving the National Ambulance Service.”

Tadhg Daly, CEO of Nursing Homes Ireland, who represents private and voluntary sector nursing homes, said that the speed of testing and PPE need to be addressed.

“If you have a staff member who is awaiting testing or waiting for results, they have to stay at home. This can create staffing issues.

“In fairness to the HSE, they have re-prioritised healthcare workers and nursing homes. We haven’t seen this fully delivered yet, although the HSE are trying their best. The reality is there are huge logistical challenges.”

In terms of PPE, Mr Daly says where there was an outbreak or a critical need, the HSE delivered: “But this has not been consistent across the system, [we believe] every nursing home should have a three-day supply of PPE, in case there is an outbreak.

“In the early stages, [nursing homes] were buying their own PPE, but then suppliers were only selling to the HSE.”

Mr Daly also says he was “surprised” when the chief medical officer, Dr Tony Holohan, said that Nursing Home Ireland’s visitor restrictions at the start of March were premature – Mr Daly believes it was the correct decision.

Other conflicts arose when staff in the private or voluntary sector left to join the HSE: “In the teeth of a crisis, we need a moratorium on recruitment from the frontline,” he said.

However, Mr Daly is hopeful.

“The nursing home sector is very resilient, with highly qualified staff. With the right support, it will be well able to deal with this. This sector is dealing with the wave now, it’s at the coalface.”