Sign in. It’s quick, free and it’s up to you.
An account is an optional way to support the work we do. Find out more.
WHEN RTÉ CONTACTED me about a programme based on poor treatment of older people in two residential care facilities, I said ‘oh no, here we go again’.
I was disillusioned that 20 years after Leas Cross’ landmark Prime Time Investigates exposé, the lives of residents could be similarly impacted.
I remember Leas Cross in 2005. I remember Aras Attracta in 2014. I remember the anguish, both from politicians and society, that people’s lives could be trapped in a power dynamic of helplessness within poor residential care.
Again, the RTÉ follow-up presented the distress and desperation of families, with one speaking of their efforts to ensure the safety and quality of care for their father in one of the featured facilities, Beneavin Manor, Glasnevin.
Most worryingly, after the response “cavalry” of various statutory teams in the last week, the son of this resident, Paul Guy, spoke with continued considerable concern about the care of his father, Audeon.
Emerging from the embers of the Leas Cross scandal, the Health Information and Quality Authority was established in 2007. This was the political solution to standardising care within a framework of person-centred care and safety governance. Yet here we are once again with several points that still need learning.
Firstly, HIQA’s inspections simply represent a point in time. Once they are completed and filed away, the context of care can change or revert to a normality that falls below the illusion of good care.
Yet, when a complaint is submitted to HIQA, the response time is unacceptable. While we were reassured by the Minister for Older People, Kieran O’ Donnell, that resources were not an issue, it is perplexing to understand why a response to the complaints aired in the RTÉ Investigates programme was so prolonged.
What is the assessment and follow-up process? Given that these complaints pertain to human rights abuse and neglect, why is there not a rapid response system which has acceptable and stringent timeframes? Equally, while HIQA can assess such complaints at a facility level and benchmark them against regulations and standards, investigations are pursued only on a ministerial request.
While HIQA can pass concerns on to relevant authorities, there remains a vacuum regarding complaint management that needs to be urgently addressed. Equally, it leaves those with concerns, rightly, becoming frustrated and disillusioned.
From the outside, both nursing homes in the RTÉ Investigates Programme looked impressive, modern and comfortable. However, quality has many dimensions, and the most important is how facilities care for residents. We saw incidents of staff shortages resulting in care plans being ornamental rather than operational. Fundamentals such as assistance in going to the bathroom, having the appropriate equipment, supplies and supports to provide comfort and quality of care were lacking.
Moreover, many of these experiences older people endured were shown to be based on practices and operational culture at several levels. There were moving and handling practices in which staff had training, but chose unacceptable alternatives.
The leadership and governance locally, and indeed within the Emeis group, seemed to accept the reality of such practices. There was a shrug of the shoulders attitude to poor practices and to staff who did express concerns. While some staff tried to compensate, their actions were generally not clinically appropriate.
There are fundamental issues we need to get right in aged care. We need to authentically offer older people choices when their needs change due to cognitive or physical challenges that impact their independence. Choice should not privilege one care setting over another. The “Fair Deal” scheme has, since 2009, made that choice disproportionate.
Older people with care dependencies have a statutory right to financial support for residential care, yet home care remains dependent on local provision and availability, with many carers struggling to support ageing in the home.
Since 2021, a new statutory initiative has been in train to strengthen home care. The Health (Amendment) (Licensing of Professional Home Support Providers) Bill seeks to regulate home care and needs urgent advancement. This will provide a licensing requirement for home care providers who will be regulated by HIQA. Moreover, the Government will develop a statutory scheme providing eligibility for home support. This will help older people’s choice of where they can access support. We also need to ensure care quality issues are not simply repeated in a different care setting.
Another issue that needs urgent attention is the introduction of Adult Safeguarding Legislation. An adult safeguarding policy is due to be published by the Department of Health. It needs legislative teeth to enhance people’s right to safety, dignity and respect. We need individual, organisational and statutory reviews that ensure the processes do not fail people.
World Elder Abuse Awareness Day is 15 June, this Sunday, and as the RTÉ Investigates programme shows, we need to do so much more legislatively, professionally and within society if we are to prevent and address elder abuse and neglect, whether it be physical, emotional, or financial. All three were on display in the two nursing homes, as arguably, financial abuse manifested in fees paid for care below expected standards.
Ireland ratified the United Nations Rights of Persons with Disabilities in 2018, but what do these rights mean to a society that does not authentically prioritise them, and actively vindicate them for our older population?
As Eleanor Roosevelt said in 1958, rights begin in small places, close to home. Unless these rights have meaning in nursing homes, they have little meaning anywhere.
Amanda Phelan is Full Professor, School of Nursing, Psychotherapy & Community Health, Dublin City University.
have your say