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Irish Times
3 days ago
- Health
- Irish Times
Letters to the Editor, June 7th: on nursing home revelations, Trump versus Musk and bird droppings
Sir, – It is 20 years, almost to the day, since RTÉ broadcast the Prime Time Investigates documentary which revealed the horrors of Leas Cross nursing home in Dublin. On Wednesday, further outstanding investigative journalism by RTÉ revealed yet more horror stories in Ireland's private nursing home sector. I have no words to adequately describe the anger, profound sadness and deep frustration I felt as I watched frail, vulnerable, elderly people being denied the most basic care. As I listened to frightened residents begging and pleading for help, I also felt an overwhelming sense of the deepest fear. READ MORE My mother lived with dementia for 20 years. She has a strong family history of dementia and all her siblings have either succumbed to, or are living with, Alzheimer's disease. I cared for my mother at home for many years. I am forever thankful that she received excellent quality care, and extended care, in both our acute and voluntary hospitals. Developing dementia is one of my greatest fears. I have no family. There will be nobody to fight for good care for me, or to advocate for me, should I also succumb to dementia. When I watched frail elderly residents with dementia being treated so horrifically on the RTÉ Investigates documentary this week, I despaired. Those residents were the victims of blatant abuse. Residents with advanced dementia would most likely be unable to accurately explain their experiences to anybody, or to identify their abusers. That also makes them easy targets for such abuse. I concluded that, should I ever be diagnosed with dementia and reach that stage of illness and dependency, I would rather not be alive than be at the mercy of such so-called 'care providers'. Twenty years after Leas Cross such horrors are still happening. What does it take to make this stop? Or will this latest horror simply result in more transient outrage, more eloquent statements and yet more empty promises, until the next time? Is there always going to be a next time? – Yours, etc, BERNADETTE BRADY (PHD), Rathfarnham, Dublin. Sir, – The RTÉ Investigates programme, Inside Ireland's Nursing Homes, was truly disturbing. RTÉ and all who contributed to the making of the programme, both to camera and undercover, deserve our thanks. It does however raise some important questions which a follow-on programme might wish to address. Twenty-five years after the Leas Cross scandal, and the follow-on establishment of the Health Information and Quality Authority (Hiqa), how come care in congregated settings is increasingly provided in large for profit facilities (a worrying trend to which Hiqa has drawn attention) and what difference would it make if the Health Service Executive (HSE) were to build and run more such facilities? How come private and voluntary (non-HSE) nursing homes are not part of the overall planning process for integrated services in the six new regional HSE organisations, despite a clearly identified need to improve clinical governance across the sector as suggested by the expert group on nursing homes which reported during the Covid pandemic? Where is the evidence of follow through on all the recommendations for the development of a wider range of alternatives to nursing homes, including the development of small scale 'Household / Teaghleach'models of nursing home and congregated care? Why is the National Treatment Purchase Fund (NTPF), essentially a medical procedures agency, still involved in 'purchasing' care for older people through a nursing home support scheme (Fair Deal) administered by the HSE across all nursing homes (most of which it does not control) while the regulator, Hiqa, has no role in regulating the payment levels to those nursing homes? Why is the Law Reform Commission report on adult safeguarding, published in April 2024, not being progressed with urgency by the Oireachtas given that the report included draft legislation? The RTÉ programme concerned two nursing homes owned by Emeis, formerly Orpea. There is plenty of information available concerning Orpea, particularly in France (where it was partially nationalised), to have at least raised concerns. There must have been some awareness of this and consideration of the possible consequences for older people in Ireland when they were allowed operate in the Irish market. It is interesting to note that the group's facility in Portlaoise is described as a nursing home but with a capacity for 101 residents it is not far off the size of Portlaoise hospital. To describe such a facility as a 'home from home' is seriously mistaken. The images of abusive and cruel behaviour and of residents corralled into one room are more suggestive of a human warehouse than a home. Finally, for all those many staff currently providing care in nursing homes to the highest standard they possibly can, in the often difficult circumstances in which they find themselves, it would be helpful if they could rely on a public system of support and guidance, including clinical support and governance, to deal with issues and concerns at short notice rather than having to await an occasional inspection from the regulator followed by a report some while later. Regulation and inspection are important but they are no longer enough. Practical supports to encourage quality care are far more likely to pick up on issues and have them addressed as they arise. – Yours ,etc. MERVYN TAYLOR, Stillorgan, Dublin. Sir, – The RTÉ Investigates programme laid bare the inhumane treatment of vulnerable residents in private nursing homes – many of whom are paying exorbitant fees of €1,400 per week. At such a staggering cost, these individuals could instead receive dignified, high-quality home care in the comfort of their own communities. That these abuses persist is a damning indictment of systemic failure. Hiqa, tasked with safeguarding standards, has clearly failed residents, families, and the State. Paper-based inspections and sporadic visits are not enough to prevent cruelty behind closed doors. If we are serious about accountability, Hiqa must have a permanent, on-the-ground presence in every facility, with 24/7 monitoring via live video feeds covering all areas – excluding only private bathrooms for dignity. Modern technology makes this feasible; what's lacking is political will. Why not implement this? If prisons and childcare centres can adopt stringent oversight, why not nursing homes, where our most fragile citizens reside? Until real-time transparency is enforced, families will never trust that their loved ones are safe. This isn't just about regulation – it's about basic humanity. – Yours, etc, PETER MALBASHA, Co Dublin. Sir, – This nursing care scandal has scared many people. My 80-year-old mother has just told me how, as she was lighting her candles for her grandchildren sitting their Leaving Certificate, she also lit one for herself. Her prayer is that she doesn't fall, break her hip and end up in a nursing home like that. Calling for help, with no one answering. I hope our Minister for Older People is listening, because this is a loud voting issue. – Yours, etc, CARMEL DOYLE, Beaumont Woods, Dublin 9. Trade union dues Sir, – Do I get a hint of disdain in Barry Walsh's letter (June 5th) about unions suggesting all should pay dues whether a union member or not ? He wonders why the general secretary of Fórsa earns three times the average pay. Does he suggest they earn the same as a shop-floor worker? I have been lucky to have been a union member most of my working life especially having been made redundant once. I do think it unfair that some colleagues refuse to join a union but at the same time are more than happy to accept the pay and benefits that a union has negotiated or earned, often by its members having to strike. – Yours, etc, ENDA SCANLON, Ennis, Co Clare. Trinity College and Israel Sir, – In deciding to boycott and divest from Israel, Trinity College Dublin has, in my view, abandoned the key principle of institutional neutrality which should underpin the actions of a serious university. In 1967, the University of Chicago led the way on this fundamental issue during the white heat of the campus riots across America during the Vietnam War and apartheid in South Africa. The faculty debated how a university should respond to the burning political and social issues of the day. When passions are running high, what should a university say or do when activists demand it choose sides and take action? Chicago's conclusion was straightforward: the university must remain neutral in order to meet its long-term core mission of the 'discovery, improvement, and dissemination of knowledge'. This did not mean ignoring difficult issues. Faculty and students must have full freedom of criticism, dissent and open inquiry, but the university itself 'is the home and sponsor of critics; it is not itself the critic'. Bizarrely, the board's chairman noted explicitly in a message to the college community that while Trinity is engaged in a number of EU-funded research consortia which include Israeli partners 'here is no evidence to associate any of these with breaches of international humanitarian law or human rights violations.' So what is Trinity's problem with individual Israeli academics and universities who are often eloquent critics of their governments' actions and policies? Is it not overreach to insist that the 'college should seek to align itself with like-minded universities and bodies in an effort to influence EU policy concerning Israel's participation in such collaborations?' So many questions remain unanswered. Can Trinity's decades long partnerships with Intel continue when the tech firm is thought to be Ireland's biggest importer of Israeli goods, most from its sister factory in Kiryat Gat? Are Trinity's teaching hospitals, St James's and Tallaght, now prohibited from accessing Israeli medical products and pharmaceuticals? Can Trinity's partnerships with American universities and companies continue given stringent US anti-boycott legislation? What now for Trinity's Herzog Centre, the only institution in Ireland offering Jewish studies, when your university has decided to boycott the world's only Jewish state? In singling out Israel alone for boycott and divestment while maintaining ties with other countries with well-documented human rights violations, Trinity has opened itself to the charge of institutional anti-Semitism and racism. I am ashamed of my alma mater. – Yours, etc, DR JANE MAHONY, BA (Mod), PhD, Trinity College, Dublin. Birds dropping Sir, – Reading Frank McNally's column on the provenance of James 'Skin the Goat' Fitzharris's reflection on informers , I wonder if it may come from the belief held in many places that being shat on by a bird is a sign of good luck? Personally I have never held much store in this, having been the victim many years ago on Brighton seafront of a seagull who had had a very large lunch, resulting in my repair to the nearest boutique to purchase a fresh T-shirt. That said, perhaps the informer never overflown will never again have the gift of good luck? – Yours, etc. JOHN F MCELHONE, Co Donegal. Critical climate omission Sir, – That there is a report by the Environmental Protection Agency about global warming´s effect on Ireland is welcome. ( 'Communications, transport and health of older people at increased risk from global warming, says EPA,' June 3rd). Frightening as it is in its current form, the report has a critical omission. It is has not addressed the dramatic effects of the weakening of the Atlantic Meridional Overturning Circulation (Amoc). In lay man's terms, this ocean current keeps Ireland habitable. Otherwise it would have the climatic conditions of southern Alaska and Canada's Hudson Bay. The weakening or ending of the Amoc is probable. It is certainly an existential threat to Ireland. Ireland is not geared for an average winter temperature of –18 degrees. It is presently comfortably above 0 degrees. It is very surprising that the EPA has decided not to include this essential element. Policymakers need all the information to get to comprehend the scale of the challenge. The Irish Government, regardless of its political hue, needs to understand the new business as usual will involve planning and action to protect the State and its citizens. I don't believe that the timescale is as long as many politicians assume. One of the stand-out facts from my Earth Science education (1992) was the speed of climate change. The Younger Dryas climatic period ended over less than 50 years, so starting our current phase. Climate systems are stable until they are not. – Yours, etc, RICHARD HERRIOTT, Aarhus, Denmark. Trumping Trump v Musk Sir, – We can all now relax and enjoy watching the world's two biggest egos burn themselves out in front of a potential audience of billions. Could this be the template for settling all global disputes in the future? Yours, etc, NIALL GINTY, Killester, Dublin. Sir, – The very serious online and very public spat between the world's most powerful man and the world's richest man is a 'big beautiful example' of how reciprocity works in real time. – Yours, etc, NOIRIN HEALY, Goatstown, Dublin. Sir, – In the very public, very dirty divorce between Trump and Musk who will get custody of JD Vance? – Yours, etc, BRID MILLER, Athlone Road, Roscommon. Sir, – I wonder did Elon Musk realise how his social media platform X would become really so apt! – Yours, etc, AIDAN RODDY, Cabinteely, Dublin 18. Funding and the arts Sir, – The tenor of Yvonne O'Reilly's letter about funding the arts in yesterday's letters page chimed with the findings of a research project I recently undertook with colleagues from Queen's University, Belfast, and Liverpool University into a wide range of 'Arts for Peace' projects in Northern Ireland. Too often what passes for evaluation is really about accountability with funded organisations wanting to assure funders they have achieved their set goals. Funders for their part tend to see it as a purely administrative process, with vasts amount of data going largely unanalysed. But the value of this data must be questionable given the limited scope for acknowledging what is learnt from unsuccessful aspects of funded projects and outcomes that were not envisaged at the time of application. I can reassure your correspondent, however, that there are examples of good practice out there that will hopefully in due course inform a more productive evaluation culture. – Yours, etc. DAVID GRANT, School of Arts, English, and Languages, Queen's University, Belfast.
BreakingNews.ie
5 days ago
- Health
- BreakingNews.ie
Government need to implement safeguarding legislation in nursing homes
The chairperson of Safeguarding Ireland, Patricia Rickard-Clarke, has repeated a call on the government to establish an interdepartmental interagency working group to implement the recommendations of the Law Reform Commission's report from April 2024, which set out the policy changes that needed to be made to implement safeguarding legislation. Ms Rickard-Clarke was responding to an RTÉ exposé into two nursing homes where residents were manhandled and ignored for long periods of time. Advertisement 'I am very disturbed and very distressed and very, very angry about this,' she told RTÉ radio's Morning Ireland. 'We're 20 years after Leas Cross. We have gone backwards, I think.' While Leas Cross had been closed down advances had not been made in terms of what to do or what we should be doing, she said. 'There are questions to be answered by Hiqa. I would say, though, that in relation to Hiqa, one of the limitations it has is that it doesn't have the function of taking individual complaints or concerns. It looks at systemic issues, and it goes in on an irregular basis, and also, there was a delay in responding to a particular request (by a whistleblower).' 'That's just not acceptable. It's not acceptable even if there's one person being abused; that is a serious incident that should be followed up immediately.' Advertisement The implementation of the recommendations about safeguarding would provide a legal framework, she said. 'At the moment, we're working to a HSE limited policy, which is run by the HSE by safeguarding and protection teams, but it is limited to healthcare issues. 'There are much wider issues in safeguarding, and again, there are offences that should be implemented straight away. The Law Reform Commission sets out a number of offences that straight away could be enacted under criminal law. "This is the Department of Justice responsibility. So, an offence of intentional or reckless abuse and neglect or ill treatment, an offence for exposure to serious harm, an offence of endangerment. The criminal law it's all set out in the 2024 Bill. Advertisement 'We need what Safeguarding Ireland has recommended, which is the establishment of an independent adult safeguarding authority which will have functions and roles in relation to adult safeguarding to protect people from abuse. It would have the function of receiving reports of suspected abuse or actual abuse, and it would have the statutory function of responding to those abuses." Meanwhile, the CEO of The Alliance, a trade association for the nursing home sector in Ireland, Shane Scanlan, has said he was 'utterly shocked and appalled' by the RTÉ exposé. 'As a nurse myself and the director of nursing for over 10 years, you just really feel for the residents and families that have been affected by this,' he told Newstalk Breakfast. Mr Scanlon paid tribute to nurse Claire Doyle who was the 'whistleblower' who approached RTÉ and made protected disclosures. Advertisement 'The real question is, what if she never went to RTÉ with those protective disclosures, that she met and her students met, still went into Hiqa months before that? And it's a very brave thing she did, because it's not easy to pick up the phone or put something in writing and whistle blow. "And in her own words, she said, 'from my point of view, within the system, I cannot blow the whistle any louder. No one is listening.' So, fair play to her in fairness. She's really called out what's happened here.' The effectiveness of Hiqa had to be questioned, he added. Hiqa had been set up in the wake of the Leas Cross nursing home controversy to prevent such abuse from happening again. 'It's clear to us that they have failed to deliver on what they were set up to do. And there will be calls for further powers to be given to Hiqa, the Office of the Chief Inspector of Social Services, and that's not the answer here. Advertisement 'I'd be calling for an immediate, independent, root and branch review of how Hiqa carries out their inspections and their methodology. Because inspectors clearly need to spend more time observing care, speaking with staff, speaking to residents. "There's a huge amount of agency staff that's currently being used by Hiqa. Last year alone, they spent €1.89 million on agency staff. And you'd be wondering, what are agency staff doing within that organisation? "As I've said, a full review of the current leadership of Hiqa and its effectiveness needs to happen. And off the back of this scandal, you have the question, should there be some resignations here at the senior level?' Mr Scanlan called for stronger protection measures for those who make protected disclosures. How that person can be protected and what will happen immediately afterwards. 'I think there's a taboo still in Ireland about making a protected disclosure for the fear of what will happen afterwards. You know, you might be in a job, you may be thinking down the line of a future career, will this get out in the public? We need to really look at that as a country.'
Irish Examiner
5 days ago
- Health
- Irish Examiner
We need to talk about our nursing homes
I was recently invited by RTÉ to review images taken surreptitiously by an undercover worker in a nursing home setting. In general, I'm not in favour of such approaches as clandestine 'fly on the wall' filming will often capture moments in time that may not be representative of the culture of a place or an individual's performance. We all have moments when we are not at our best. That said such an approach must be weighed up against public interest especially when the subject matter relates to vulnerable people. This is such a situation. Ever since the Leas Cross report by Professor Desmond O'Neill in 2006 highlighted the poor standard of care of older people in a residential setting it became obvious that nursing homes required not only a greater regulatory focus but also greater societal attention. There is no doubt that the resultant formation of the Health and Information Quality Authority (Hiqa) led to greater standards in residential settings but regulation in isolation does not guarantee standards of care. The expert report and recommendations into the care of residents in nursing homes during covid-19 highlighted our continued collective blind spot around vulnerable older adults in residential settings. The report identified not only, the now well recognised, lack of planning and provision of protective equipment to nursing homes by the State during the pandemic, but a system-wide lack of medical and nursing governance and gerontological training in the sector. Many of that report's recommendations have not been implemented and Hiqa have not reported on our response to that report. The Leas cross report had identified staffing as a core issue, summarising that the inadequate staffing and training amounted to the "institutional abuse of older people". In all the cases of substandard care that I witnessed in this documentary, there was a significant staffing factor, most often unavailability of staff members and on a few occasions a very evident lack of training. An inability to supervise or attend to a person's care, answer a call bell, appropriately handle a person's positioning or continence needs, all reflected to my eye a lack of personnel and training. There were distressing moments to watch, older frail people being poorly or roughly handled, left sitting on toilets, or left in their own urine and without the basis of a sheet. In some instances worryingly there was a shortage of resources as bad as any we witnessed during covid-19, and in most cases in these snapshots there was an absence of any aesthetic or joy in resident's lives. As we celebrate the greatly improved life expectancy we have achieved over the last century, I was moved having watched these vignettes of care, to again reflect on the gerontological dilemma and ask "what is the point of adding years to life if we cannot add life to years as well?" Although almost all the care I have witnessed personally in nursing homes has been good, I do wonder how much joy of being alive the almost 30,000 vulnerable adults in nursing homes actually experience. We have approximately 32,000 nursing home beds in Ireland with over 90% occupancy. Four in five beds are made available by private providers. Our demographic trends forecast almost 1.25 million people over the relatively young age of 65 by 2040, and 300,000 over the age of 80. During the cost-of-living crisis many smaller nursing home businesses struggled, folded or were unable to undertake structural improvements mandated by the new era of concern around infection control. Not all will age healthily, 25% will have at least one chronic disease by the age of 50. The 2022 census showed 23,500 people were resident in our 557 nursing homes, up from 22.300 in 2016. While the shifting emphasis of our health service is concentrating on maintaining people at home, many of us will need residential care and in many cases it would be preferable or it should represent a richer possibility than to be to living isolated and alone with a call for half an hour three times a day. In any case we are likely to need 1,500 extra residential care beds per annum over the next 25 years or so. How is this to be funded to scale and to what model? It is unlikely after years of closing down institutions that the State is coming back to become a provider of long-term residential care on any significant scale - though this needs discussion. The State has a role, in my opinion, to provide training and expertise through a 'teaching nursing home' model and is currently de facto the guarantor provider in very complex case needs declined or 'returned' to hospital by the private sector when it is determined by their evaluation that care needs cannot be met, or at least not without substantially more funding. In addition, the public health system has considerable real estate through its community hospital network that often provides more complex longer term care in people's communities such as in my native town of Kinsale. Nevertheless, the cost of providing this care through public services has been seen as more prohibitive than commissioning through private providers. Private providers themselves complain they get significantly less capitation per bed than that given to public residential facilities. Currently our private providers are a mixture of Irish family-owned businesses and small companies and larger nursing home chains funded through foreign investment funds. Both models need to be profitable to build capacity and provide care, but it is clear from talking with providers that their view points and cultural mores may differ. There is the motivation to provide excellence in care juxtaposed to a requirement for a guaranteed investment prospectus to fund new developments to scale. Fair Deal One root of the problem evident in this documentary lies in the current nursing home support scheme or 'fair deal' which provides State funding, by means of a 'mortgage' loan on the person's estate, that covers the bare costs of residential care. It does not cover 'hotel luxuries' such as cable TV, or newspapers, access to activities and there is limited continence wear provision. These costs, as well as access to chiropody, physiotherapy, speech and language therapy must be met as additional charges to the resident and their families. What ostensibly should be an automatic right to assessment and treatment through our community structures does not exist either through local policy or lack of resource. The model of 'basic' funding rather than 'reasonable' funding of the lifestyle and care needs of residents creates a culture of 'skimping' on our vulnerable older person's quality of life and care. During the cost-of-living crisis many smaller nursing home businesses struggled, folded or were unable to undertake structural improvements mandated by the new era of concern around infection control. This created its own crisis for residents and families as people who had lived in a nursing home for many years were compulsorily forced to move, a stress that should always be avoided and surely has a rights-based argument. I am aware of one family whose relative was on their third move due to nursing home closure, moving more times in the last two years of her life than she had in her entire adult life. 'Aging in place' is a relatively modern but important concept. In its fullest realisation, it should mean being able to live an enriched life in an environment that enables you to enjoy life and realise your later life goals. That may or may not be best achieved in your adult home. A proper personalised and supportive assessment of this, such as currently provided through the Healthy Age Friendly Homes Initiative by Age Friendly Ireland, is a great example of how we need to engage with later life planning. But 'rightsizing' our accommodation needs alone does not address the inevitability of needing more support as we age. We need more developments in our communities that integrate age friendly design in residential accommodation with integrated structures that allow for escalation of care needs if we get frailer, so we can truly age in place and in our communities rather than moving several postcodes away to solely congregational settings. This will need planning and funding but examples like Macauley place near Kildare town, are emerging in Ireland, emulating the 'green house' approach to residential design, so evident in Phoenix, Arizona, a city that has taken the business of aging seriously. Caring skills Caring for older adults is complex challenging and hard work. It can be very rewarding and full of joy but it is also often hard work, physically mentally and intellectually. Looking after patients with dementia, multiple medical problems, on 13 medications and with poor mobility, needs highly developed interpersonal skills, empathy, clinical acumen and mental resilience. How do we value such skills in our society? How is pay determined and what are the terms and conditions of such employments? What are the opportunities for training, continuous learning and career progression? Many of the clips I watched seemed to show staff under stress, poorly motivated and lacking training. Compounded by a basic lack of supplies at times there was a helplessness to the situation bordering on burnout, the phenomenon by which repeated inability to deliver a standard care creates moral injury, stress and eventually a reduced empathy in healthcare workers. What then is the solution to our repeated nursing home scandals? How do we best meet the challenge of our needs in this area as we age? The Irish Society for Physicians in Geriatric medicine (ISPGM) in its paper Responding to the needs of Residents in long Term Care in Ireland highlighted a number of important principles worthy of more focused consideration. We have approximately 32,000 nursing home beds in Ireland with over 90% occupancy. Four in five beds are made available by private providers. Included among its many common sense recommendations was that all residential nursing homes needed a clearly defined system of governance, with an identified medical and nursing lead who had appropriate gerontological training. Nor is it enough that we should just expect our care staff to have the necessary training, but that they also should have a career opportunity to operate at the highest licence of achievement. We must attract talent by developing talent in the nursing home sector through promised career opportunity. Allied to that must be a linking of salary and conditions to equivalent HSE staff grades, both to attract and retain staff and stabilise manpower across the sector to reduce the risk of significant staff shortages. Regulation must be linked with scientific development and research so what we are inspecting is relevant and matters to the care and lives of older people. That regulation must be encouraging and well informed but it must also have a 'stick'. We cannot have residential care homes operating despite repeated serious failures of regulatory inspections as was alluded to in this documentary. What does that say about the importance we ascribe to the care of us all as we age? The right response How then should we - and minister O'Donnell, who has responsibility for older people - respond to this latest documentary? Let's start by recognising that we have had recurrent exposés of poor care in our nursing home sector and a number of expert reports highlighting systemic problems that need remedy but go unresolved. The citizens assembly in 2017 brought focus to the challenges for aging in Ireland but we now need a proper authoritative commission on residential long-term care in Ireland. This commission needs to involve older people and their advocacy agents Like Age Friendly Ireland, the department of health and Health Service Executive, multidisciplinary gerontological expertise and the providers of nursing home care. Such a commission needs to set out the future framework for residential and nursing home care in Ireland, to include a forecasted need by geographical area, the model of this care and how this development should be funded. It needs to describe the model of governance, training and career development and employment conditions of healthcare workers in the sector. It must define the funding per residential care home bed and what services this must statutorily. The model of a safer staffing framework to determine staff levels on an hours per resident per day must be defined, funded and implemented. Regulation of the sector must be informed by scientific research, digital technology and a cycle of meaningful audit with the power and intent to withdraw or transfer licensing where serious recurrent breaches are evident. We all want to feel the security that a loved one and that we ourselves would be treated with dignity and care if and when we need residential care. It's time to properly discuss our need for residential care and what this should look like. Professor Rónán Collins is a consultant physician in geriatric medicine Read More Investigation shows dire practices at privately-run nursing homes
