Latest news with #nursinghomes
Irish Times
14 hours ago
- Health
- Irish Times
I wrote the Leas Cross report. Two decades on, has anything changed in Irish nursing homes?
Almost the worst aspect of the heartbreaking and horrifying scenes from the nursing home RTÉ Investigates programme was the predictability that these should still occur 20 years after the Leas Cross scandal. The Leas Cross report , which I authored, followed a similar exposé on shocking conditions and work practices in the private Leas Cross Nursing Home in Swords. It led to a range of recommendations and the institution of the Health Information and Quality Authority (Hiqa) . Last week's documentary featured scenes of older people allegedly being manhandled, 'forced' down into chairs or left in incontinence pads for so long their clothes were soaked. The persistence of gross institutional abuse of vulnerable older people signals the lack of serious intent and will in the Department of Health and successive governments to address well-signposted problems and proposed solutions to a deeply flawed nursing home system. READ MORE Not only are some of the recommendations from the Leas Cross report as yet unfulfilled, but none of those of significance from the ministerial panel on Irish nursing homes during the Covid-19 pandemic have been met, and others have been watered down. This is despite Irish nursing home residents experiencing very high death rates in comparison with the rest of the developed world and a torrid experience paralleling that of Amnesty UK's report on nursing homes during the pandemic, As If Expendable . At the heart of the problem is the shift from a largely public nursing home system to a private one without debate, foresight or learning from international experience and research. This occurred in a context of multiple failures by the professions, advocacy and the health system to develop a clear blueprint for the development of a high-quality framework for our future care in nursing homes. Put simply, the health service has no control of care standards in the private sector, and in particular what is known as clinical governance, a clear framework for leadership, responsibility and accountability, both internally and externally, in a complex care environment with vulnerable older people. Added to this is a profit-driven business with large chains, at least one of which, Emeis Ireland, has a deeply tarnished reputation outside this country – as detailed in Victor Castanet's book Les Fossoyeurs: Révélations sur le système qui maltraite nos aînés (The Gravediggers: Revelations about the system that mistreats our elders). In some, profit trumps care and, as we saw with the documentary, cost-cutting erodes care. In addition, this is associated with the building of huge impersonal nursing homes distant from the communities where residents formerly lived. Despite Sláintecare pledging to reverse the ratio of private to public nursing home beds, the reverse has happened with an increase in the proportion of private nursing home beds. [ What is Emeis and where are its Irish care homes located? Opens in new window ] The framework is so rickety and uninformed that there is a misplaced belief in regulation and safeguarding. Standards in hotels, restaurants and hospitals are not high because of regulation or safeguarding, but rather because we, the public and professions, have set high expectations of what we should receive. This has long been accepted in healthcare. The author of the first major medical ethics scandal in the US, where African-Americans were left untreated with syphilis, wrote that regulation, while necessary, would never succeed on its own: what was required was a system that upheld virtuous thought and virtuous action. As was obvious from the RTÉ documentary, and long clear to informed healthcare professionals, Hiqa cannot assure the public of appropriate and dignified care standards in Irish nursing homes, nor respond effectively and in a timely manner to grave concerns reported to it. Instead, we need a radical reset of prioritising informed support to residents in nursing homes and those working in them. We can do this while recognising the many who strive to provide good care – they are not tarnished by critique of lack of policy or the inherent problems of an untrammelled private sector. If anything, all suffer if we do not address the glaring problems of the system. There needs also to be soul-searching among the professions about supporting care in this sector. It would be helpful for the Nursing and Midwifery Board of Ireland to engage proactively on advising how nurses should engage with the challenges of providing high-quality care in a profit-driven nursing home system. The public also need to start pushing their politicians to do better. As things stand – and hard as it is to accept – we have no assurance that the scenes played out in the RTÉ documentary are not occurring elsewhere in the Irish nursing home system. The Ombudsman has already pointed to the lack of dignity and choice in Irish nursing home systems. [ Review of all nursing homes operated by Emeis Ireland requested by Department of Health Opens in new window ] It is not just a question of 'it might be my mother' but actually 'it might be me': men have a one in four, and women a one in three, chance of spending time in a nursing home before we die. We need to clearly signal that we expect a setting where choice will be respected and that we can continue to flourish. We must demand a lower tolerance for uninformed passivity from the Department of Health, HSE and other State bodies, and inclusion of stronger advocacy and gerontological voices (notably absent from the ministerial panel oversight implementation team) in responding to this lingering crisis. Politicians are adept at detecting the priorities of their constituents. If we do not push for a better present and future for those we care for and our future selves, nor will they. Prof Des O'Neill is a consultant geriatrician and author of the Leas Cross report 2005-6
Irish Times
15 hours ago
- Politics
- Irish Times
Time to get real on nursing home costs
Never one to miss the opportunity to capitalise on Government blushes, Sinn Féin leader Mary Lou McDonald has called for a less commercial (ie, private sector) approach to caring for our elderly It's a sentiment any family would share and an easy point to make in the aftermath of last week's RTÉ Investigates programme on abuse and neglect of elderly nursing home residents. However, divorced from the financial realities such an approach entails – financial realities that everyone in national politics is fully aware of – it is little more than a cheap populist stunt. No more or less than the health sector in general, nursing homes work under a two-tier structure. There is a modest network of public nursing homes and a far bigger and growing private nursing home sector. READ MORE Accepting the fact that very few people will have the capacity to pay up to €8,000 a month for their own care or that of their loved ones, the State partly funds the private sector through Fair Deal. The alternative is to invest in tens of thousands of additional public nursing home beds, but there is no political appetite for that. What the State pays per bed per week under Fair Deal is a fraction of the State-funded cost per bed in public nursing homes. In other words, the State pays private nursing homes substantially less per bed than it pays for the same bed in a public nursing home. Upwards of three-quarters of all long-term residents in private nursing homes are funded by the Fair Deal. That inevitably means that private nursing homes must operate on far lower costs per bed. And that's even before you consider that private sector business, by definition, operates on a for-profit basis. How to manage your pension in these volatile times Listen | 37:00 Everyone will rightly be horrified at the abuse and neglect captured by the RTÉ Investigates team in two homes run by the State's largest single private sector provider, Emeis/Orpea. But equally, no one with any experience of nursing homes in the Republic would have great confidence that such incidents are isolated to those nursing homes or that company. Politicians, on the Government side and in Opposition, can engage in cheap soundbites, but for those in nursing homes and their families, honest engagement on how the State can help meet the real cost of eldercare would be far more welcome.
Irish Times
2 days ago
- Health
- Irish Times
The Irish Times view on Ireland's nursing homes: the need for fundamental reform
The scenes broadcast on the recent RTÉ Investigates programme were deeply upsetting. It showed multiple examples of unacceptable care failings and neglect of vulnerable older residents in two private nursing homes. This comes twenty years after a similar expose on shocking conditions and work practices in the private Leas Cross Nursing Home in Swords, which triggered the landmark Leas Cross review by Professor Des O'Neill, and a subsequent programme of reform of the nursing home and home care sectors. Since then, we have had the creation of Hiqa to set standards, monitor compliance, and inspect all nursing homes. It also has the power to shut down non-compliant facilities. But it is clear that despite this increased regulation, some nursing home patients are still being failed. As was highlighted in the Leas Cross report, and now again in the RTÉ Investigates programme, staffing remains a core issue; both in numbers as well as training levels and oversight. The way checks are conducted on nursing homes by Hiqa must also be examined, as underlined by Taoiseach, Micheál Martin this weekend . The organisation has played an important role in improving standards, but there are questions about how these are monitored. READ MORE The issues raised are bigger than the specific failings shown in the report. Ireland needs to reconsider its whole system of care for vulnerable older adults in need of longer-term nursing care. The number of nursing home beds in Ireland increased by 12 per cent between 2013 and 2023, to over 32,000. About 440, or 80 per cent, of our nursing homes are private, or voluntary. Many smaller family run nursing homes, particularly in rural areas, have closed in recent years, with others bought up by large international for-profit companies. There is also a trend towards building larger nursing homes with more beds. We have a growing, ageing population with projections that we need potentially thousands more nursing home beds in the next two decades. But is our current model of nursing home care provision and significant outsourcing to the private sector really the best way forward? We have largely moved away from congregated institutional-type settings for the care of people with intellectual disabilities and mental health. Is this an option for many older adults needing care? The Covid-19 pandemic highlighted how isolated and vulnerable those in private nursing homes can be, and the differences in their care and entitlements compared to their public counterparts. While there have been increased supports provided to private nursing homes since then, and a raft of new regulations, it is clearly not enough. It is tinkering around the edges of a system, important parts of which look broken. More comprehensive reform is needed.
Bloomberg
3 days ago
- Business
- Bloomberg
UK's Visa Crackdown Leaves City of London Immigrants in Limbo
One banker in the City of London is faced with paying an extra £40,000 a year in university fees for his children. Nursing homes are worried about finding enough caretakers for residents. The insurance industry says overseas relocations have now ground to a halt. Such is life in the UK after the government announced it would now take ten years for immigrants to receive preferential status known as indefinite leave to remain, or ILR. That's twice the time it used to take.
Irish Times
4 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.
