The Ombudsman landed herself in hot water in recent weeks over comments on nursing home care. Some of her language was unfortunate, particularly a reference to “warehousing ” of older people.
The phrase drew a feisty response from Nursing Homes Ireland. This body has done much to promote quality of care for private and voluntary nursing homes, and includes public nursing homes in their annual awards for excellence.
It is a pity that this controversy may be what most people will remember, as her reflective and insightful speech otherwise presented important and sometimes unpalatable truths to Irish society.
These include the steady attrition of public nursing homes beds, the systematic under-funding of nursing home care under the so-called Fair Deal scheme, the location of large nursing homes away from communities and population centres, and continuing uncertainty as how the most vulnerable of our fellow citizens are supported in terms of therapies, activities and support.
Public nursing homes, particularly in urban areas, represent a very important focus for care of the most disabled, and have suffered from a quasi-total lack of investment which now poses problems in terms of the physical requirements of HIQA nursing home standards.
Foreseeable for decades, this reflects very badly on successive generations of health service leadership. It is notable that the health minister currently overseeing further closure of public nursing homes has had financial involvement with the private nursing home sector and expresses little public awareness of the wider range of services needed.
On a ministerial visit to the voluntary nursing home with which I am associated, the only comment to me was that we were “very expensive ”. As I had just finished a multi-disciplinary conference with a patient and family, nurses and therapists that had lasted for an hour, the only response possible to this is “not for what you are getting ”.
At the heart of the problem is a failure to embrace the key principle that the complex care of older people in nursing homes goes beyond bed, board and nursing care. Services required above this are often either not provided or else a range of charges may be added, including for continence wear, activities and therapies that should form a part of the basic package of care.
In the absence of clarity, these tensions often erupt into a dysfunctional debate which seems to suggest that the public nursing homes are over-funded, whereas in fact, if the full range of services were provided, it is clear that the so-called Fair Deal funding would be inadequate.
The HIQA Nursing Home Standards introduced in 2009 represented an important start for overseeing quality in Irish nursing homes, but must be seen as a work in progress to articulate a wider vision of what support means.
One good comparator is whether we would tolerate a policy of charging children in HSE homes for supervised play and activities, or for their nappies, when they grow up? This is effectively happening to significant numbers of older people.
Even HIQA suggests that nursing homes direct residents towards private occupational and speech therapy: these are pressing and direct clinical needs if indicated, and may be above the means of many residents. It is these aspects that the Ombudsman was properly addressing in her speech, stating how current arrangements risk turning older people into not only the “other ”, but the “lesser ” citizens.
We need to find ways to counter the relative passivity of the public and the professions about these issues, breathing life into a shared vision that those in nursing homes are our valued relatives and co-citizens, and when given appropriate support can thrive emotionally despite the limitations of physical and intellectual disability.
For this, we also need to infuse a deeper emotional charge into the often dispassionate language of needs and services. A notable feature of the Ombudsman ’s speech was her expression of affection and love for her older relatives, something that we perhaps do not sufficiently articulate in public discourse about older people