If we are fortunate enough, we will all grow old. Last week’s RTÉ Prime Time investigation into Covid-19 and nursing homes is yet another indictment of the State’s failure to safeguard older adults at a time when they were most vulnerable.
Key stakeholders such as the Irish Association of Social Workers and the family-run advocacy group Care Champions have repeatedly warned of the risks associated with prolonged cocooning of the elderly in homes; highlighting that family visits are a vital protection for residents in a poorly regulated system with weak safeguards.
In Ireland, nursing homes tend to be regarded as a place of last resort and are often situated geographically and metaphorically off the public radar. Most residents are aged 85 years or over and have complex co-morbid conditions, with dementia estimated to affect two-thirds. On any given day, about 32,000 people are living in nursing homes in Ireland and, according to Hiqa, private entities manage 80 per cent of beds nationally.
Social policy has increasingly been driven by a neo-liberalist marketisation of care with the shift “towards the private” at the expense of our most vulnerable citizens. Such policies, allied to failures to invest appropriately in supports to help people to “age in place”, have resulted in premature and unnecessary admission to nursing home care, particularly for people with dementia.
Unfortunately, people are “falling through the cracks” and coming to harm because of gaps in our health and social care system. Poor standards of care, as well as neglect and abuse of residents, are not always reported, and sometimes may be deliberately concealed. The closed organisational culture in some nursing homes makes it exceptionally challenging for staff to speak up and report abuse.
Individual cases
The Health Service Executive has highlighted that safeguarding and protection social workers are operating in a “legal lacuna” in the absence of primary adult safeguarding legislation. Simply put, safeguarding social workers do not have the legal right of entry to private nursing homes where 80 per cent of residents in question reside and indeed, must seek the agreement of private care providers to do so, while the Health Information and Quality Authority (Hiqa) cannot investigate individual cases.
On any given day, about 32,000 people are living in nursing homes in Ireland
Hiqa can take action to cancel the registration of a failing nursing home provider. However, this is often a slow process: legislation currently permits a 28-day right to appeal and the threshold to cancel registration is high. Department of Health-commissioned research and a recent Red C poll show a low awareness among respondents in relation to HSE safeguarding and protection teams and poor knowledge of where or how to report abuse. Social workers have repeatedly asked how could residents seek help if neglect or abuse occurred when they were not even facilitated to see their loved ones through a window for months on end.
Nursing homes may well be the final “home” of the people who live there and should be places where residents feel safe, secure, cared for and protected. Nearly 15 years after the Leas Cross scandal, and seven years after Áras Attracta, it is evident that deeply embedded resistance to institutional change signals an urgent need for adult safeguarding procedures to be placed on a statutory basis.
General invisibility
Nursing homes are part of our wider health and care system and an integral part of our society. However, their lack of connection and integration into local communities, the absence of adequate legal protections for residents, the profit-driven nature of much of the care home sector, and the general invisibility of nursing homes in the public consciousness combine to exacerbate the vulnerability of residents.
Safeguarding adults from harm and abuse requires a multiagency, whole-system approach. Passage of the new Adult Safeguarding Bill 2017, first introduced by Senator Colette Kelleher, now being progressed by Senator Frances Black, must now be expedited. The Bill proposes the establishment of a national safeguarding authority with a variety of powers to respond to concerns and intervene in situations of abuse.
We must not forget the trauma caused to the families of many nursing home residents during the pandemic
As society returns to normal, we must not forget the trauma caused to the families of many nursing home residents during the pandemic. Now is the time for a comprehensive public inquiry involving a root-and-branch review and reform of our nursing home sector, based on human rights principles. The issues brought to light in the recent Prime Time programme are of national importance. They do, or will, affect all of us if we are “fortunate” enough to grow old. They merit a collective outcry and demand for meaningful change, not only for current nursing home residents but for our future older selves.
Sarah Donnelly is an assistant professor of social work at UCD and a member of the Irish Association of Social Workers