An intellectually disabled man was removed to hospital by court order after been found living with his elderly sister in "squalid" and "substandard" conditions at their home, the High Court heard.
The house, in a rural area, was described as cold, dilapidated and neglected, with mould on the walls and insanitary bathroom and toilet conditions.
The man's bedroom was described as dirty and cluttered and he was sleeping in a sleeping bag on his bed rather than sheets.
The man is a ward of court for many years and his sister had been appointed to represent his interests.
Concern about his situation and about refusals by his sister to permit social workers access to the house was expressed by a senior social worker in a letter to the wards of court office last October.
The matter then came before Mr Justice Peter Kelly as president of the High Court managing the wards of court list.
He made orders for a court-appointed medical visitor to go to the house with a view to assessing the man and also appointed Patricia Hickey, general solicitor for wards of court, as joint committee of the man.
The medical visitor was refused access to the house but, having looked through the windows, she had concerns about the living conditions.
Further orders permitted the doctor to return just before Christmas, accompanied by two gardai and a HSE safeguarding team leader. After the sister refused to answer the door, a Garda got in a side window.
The sister then permitted access and the doctor assessed the man and spoke with his sister.
In her report to the court, the doctor said a public health nurse was visiting the man for many years and she was surprised the "first note of concern" was expressed by the senior social worker. She was also shocked the community intervention team had not reported or documented any evidence of poor health or hygiene over the years.
She considered the living conditions totally unsuitable for the man and that he needs long-term residential care.
On foot of her concerns for his physical health, he was removed to hospital where he remains for the time being.
His sister is still at home but Mr Justice Kelly, having been told on Tuesday there are also concerns about her capacity and living skills, directed an inquiry into whether she too should be made a ward of court.
On the current state of affairs, the judge said the man's going home to "very substandard" conditions is "not a possibility". There was also an issue whether the sister herself should remain a dwelling which was "quite squalid".
He adjourned the matter to next week so that photographs of the conditions at the house can be provided.
Katherine Kelleher, solicitor for the HSE, agreed the home conditions were very poor and substandard but noted a senior social worker with considerable experience of situations of rural poverty had said she had seen "far worse".
Ms Kelleher said the HSE is concerned about the sister's decisions concerning her brother. The social worker who wrote to the wards of court office had made several attempts to visit but was refused access, she added. The HSE considered the man will probably need long term care, probably nursing home care.
Ms Hickey said she had concerns the man is quite young for nursing home care and wanted the HSE to explore other options.
Issues arose concerning why the man's situation was not brought to the attention of her office earlier, she added.