Failures in assessing elderly patients, INMO conference hears

Elderly people are not being properly assessed before hospital discharge and frequently end up in nursing homes that cannot meet their needs, and where patient mix is inappropriate, a conference has heard.

Delegates attending the Irish Nurses and Midwives Organisation’s (INMO) annual delegate conference in Cork unanimously carried a motion calling on the HSE to ensure multidisciplinary teams conduct thorough assessments.

Aideen Smith of the Galway branch described a nursing home where the youngest patient is 35 and the oldest 104. She witnessed a man with a brain injury “shouting at an older man with vascular dementia”. She said patients in nursing homes often had a range of disabilities, ranging from challenging behaviour as a result of brain injury, to mental health illness, to dementia, to multiple sclerosis.

“We need to safeguard these people and ensure they are correctly placed,” she said.

Eileen O’Keeffe, Cork Private voluntary branch, said it was a “huge milestone” for people to move into long-term care, “and it is not enough to say it’s better than being at home or in an acute hospital”.

She said people were being misplaced and that sometimes staff did not have the appropriate skills mix to support them.

Another delegate spoke of visiting patients in a nursing home, one of whom had a fractured femur, but who was in a unit where most patients had dementia.

“I felt he was blending in after a few days, and he shouldn’t have been,” she said. “He needed rehab, but the facility was very small and pokey and not conducive to that.”

Nurses also unanimously backed an emergency motion calling on the HSE not to “demolish” the role of the Director of Public Health Nursing under plans to introduce a new layer of bureaucracy within the community. The HSE is pushing a new management structure which would see the introduction of a network of upwards of 90 lay managers across the nine community healthcare organisations (CHOs).

INMO director of social policy and regulation Ed Matthews said it would mean public health nurse directors were left with “no managerial authority but full clinical responsibility” for patients. The reverse would be true of lay managers, who would have no clinical responsibility, but would control resource allocation.

Mr Matthews said a network of lay managers would not only cost money but “we believe it is dangerous for the service and for service users”.

Health Minister Simon Harris said he was “particularly conscious of the need for clinical governance in the light of recent events” and he assured nurses: “I will not be making any changes to the managerial structures in community nursing.”


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