When abuse is the only word for care of the elderly

Dan Buckley on how long-term neglect has eroded care for our vulnerable senior citizens.

THE outside of the grey, Victorian hospital was dark and foreboding, like something out of a badly made 1950s Gothic horror movie. Despite meagre attempts to beautify the grounds with flowers and shrubs, there was no denying that this was a grim and cheerless place.

Inside, that sorry facade was mirrored by murky pea-green walls, a well-trodden and cracked tiled floor and threadbare curtains dividing the beds in the public ward.

Each metal bed contained an elderly patient, all seriously unwell and many of them in an advanced state of dementia. A nurse's station nearby monitored the patients' movements and every now and then a nurse would pass by to hand out medicines or help to make someone more comfortable.

The care was being administered with kindness and compassion but it was still shocking to observe the everyday conditions these elderly men had to endure. One was tied with a used bed-sheet to an armchair, his head hanging down and spittle dribbling from the corner of his mouth. Another was in a similar condition nearby and every now and then he would become agitated as the sheet chaffed his skin.

"It's for their own good," I was told. "Otherwise, they could fall and hurt themselves and we just don't have enough staff to keep an eye on them every minute of the day."

Private nursing homes are not the only places where our elderly are neglected. State institutions are well up to the job, too. This is the silent scandal of Ireland's health service: thousands of old and infirm citizens languishing in beds with little stimulus because it is easier and cheaper to 'care' for them that way. Abuse is the only word for it.

A study commissioned by the Government estimates that between three and five per cent of older people in care, at home or in institutions, suffer abuse at any one time. The scale of abuse of older people has many parallels with that of child abuse, in terms of denial, underestimation and then

final realisation. Yet little is being done to address it.

In Britain, it took a series of serious abuse incidents before legislation was enacted which provided for greater control, higher quality and the standardisation of services across the whole home care sector. In Ireland, however, no such measures have been taken. And all indications are that it is still not being seriously acted upon at the highest levels of government.

Monday night's Prime Time revelations of appalling neglect at Leas Cross nursing home points to penny pinching, not just by those running the home but on the State's behalf. There is a chronic lack of inspectors to rigorously enforce proper care and that will not change until the inspectorate is properly funded. Lack of money means lack of care.

There was no shortage of money, though, for the owners of Leas Cross in seeking a High Court injunction to prevent broadcast of the Prime Time programme. They lost. In a

decision delivered at 7pm, just hours before the Prime Time programme was due to be screened, Mr Justice Frank Clarke refused an application by John Aherne, Georgina Aherne and Sovereign Projects Ltd, for an order to prevent the broadcast. The

Ahernes are directors of Sovereign, which operates the home.

The programme, which was viewed in private by the judge, included footage secretly filmed inside the Leas Cross home by an RTÉ reporter, who is also a qualified care worker and who had worked for some weeks at the home as a care assistant.

Leas Cross is not the only example of abuse. Many homes have been under suspicion for years.

There has been anecdotal evidence of neglect and incompetence, if not worse, and of the inadequacies of the regulatory system. Perhaps the most outlandish has been the issue of inspections. There are none for public nursing homes and notice can be given in

advance to private nursing homes. That defeats the whole purpose.

A litany of poor practice in several private nursing homes across the State, including instances of dinner food being recycled for use on another date, has been found by

inspectors. In one recent inspection on a home in north Dublin, it emerged that patients only got a bath or shower every 10 days.

THE Health Services Executive, the body charged with supervising proper standards, has promised an inquiry into conditions at Leas Cross. It is also putting in place at the home a "clinical governance steering committee", representative of residents and independent experts. However, this is the same executive that gave advance notice of an inspection to Leas Cross, giving the nursing home sufficient notice for the owners and staff to hide the evidence of their abuse and neglect.

Health Minister Mary Harney has apologised to the nursing home residents and said substandard care in the home should have been picked up. The Minister of State with

responsibility for older people, Seán Power, said he would ask gardaí to investigate the programme's allegations. "I think some of what we witnessed last night on television was horrific and I will be asking the gardaí to investigate it," he said.

He also acknowledged that it was "quite obvious" an independent nursing homes inspectorate was necessary and legislation underpinning it was being drafted. He hoped the inspectorate would be in place before the end of the year.

That will be little comfort to those who continue to suffer appalling neglect because the Government is not prepared either to properly fund their care or to ensure that standards of care are rigorously upheld.

In the North, standards are laid down, rigidly enforced by the Social Services Inspectorate and there are consequences for any residential care facility that fails to live up to those standards. Not so on this side of the border.

FOR many people at the coalface of caring for the elderly relatives Monday night's programme not only exposed a scandal, but struck a chord.

Apologies and promises by ministers are all very well but, unless serious action follows, they will always sound hollow.

The sight of a loved one, perhaps disorientated or upset, being the subject of neglect is very painful for family members to bear.

Particularly if the man tied with a bed-sheet to an armchair happens to be your own father.